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

Dr. Kelly as a back up plan...but what do I do when i get back?

Dualstarr

Recommended Posts

Dualstarr    104

Dualstarr
Posted

I currently have Kaiser as my insurance and am about to start the Options class in order to have the surgery done. Problem is, I am also in the process of a divorce and on my soon to be ex-husbands insurance. I am hoping I can complete the class and the surgery before our divorce is final and insurance runs out. I am thinking I have a good 6-8 months (fingers crossed before everything gets squared away. Our divorce process has taken over a year and a half and I am KICKING myself that I didn't start this process sooner. My insurance covers the sleeve 100% with no c-pay. Would not have cost me a dime! :(

Anyways, if the insurance runs out before the surgery, i have money saved to go to Mexico (Dr. Kelly) and have the surgery done. My question is, When my insurance runs out I will only have state funded medical insurance (Medi-Cal..I'm in California) until I find a job (Nursing School Graduate). My worry is that if I have the surgery in Mexico and then try to get coverage in the states with insurance it will be considered a Pre-Existing condition and no insurance will take me?

For those of you that went to Mexico. has your insurance covered anything pertaining to your sleeve...ie compliction, medications etc.

Share this post

Link to post
Share on other sites

MizzouGirl    148

MizzouGirl
Posted

Just take COBRA under your husband's insurance for as long as you need. Or, ask for him to cover you for 12 months as part of the divorce settlement. Just a couple ideas that you may not have considered....

losingit2013 reacted to this

Share this post

Link to post
Share on other sites

Bufflehead    6,358

Bufflehead
Posted

If you can make it to Jan. 2014, the Affordable Care Act kicks in and insurance companies will be prohibited from denying you coverage or charging you a higher rate due to a pre-existing condition.

Kristen125, losingit2013 and dork reacted to this

Share this post

Link to post
Share on other sites

serenity1959    67

serenity1959
Posted

I have not had my surgery yet, but my insurance absolutely excludes anything related to my weight loss surgery. I am going to purchase complication insurance.

Share this post

Link to post
Share on other sites

Ms.AntiBand    2,984

Ms.AntiBand
Posted

I pay $750 a month for insurance and my employers pays another $750 for us and they refuse to cover ANYTHING related to wls even if you're on your death bed. I'm out $100,000 because of band related complications. Nothing I can do. I'm still not cover if anything goes wrong with the sleeve.. BUT THERE WON'T BE ANY!

Share this post

Link to post
Share on other sites

Dualstarr    104

Dualstarr
Posted

Just take COBRA under your husband's insurance for as long as you need. Or, ask for him to cover you for 12 months as part of the divorce settlement. Just a couple ideas that you may not have considered....

I don't think this is an option. My husbands insurance is paid 100% by his employer we pay zero co-pays for anything...I mean NOTHING. I don't think cobra is an option...and if it is it would probably be CRAZY expensive. I will talk to my lawyer about seeing If I can get him to keep me on but in all honesty I don't think that will be an option either.

Share this post

Link to post
Share on other sites

Dualstarr    104

Dualstarr
Posted

If you can make it to Jan. 2014, the Affordable Care Act kicks in and insurance companies will be prohibited from denying you coverage or charging you a higher rate due to a pre-existing condition.

Do you have any more information on how this works? are pre-existing conditions only an issue with self-pay insurance? For example if I get insurance under a job do pre-existing conditions still matter?

guate_mama05 reacted to this

Share this post

Link to post
Share on other sites

Bufflehead    6,358

Bufflehead
Posted

It looks to me like it applies to all insurance policies. http://www.whitehouse.gov/sites/default/files/uploads/careact.pdf

"Starting in 2014, the Affordable Care Act will prohibit health insurers from charging more or denying coverage to people because of pre-existing conditions."

It doesn't say this is just for individual plans purchased from the exchange so I assume it applies to all insurance plans.

All this said, I guess insurance companies might be able to do something like put a clause in their policy excluding coverage for complications for elective surgeries or something like that? That would probably require a lot more research to figure out though!

Share this post

Link to post
Share on other sites

losingit2013    48

losingit2013
Posted

Do you have any more information on how this works? are pre-existing conditions only an issue with self-pay insurance? For example if I get insurance under a job do pre-existing conditions still matter?

Employer sponsored plans do not ask about pre-existing conditions.

Share this post

Link to post
Share on other sites

rhw94123    115

rhw94123
Posted

This is very late, and I have to wait until I get the actual policy in hand, but the word I have on Blue Cross ACA exchange policies in my state is that they will not cover surgery, weight loss drugs or exercise instruction, but they WILL cover three nutritional counseling sessions a year and reversals of (or revisions to) previous WLS if that would correct a life-threatening condition. I have not been able to sign up for an actual policy yet because the system is so slow, but I will report back when I do and I receive the thick booklet in the mail.

Best wishes.

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 Mexico & Self-Pay Weight Loss Surgery

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • KeeWee

      KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 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!

    ×