Hi!

I am thinking I am most likely a self-pay. Most of this is baby weight, and I am leaning towards Dr. Pompa in Mexico.

So, for all of you out there going to Dr. Aceves, Almanza, etc. who are self-payers... Why did insurance deny you?

Thank you! And Happy Friday!

My insurance only covers WLS for "morbid obesity," and since my BMI was only 32 there was no way I was going to be covered. Simple as that -- I didn't even both applying. We were fortunate to have an income tax refund this year that was large enough to pay for my surgery, and I was very happy to be able to make it happen on my timetable, without jumping through the insuance company's hoops!

My insurance would cover but only with medical issues. Then if I could get past that hurdle it would still cost 15,000.00 Ugh. I went to Mexico for 7,000.00

I have Kaiser and you have to have a BMI>40 if you do not have diabetes. My BMI is 36 not diabetes and my HTN , high cholesterol, carpal tunnel, and joint issues are considered below 40. I really did not want to have to gain more in order to get them to qualify me especially since their wait time is close to a year.

Nancy

Mostly the same here as well. Never applied to the insurance. Requirements for our plan was a BMI of 35 or more with other medical issues (which I had) or 40 without. My BMI was only 33. They also tho required a one year doctor supervised diet and exercise program prior to even approving surgery. My out of pocket would have equaled or exceeded the $6k I spent going to Mexico - and I had the surgery in three weeks. Have never been known for my patience anyways : )

My insurance didn't deny me, I just never bothered with it since ANYTHING weight-loss related, including surgery, is a specific exclusion on our policy. That's the the insurance's fault, it's my cheap-ass greedy s.o.b. employer (who really is a horrible person in many ways, I'm not just an angry employee LOL) who chose to go as cheap as he could get with our policy.

Weight loss anything was also excluded by my employer....

But! After I look at what other people have been through with insurance, I'm glad it was! The hoops that some jump through only to be denied and the waiting....ugh. I figured that after paying co-pays, deductibles, co-insurance, etc etc etc (especially when it would have been $50 for each visit with a surgeon, psych, nut, etc)....I'm not paying much more then I would have anyway....and it is on MY terms and on MY time. Wouldn't have it any other way!

Posted something similar to this on another thread just a few minutes ago.

I don't want to hassle with the insurance. I deal with insurance idiocy in my job every day, and I want to be in the driver's seat with my health issues. I had surgery scheduled with Dr. Aceves, but had to cancel due to knee injury/surgery problems. I will be rescheduling when these problems are resolved...not when someone else tells me I can. Do I have control issues??? Surely not:)

after being cancelled 2 x for the lap band, I started feeling that maybe it was a sign I shouldn't have that surgery...and in the middle of the 2 cancellations I started reading about VSG. And then I found out my ins. co considers it experimental. I knew I could apply, get denied, and appeal, but I was just so fed up w/ all the waiting, the hassle, the red tape, the "just days before surgery cancellations" that I said screw it and found a way to pay in Mexico. LOL

My BC/BS says it will "not pay for any services related to the treatment of obesity." It did however pay $27,000 for my knee replacement, it will pay for my arthritis medication, it also pays for my blood pressure medication. When I was researching my policy limits before my surgery I noticed that it will even pay for treatment of erectile dysfunction lol. It will pay for all of the effects of long term obesity - stroke, heart attack, nursing home care, etc. But nothing preventive so you don't get to that point. :thumbup1:

I am hoping to not self pay...

I am currently going through all the hoops...but I am lucky (IF I get approved). My ins pays 100% of the surgery (after I hit my $5k deductible...which I hit with treating my TMJ and having an uterine ablation done this year..moles removed, etc). I have decided that this is the year for medical things for our family since we hit our family deductible of $10k in June. (dd needed sinues surgery, allergy testing, etc). So....we are slammed with dr. appts right now trying to get everything taken care of. =) I am HOPING they approve the sleeve for me. My BMI is 50. (I hit that requirement but I don't have any comorbities...yet.)

If I am denied we will probably look into Mexico and pay out of pocket.

I'm in Canada so insurance doesn't pay here unless you have a BMI of >40 and comorbities. My BMI was only 37 so I didn't bother applying.

Takes too long to get approved here anyway. I hear the wait in Canada is over a year and you have to go through testing after testing.

My GP wasn't comfortable with me going to Mexico so she gave me a number in Michigan. Self pay they wanted $25,500 for either sleeve or GBP.

According to Kaiser, I could either gain more weight or just sit around and wait until more comorbidities developed. I didn't like either option so I self paid at UCSD in San Diego. I am so happy and feel amazing. I looked at the loan as a new car, only this vehicle is going to last me for the rest of my life!

My insurance had a lot of hoops to jump through before surgery. I would have to be on a 6 month physician-supervised diet. So, going to the doctor 6 months x $35 co-pay. Then they want you to have a sleep study done (on your own dime, because I really have no reason other than my fatness for them to think I need one). Then there's the psych eval, EKG, etc. The costs piled up before my very eyes. Add to that, I only have the plan that costs me $200 every 2 weeks, instead of the one for $325 every 2 weeks, and my deductible is (I think) $2000 per person, or $5000 for a family. Then they pay 80%. My co-worker went through all these hoops and got RNY a year ago. What she ended up having to pay was over $8500 and she has the better insurance.

I decided I would take out a loan instead. I went to Mexico and had it done for $6700 without the 6 months and possible denial drama. I am happy with that decision!

My insurance, United Healthcare, excludes weight loss surgery and complications with my husband's employer in Houston, Texas. But I stuck with an American doctor in my hometown for reasons that made sense to me - like in case of complications I wanted to be under the care of a local, respectable, bariatric surgeon specialist. Paid almost 15k and it was worth the peace of mind. I see some are 12k now.