Jump to content
×
Are you looking for the BariatricPal Store? Go now!
$99 Yearly Supply Alert! 🎉 "1 per Day!" Bariatric Multivitamins

PLEASE SOMEONE HELP!!

Cristal2star

By Cristal2star, in Insurance & Financing

Recommended Posts

Cristal2star    0

Cristal2star
Posted

Hello everyone... i just recently was put on my husbands ins. and looked to see if there was a way to get the lapband surgery. When I was reading it over I seen there was an exclusion that they do not cover services and supplies related to obesity, including surgical or other treatment of morbid obesity, this right away made me unhappy. I am 28 years old soon to be 29 and 5'6 and 396 pounds. I would say that I am WAYYYYYYYYYYYYYYYYYYYYY over weight. I dont think I can afford to go pay for it out of pocket at the moment. What I wanted to know is does anyone else have BC/BS of Texas PPO and have you gotten approved. Please all help would be nice . Thanks in advanced I would love some good news right about now.

Share this post

Link to post
Share on other sites

HeatherinCA    10

HeatherinCA
Posted

Hmm you have a PPO and they don't cover it? Maybe call them up and make sure...

Share this post

Link to post
Share on other sites

Cristal2star    0

Cristal2star
Posted

Hmm you have a PPO and they don't cover it? Maybe call them up and make sure...

That is what it says in the handbook they gave me. I had a few people tell me they did get the surgery with TX BC/BS PPO. I am hoping that once the ins kicks in on April 1st and I start going to the doctor that it will be approved.

Share this post

Link to post
Share on other sites

xxm4ndaaxx    2

xxm4ndaaxx
Posted

That is what it says in the handbook they gave me. I had a few people tell me they did get the surgery with TX BC/BS PPO. I am hoping that once the ins kicks in on April 1st and I start going to the doctor that it will be approved.

call the company.. theyll tell you if they do or not, and any requirments they have.

people kept telling me mine wouldnt cover it, and after weeks of stressing over it, i finally called and found out that they did indeed cover it 100%. i wish i would have just called sooner.

:)

Share this post

Link to post
Share on other sites

Acadia    20

Acadia
Posted

It could be that your husband's company put that exclusion clause in. It's not specific to insurance but the employer. They decide if they'll cover it or not. If it's excluded in the handbook then chances are, you have absolutely no recourse to get approved.

Share this post

Link to post
Share on other sites

Ponderer    14

Ponderer
Posted

I have what I consider to be very good insurance with Regence PPO. Any treatments, surgery, etc. for obesity is clearly outlined as an exclusion with our policy as it is how my company chose to do things. If they have written that they will not cover it.....it is not about if a BMI qualifies or even if it is considered "medically" necessary by one's doctor....chances are it will not be covered. When companies purchase medical insurance for group coverage they have to customize and choose various plans and when things like obesity treatment are excluded that is typically done to keep the fees down for all. I know where I work I am in the minority and can understand why a small company like the one I work for would opt to leave this out and keep rates low. On one had it drives may crazy that I have spent as much as I have for my insurance over the past 7 years and am about to pay $15,000 out of my own pocket for lap band. On the other hand....it would also drive me crazy to think that everyone in my company was spending thousands of extra dollars for a service they were never ever going to use. It can feel like a catch 22 but I guess I want to look at the cup half full.

Share this post

Link to post
Share on other sites

losetobemeagain    9

losetobemeagain
Posted

call just them because my insurance co. website said they didn't cover it, but I called twice myself and had to different surgeons office's call and they do cover it... I think when they make some of these handbooks and websites it more of a general type thing instead of an indiviual depending on your company's policy...

Share this post

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Go To Topic Listing Insurance & Financing

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    Bariatric Forums

    For Patients

    Health Professionals

    Search Surgeons

    Bariatric Surgeons: Want to research a weight loss surgery surgeon? Enter their last name below to start!

    ×