No Insurance coverage for weight loss surgery.

[Adermyer 2]

Hey guys, I am new here! I recently found out that I have what is called a complete heart block, where by electric signals are working as they should in my heart. I am over weight with a BMI of 38.4, I have high blood pressure, i am pre-diabetic, high triglycerides and cholesterol (hereditary), fatty liver, acid reflux and I am getting a sleep study done for sleep apnea. My heart doctor said it is 100% nessesary for me to lose weight or I won't make it to see my kids grow up.

My insurance is United healthcare choice plus and my employer doesn't have weight loss surgery on our plan and my HR said they never have and won't add it to our plans, so it is obviously going to be denied.

My question is being that it willow sure be denied and I don't have coverage for it on my plan, if I appeal it and have my doctor write a letter stating that it is very medically nessesary for me to have this surgery would that change anything? Or is there zero chance of it getting approved because I don't have the coverage?

[catwoman7 11,210]

I had to change insurance company because my former one wouldn't cover it under any circumstances. But it's always worth a try...

[Adermyer 2]

9 hours ago, catwoman7 said:

I had to change insurance company because my former one wouldn't cover it under any circumstances. But it's always worth a try...

That is what I am worried about. My husband work offers insurance however open enrollment isn't until November then it would be another 6+ months after that. Looks like I will be paying out of pocket.

[Kris77 1,534]

My insurance company didn’t cover weight loss surgery either. Had to self pay. Of course the next year they switched plans and it was under that plan but by then it was done. No regrets what so ever. Yes it costs but for me worth it to be healthier. Good luck to you in which ever way you decide to go. Sorry it’s not in your plan.

[GradyCat 3,695]

No, the insurance company doesn't have to cover it if the employer didn't choose that option on their plan.

[Maisey 260]

You can try, but I think it's doubtful. Doctors mean well but don't always understand the differences in insurance. I had an endo who years ago, suggested WLS. When I told her my insurance didn't cover it, she said it did. The *** that I was covered under and seeing her under, did in fact cover WLS for some people depending upon the contract between the insurance company and the employer. However, the contract with my employer specifically excluded it until last year. You have to do your own research and make sure you know your benefits.

[blackcatsandbaddecisions 851]

I work with insurance and I can say with certainty it is a zero chance. If it’s excluded it’s excluded and a hundred doctors could say it’s the best thing and they still won’t cover it. The contract says they don’t have to cover it and they absolutely won’t. Unless you change jobs to a company with bariatric coverage you’ve likely tapped out this option.

With that being said, there are a ton of people on these boards who have gone the self-pay route and had great success. There are affordable options abroad and in the US and financing available. Don’t give up hope because of the insurance.

[JMJames92 114]

5 hours ago, Kris77 said:

My insurance company didn’t cover weight loss surgery either. Had to self pay. Of course the next year they switched plans and it was under that plan but by then it was done. No regrets what so ever. Yes it costs but for me worth it to be healthier. Good luck to you in which ever way you decide to go. Sorry it’s not in your plan.

Just out of curiosity, how much did the surgery cost you out of pocket? Feel free to tell me to beat it if you are uncomfortable telling me. I just know that my insurance paid ~$80,000 for my surgery. It was definitely one of the best decisions I have ever made but I couldn't imagine dropping that kind of money.

[Kris77 1,534]

If def wasn’t 80k! I can’t remember the number. You know how you pay this person this and other person that...I honestly don’t know. But I do know diff surgeon/diff places have diff fees. Maybe find the surgeon you feel will do the best job and talk to his office about what kind of discounts they offer for cash pay patients. I think most hospitals charge less to cash pay.

[GreenTealael 25,310]

On 2/3/2021 at 8:36 PM, Adermyer said:

Hey guys, I am new here! I recently found out that I have what is called a complete heart block, where by electric signals are working as they should in my heart. I am over weight with a BMI of 38.4, I have high blood pressure, i am pre-diabetic, high triglycerides and cholesterol (hereditary), fatty liver, acid reflux and I am getting a sleep study done for sleep apnea. My heart doctor said it is 100% nessesary for me to lose weight or I won't make it to see my kids grow up.

My insurance is United healthcare choice plus and my employer doesn't have weight loss surgery on our plan and my HR said they never have and won't add it to our plans, so it is obviously going to be denied.

My question is being that it willow sure be denied and I don't have coverage for it on my plan, if I appeal it and have my doctor write a letter stating that it is very medically nessesary for me to have this surgery would that change anything? Or is there zero chance of it getting approved because I don't have the coverage?

If it’s not covered in your policy, it will not be covered (unless there is some extreme circumstance and it becomes part of an emergency surgery for some other reason like stomach cancer resection and even then it may not be covered only the hospital stay)

If you can change insurance companies it would be easier than contending with your current company. If you have the funds then Medical Tourism is the fastest way.

Good Luck ❤️

[Shanto 14]

23 hours ago, JMJames92 said:

Just out of curiosity, how much did the surgery cost you out of pocket? Feel free to tell me to beat it if you are uncomfortable telling me. I just know that my insurance paid ~$80,000 for my surgery. It was definitely one of the best decisions I have ever made but I couldn't imagine dropping that kind of money.

I live in Canada and I did self pay and it was about 20,000. There were a few things like medications, bloodwork and other tests that were covered by our Medicare. When I was researching options, the surgery typically was cheaper in US then Canada.
I know now might not be the best time with COVId but lots of people have had great success with clinics in Mexico for much less then what I paid. That being said do your research and make the best decision for you and your family. At the end of the day my husband didn’t feel comfortable with me going to Mexico to get it done even though I felt confident. One good point he made was if there were any complications the bills could mount up quickly and I’d be far from home.
good luck with your decision. I am happy I got the surgery and don’t regret it even though it was expensive.

Edited February 5, 2021 by Shanto

["Henry" 109]

Hi Adermyer,

Sorry to hear about your situation, but it is very common. Most of the patients that come to Mexico are in the same boat as you. Please look us up, maybe we can help you.

[It's time. 145]

See a cardiologist immediately. With complete heart block you need a pacemaker.

[SophieJo 6]

I have two insurances and neither covered my VSG. I went the self-pay route & was able to prepay for the majority, then had two little bills come in afterwards, which were not bad. I was glad to go the self-pay route, bc I didn't have to abide by insurance rules: insurance requires many more visits to the nutritionist & therapist, etc... I had a great group of folks taking care of the beginning of my journey & they're available as needed. I wouldn't trade the experience for the world.

[Officially Not Fatty Matty 461]

Mine was $4400 out the door for self pay which included hiatal hernia repair. Dr Villarreal in Nuevo Laredo. Zero issues, great success.