If your insurance specifically tells you weight loss surgery isn't covered...

[Mel1071 149]

..is it a hard fast no always? I called and asked my insurance about medical weight loss/WLS surgery and the agent basically read off a script and said it's not covered. So I asked well, what if I have a letter of medical necessity from my doctor? To which she simply re-read the script *sigh*

So does no really mean no or does this mean I have to look at jumping through a bunch of hoops? I'm hoping for jumping through hoops. :-)

Before I found this info out, I made an appointment for a seminar on 8/19 with my surgeon of choice and one of the things that was mentioned when I made the appt I that I need to bring my insurance card with me. Apparently their insurance coordinator will contact them as well. But if this no is a definite no, do I even need to bother with having them contact my insurance?

Thanks in advance!

Melissa

[Beach Lover 1,084]

Unfortunately for me no meant no even with the insurance coordinator. I ended up being a self pay but found an awesome doctor in Boca Raton that did mine for $10,500 all inclusive. His name is Dr. Shillingford. A lot of people also go to Mexico because the rate is even cheaper there. I know of several people who have flown to Boca for the surgery with my doctor because they could still save a lot of money. Do a lot or research the prices are all over the place including countries!! Try and fight it out with your insurance company don't give up. Best of luck to you!!

[BlueOctoberGirl 111]

Same here...never ment never. I had to self pay. They would not even cover the Excess skin removal after I lost the weight loss. I was so sick from it and they were pretty much :sucks to be you". I hate insurance companies!

[Mel1071 149]

Thanks for the info! I am already looking into self pay options - not really interested in going out of the country. I know the place I'm looking at offers lap-band self pay for 12K but I'm much more interested in VSG. Will contact them to see if they offer a VSG self pay.

[Beach Lover 1,084]

Thanks for the info! I am already looking into self pay options - not really interested in going out of the country. I know the place I'm looking at offers lap-band self pay for 12K but I'm much more interested in VSG. Will contact them to see if they offer a VSG self pay.

Please think very carefully about the lapband..........the horror stories are adding up fast!! You can get the VSG cheap enough somewhere. Don't settle because of price it will cost you more in the end. A lot of surgeons are discontinuing the lapband because of the complications. Keep looking I promise you there is a surgeon out there who will do this at a very reasonable cost.

[Mel1071 149]

Oh, I guess I wasn't clear - I have no interest in the lap band. I've been doing lots of research and I'll be honest - I never thought I would ever be considering WLS. It wasn't until recently that I had even heard of VSG and what I've read about it makes me think it is a very viable option.

I guess it just bums me out to realize that even though it seems like I am a prime example of someone who could be greatly helped by VSG (BMI of 48.something with high blood pressure, high cholesterol, pre diabetic, depression, and a history of sudden cardiac death in my family) but my insurance doesn't care about all that and would rather take a reactive rather than proactive approach to my health.

[SuNMooNStaRS816 423]

If your insurance carrier tells you it's not covered then its not covered. But it is your employer that decides what benefits it will pay for and the requirements for that.

[Beach Lover 1,084]

Oh, I guess I wasn't clear - I have no interest in the lap band. I've been doing lots of research and I'll be honest - I never thought I would ever be considering WLS. It wasn't until recently that I had even heard of VSG and what I've read about it makes me think it is a very viable option.

I guess it just bums me out to realize that even though it seems like I am a prime example of someone who could be greatly helped by VSG (BMI of 48.something with high blood pressure, high cholesterol, pre diabetic, depression, and a history of sudden cardiac death in my family) but my insurance doesn't care about all that and would rather take a reactive rather than proactive approach to my health.

I felt the same way! I am not sure if this is correct but I did read on one of the threads that WLS and your insurance covering it has more to do with the plan that your employer puts together. This made me feel a little better but I still felt the hit in my wallet. Honestly though it was the best money I could have ever spent. I am feeling so much better and today the scale finally told me I have less than 100 pounds to lose now. I had a big smile on my face. Keep looking you will find a surgeon who isn't looking to buy his next Bentley on your money. Mine was wonderful his reason for being affordable was simple. He wanted people to be healthy and he could make it possible. Good luck!!

[Pixie Dust 526]

Does your employer offer more than 1 insurance plan? Some employers offer a few diff insurance companies & each insurance company offers different options. Just something to look into. You may have to wait till open enrollment, which is only once a year, but it could give you time to look around?

[Mel1071 149]

My insurance is through my husband's policy and to my understanding it's the only one offered. I am a part time faculty member at a local college and also run my own business so I am dependent on his. The sad thing is - with this exception, his policy is great.

I figure it's taken me years to accept the fact I need the WLS - heck, it wasn't even until last week I felt brave enough to even mention it to my husband ( who has been great and aupports me 100%). I figure if there's a will, there's a way. I am nothing if not determined!

[Chele H 427]

My insurance is through my husband's policy and to my understanding it's the only one offered. I am a part time faculty member at a local college and also run my own business so I am dependent on his. The sad thing is - with this exception, his policy is great.

I figure it's taken me years to accept the fact I need the WLS - heck, it wasn't even until last week I felt brave enough to even mention it to my husband ( who has been great and aupports me 100%). I figure if there's a will, there's a way. I am nothing if not determined!

Can you opt in at your job? Some employers allow part time employees to buy medical insurance. Even if you only paid the premium for 6 months to a year it would be cheaper than a self pay.

[TwinsMama 483]

My insurance is through my husband's policy and to my understanding it's the only one offered. I am a part time faculty member at a local college and also run my own business so I am dependent on his. The sad thing is - with this exception, his policy is great.

I figure it's taken me years to accept the fact I need the WLS - heck, it wasn't even until last week I felt brave enough to even mention it to my husband ( who has been great and aupports me 100%). I figure if there's a will, there's a way. I am nothing if not determined!

Another option which may help is if you get your own personal plan for a year and pick one that offers this surgery. I looked into that when I was worried our work plan would not offer it. Just as an FYI, many indiv plans in my area (depending on the company and your health status) costs between $350 - $400 a month which would be about $4.5K - $4.8K for a year.

That's about half of the cheapest (self-pay) surgery I've seen.

[Mel1071 149]

I will need to check into the college. An individual policy is out of the question - I tried to get one after I had moved here and bad not yet married my hubby. I was turned down because of my BMI and comorbidities.

[SuNMooNStaRS816 423]

I will need to check into the college. An individual policy is out of the question - I tried to get one after I had moved here and bad not yet married my hubby. I was turned down because of my BMI and comorbidities.

Before you opt into a plan at the college find out if their insurance even pays for WLS. Would be a shame to opt into it...pay those premiums then find out they do not pay for it either. Unfortunately, a lot of employers still do not think this is a necessary benefit. It's a shame because it would in the long term cut costs of medical care.

[newat52 1,612]

My insurance would not cover it either. It is usually specifically excluded by the employer. I ended up self pay and it was the best all inclusive $12,200 I have ever spent. The upshot also from being self pay is you go straight to the front of the surgical line. No insurance hoops to jump through. Just whatever your surgeon requires regarding nutritional counseling and pre op diet.

For me, being almost 5 months out. I would self pay again in a heartbeat! I am so stinkin healthy right now! :-) And I feel great too!