Devestated - Bariatric Surgery Not in Insurance Contract

apalmer79 · March 21, 2009

I am so incredibly frustrated... Over the last 2 weeks, since going through the mental debate of going through with surgery, I finally decided to take the steps towards LapBand. The very first thing I did was call my insurance company. For various reasons, I have spoken to 3 different people - ALL of whom told me my benefits for weight loss surgery, the coverage criteria, etc. Every single one of them said it would be covered at 100% after a $350 hospital deductible. Sounds great, huh? I went to the seminar and everything- got home - and find a letter awaiting me from Health Partners stating that weight loss services, including bariatric surgery, is excluded from our contract. I called and explained that I have spoken to 3 different people and the woman said they must've overlooked it... that my husband's company opted out of these benefits. I am heart broken and angry.

Does anyone have experience with this? My husband and I considered buying a seperate policy for me for the rest of the year-- but if Im going to do that, I might as well to gastric bypass d/t the long term expenses that my insurance is not going to cover with LapBand....

I could just scream. :smile:

Losing for me · March 21, 2009

So sorry to hear that the procedure isn't covered. That sucks. I too, am awaiting funding. Should it be denied I know that I would not be able to pay for it on my own with a young family and all. Praying that we both get the result we hope for.

stevegoad · March 21, 2009

Well, then you have a decision to make.

If surgery is that important to you, then find other funding. I am uninsured, so I will be paying for my surgery for the next 5 to 7 years (I am listed as 7 years, but my wife says we will have it paid off in 5). For us, it was something that was worth the investment.

If the hospital won't extend credit, and you can't do credit cards or an independent bank loan, or borrow from friends or family (not the best suggestion anyway) then you need to decide if the surgery is the best route for you.

Whatever happens, just keep trying. Certainly, even if you don't have the surgery, hanging around groups like thic can give support to keep trying.

hakunamatata_ca · March 21, 2009

I also am not covered under my benefit plan at all. The wait for me in Ontario is 1 yr to even get an appointment to see the surgeon etc then all the hoops to jump through after that. I am going with the Sleeve anyway. Too much after care and costs with band from my research and people getting revisions to the Sleeve after 3-5 yrs and paying more money anyway. I am looking at paying over 5 yrs and for me it is what I want more than anything. Not sure where your from but keep looking into options for sure and don't get too discouraged yet if this is what you need and want. Good Luck.

hakunamatata_ca · March 21, 2009

Well, then you have a decision to make.
If surgery is that important to you, then find other funding. I am uninsured, so I will be paying for my surgery for the next 5 to 7 years (I am listed as 7 years, but my wife says we will have it paid off in 5). For us, it was something that was worth the investment.

If the hospital won't extend credit, and you can't do credit cards or an independent bank loan, or borrow from friends or family (not the best suggestion anyway) then you need to decide if the surgery is the best route for you.

Whatever happens, just keep trying. Certainly, even if you don't have the surgery, hanging around groups like thic can give support to keep trying.

I just watched your you tube video - that was great. You didn't sing! Looked like you had fun and did a great job! Congrats on your weight loss OMG awesome - where did you go etc...? I am self pay also and will be booking shortly. :smile:

flowers · March 22, 2009

I didnt have insurance, so was self pay. I went to Mexico and had it done, no wait, just do it.

I decided my life was worth more than the cost of the surgery. Im going in for my 4th fill next Saturday. The cost is what it is, if you are not covered, then you have to decide if its worth it.

I personally wouldnt choose the type of surgery based on if insurance covered it or not. I wouldnt have a different kind of surgery just because its covered. My body is important to me as is my health. I am a little nervous when folks post they decided the kind of WLS based on insurance coverage and what they perceive as "long term costs".

hakunamatata_ca · March 22, 2009

I didnt have insurance, so was self pay. I went to Mexico and had it done, no wait, just do it.
I decided my life was worth more than the cost of the surgery. Im going in for my 4th fill next Saturday. The cost is what it is, if you are not covered, then you have to decide if its worth it.

I personally wouldnt choose the type of surgery based on if insurance covered it or not. I wouldnt have a different kind of surgery just because its covered. My body is important to me as is my health. I am a little nervous when folks post they decided the kind of WLS based on insurance coverage and what they perceive as "long term costs".

That is also my plan - can I ask what you had done and by who? I have a surgeon I want to go to but appreciate feedback on any there. How was you full experience there? Thanks!

twofeathers710 · March 22, 2009

I had the same problems apalmer79. So what I did was went to my HR person and together we put together a letter to give to the committee at work. The letter was about all the facts of the surgery and how I could benefit from having the surgery.

It took about 3 to 4 weeks for them to get back to me but they lifted the exclusion for me. It might be worth your time to try that. The worst they could do is tell you no. Then you could try other way.

I hope only the best for you. Good luck.

If you have any ? just ask.

Kimberly:smile2:

flowers · March 22, 2009

I flew into El Paso TX where I was meet by a driver who took me into Juarez. We only went thru the good sections of town, where there was a 6 lane highway and I didnt spend the extra night in the hotel, just was ready to come home and a young guy and his mom were coming home so I called and paid to change my flight to come home the next day.

I paid $6,500, hotel was included. I never felt unsafe. I pay $200 for each fill but Im driving to Tyler TX from Dallas, which is quite a ways, but I get fluro and barium swallow with each fill so get that reassurance that everything is looking good. I had the choice of bands and seem to have chosen a 10 cc Realize band, even though I cant say it was a informed decision, some say you feel less restriction who post here with a Realize band, I dont know as unless you have had them both how could you possibly compare? My fills have been smaller than others here, 1.8 cc, 1.8 cc and .5 cc, so Im betting the one I get next Sat will also be tiny. I dont seem to be able to handle as much as some others here without being too tight. Everyone is very different thats why one size fill doesnt fit everyone. Dont know if age has anything to do with my losing slow either, Im 58 years old, so menopause has slowed down my metabolism. Had my surgery July 9th, last year.

I will add that I lost 9 lbs the couple of weeks pre surgery, so I started at 242 lbs the end of last June.