So, I have made the decision to go forward with the process to get the Gastric Sleeve... I called and registered for the next seminar at the best local hospital (in my experience) and was told to complete registration paperwork and send it back. I was also told to call insurance to find out what is covered for bariatric surgery. I called my insurance and after the phone call I broke down in tears. I was told that it is not included on my insurance plan and is in the "exclusions" because my employer chose not to include it.

I logged on to the United Health Care website after I got home from a meeting tonight and cried over this exerpt under the "Exclusions" heading... There's no hope for me now. I can't self-pay.

"Surgical and non-surgical treatment of obesity. This exclusion does not apply to screening and counseling for obesity for which Benefits are provided under the "A" and "B" recommendations of the United States Preventive Services Task Force under Preventive Care Services."

@@Cassiper

I'm so sorry to hear about your situation.

Just a quick question. Can you afford financing the surgery?

Hey Cassiper.....
I did the same thing....I was told here in Oregon under the Oregon Health Plan if you have diabetes then you were eligable. Could this apply to you and Kentucky as well??? I found, again here in Oregon, the best care I could get was 5hours away. The medical center took cash, credit or they did finance as well. Shop around before you sign on the line. There are really good Doc's out there that can work with you. I had contemplated cashing out my IRA, financing, credit card, but I was lucky enough I had been hurt at work and had some settlement money that I paid for mine with. I see your BMI is about what mine was at, here's an idea: While you're working on getting your BMI down find an outpatient clinic that could do the surgery and check the costs...Then when I scheduled the seminar date, ask to also speak with the finance dept. and tell them that you would like to make regular payments BEFORE your surgery date. Then you have 2 goals to hit, your BMI and getting your bill down as far as you can till that date and then ask to finance the balance. Even if I was getting an unemployment check I would send a payment. I look at it like this: It's government money, let them pay for the surgery. I used some of my financial aid from school to help pay for mine. What can they do, it's your money....There are ways to get what you need if you really work it.....
Keep tryin, don't give up, this was just a minor set back....Getting my BMI down took me almost a year, seemed like forever but in that time I completely changed how I ate, shopped, read lables, worked some walking into the mix and I am sooooooo glad I had that time....Drop the sodas, drink the water or teas or whatever.....Work on you for you....Basically get your ducks in a row before hand....
Good luck and hang in there if it's meant to be your path will be lit up.....
kim

Edited September 10, 201412 yr by oolismom

I'm still going to seminar and I might try to ask my employer to add it to our insurance for next year... maybe there is some way to get it paid for that the insurance person at the surgeons office will know. Right now, between paying off student loans, house, cars, bills, etc. I probably can't even afford to finance. :-/

I am sorry to hear that. You are not alone, my employer chooses to not cover it either.

I did decide to self-pay. A lot of people go to Mexico, I stayed in the US. I did go out of state 5.5 hours away to a doctor that does this out patient, plus surgery costs were cheaper than staying in state. I had a great experience!. I had to get a personal loan to pay for the surgery. I have seen others post about doctors in Texas mainly about that if you have a hiatal hernia you only have to pay the added cost of the gastrectomy, because the surgical costs of the hernia repair is already covered under your insurance plan. (surgical center, hospital stay, anesthesia, etc) My doctor said to me that pretty much everyone he does has a hiatal hernia. I am a lightweight at just a 35.6 BMI at surgery and I had one too.

Good luck, maybe your employer is large enough that they would be willing to take on the added cost to include it into the coverage. In the mean time... getting started on your medically documented weight loss prior to surgery is a good idea if you are holding out for insurance coverage.

Edited September 21, 201411 yr by Noragretz

I'm in Oregon and had the same issues. I have decided to self pay and have my surgery scheduled in Mexico at the end of Oct.

Hugs and I'm so sorry. I know how you feel. When I had united healthcare through my old employer they didn't offer it. Luckily for me my new job offers and covers it. Try looking into going to Mexico. I've heard and read lots of good things plus it's much cheaper than trying to pay out of pocket in the United States.

Per my Bariatric surgeon.... Obesity will soon be considered a "disease" in result requiring insurance companies to cover the surgery. I am not sure when this will change, but it's coming. ????

I think obesity is already considered a disease. But as history goes, insurance will not include it as a covered cost until they are forced to do so. Then you will get the flip side argument (like the birth control argument), why should I have to pay insurance premiums to cover someones eating problem? Or lazy problem, or fill in the blank. I wouldn't plan on any required coverage in the next 5 years.

I have United Health too so I'm paying out of pocket. I'm going to Mexico this week to have it.