I was denied coverage by the insurance company due to the employers clause

[woo woo 872]

There are inexpensive self pay options available in several states in the US.

In the northern and midwestern states the self pay prices are extremely high. I suggest researching Texas, Florida, Louisiana etc. There is also a popular self pay doc in Las Vegas.

For example prices right now in Dallas are about 10k all inclusive, only $3500 if you have a hiatal hernia (which many of us do).

[terrydumont46 1,954]

I don't know about your age or anything. but medicare pays for wls. so if you are on social security or disabliltiy you can appy for medicare I think in oct. I remember when my surgery was postponed for the second time I started crying hard in the doctor office. he took pity and made my surgery happen. and I have been so glad ever since. losing wt. is a God send

[TEXASLADY52 264]

I know how disappointed you are. I work for the State of Texas and we had a clause on our insurance for years. Only the legislator could change it. They tried and tried to get them to until finally they agreed to take the clause away, but they put a $13,000 cap for life on it. I had to pay a lot out of pocket and the bills just keep coming in.

[Sassy Little Redhead 66]

My employer offered the coverage and many ppl took advantage. In one year 11 ppl had VGS. One week before my consult they dropped the bariatric coverage because it became "too costly" So I am stuck obtaining loans and using my meager saving. My surgery is now 10/22/14 Good luck to you, I hope it works out for you

Edited October 1, 2014 by Sassy Little Redhead

[gowalking 10,790]

..yet another form of discrimination as far as I'm concerned. As Lisa noted, why is WLS any less important than any other type of preventative care?

[Bandora 136]

Have you worked already with a bariatric facility or did you contact the insurance directly? I know in some cases the facilities have experts who can really ease the insurance red tape. Do you have any conditions such as high blood pressure/sleep apnea or diabetes?

I have heard that the weight loss exclusion may be overruled in cases where patient has severe health issues. Personally, I know of one person who was successful ( she needed to lose 100 lbs for a knee replacement ) but it is worth a shot.

Try to contact a bariatric facility ( example True Results here in AZ) and see if their team can negotiate with the insurer. If not, maybe self pay will be the way that you have to go. I know it is expensive but it will be worth in the end. Start saving and maybe you can qualify for a cash discount. You are worth the investment.

[winning_by_losing 107]

To be honest, I wish this would have happened to me.

After the topic of what we all paid out of pocket came up in a support group meeting a month or two ago, I found out that even with my insurance coverage, my out-of-pocket cost was close to double that of what the self-pay folks were paying. Worst part is - one of them went through my same surgeon and paid $9,000 less than I did.

Bottom line - I'd start calling around and doing some investigation before getting too frustrated. You may find out that this is a blessing in disguise and you'll end up paying less in the long run.

[Rovobay 920]

that sucks.....

[Rovobay 920]

@@winning_by_losing positive outlook.... some hope for you OP? Or Mexico selfpay as a cheaper route? lots of positive experiences on here of folks going south!!!

[MisforMimi 760]

To be honest, I wish this would have happened to me.

After the topic of what we all paid out of pocket came up in a support group meeting a month or two ago, I found out that even with my insurance coverage, my out-of-pocket cost was close to double that of what the self-pay folks were paying. Worst part is - one of them went through my same surgeon and paid $9,000 less than I did.

Bottom line - I'd start calling around and doing some investigation before getting too frustrated. You may find out that this is a blessing in disguise and you'll end up paying less in the long run.

Wow! That is a clear example of why we need a single payor health system in the US! 9,000K difference in the same facility, same surgeon is shameful!

Also, for folks that are taking advantage of flex spending accounts to cover out of pocket costs, it would be good to find out how that works out of the country. I'm waiting to the beginning of the year so I can increase my deduction to help with what I know is gonna be a stiff bill.

[JamieLogical 8,684]

I am glad I was in a financial position to self-pay in Mexico. My insurance doesn't cover VSG (only band and bypass). Plus in order to meet their minimum requirements, I would have had to stay fat for two more years, because they require a BMI over 35 for five years and three years ago I had gotten down to an "overweight" BMI by losing 90 pounds through diet and exercise. Way to punish people who TRIED to lose weight the "old fashioned" way before resorting to surgery!

Anyway, being able to self-pay meant not having to jump through hoops, being able to schedule surgery as soon as I wanted to, and getting my pick of surgeons! Sure I had to borrow against my retirement, but it was definitely money well spent! And I've heard stories about people who had their insurance cover their surgery, but between deductibles and co-pays and whatnot, they ended up spending twice as much out-of-pocket as I did!

[MaureenVA 35]

You know what makes me mental? Insurance companies pay for inpatient treatment, counseling, etc for drug abuse. Drug abuse! For drugs that are (mostly) illegal to be on in the first place. I'm not saying that drug addicts don't need or shouldn't get help....I'm just saying, our addiction is just as strong and we broke no laws to get tothe point of needing help...and yet we're denied.

I'm an insurance agent...if you have a meth lab in your garage and it blows up...your home insurance will not cover it. If you have a DUI or DWi and cause injury or damage....your car insurance may not cover it (this varies state to state), but if you use drugs and need medical assistance, you get help. I guess I surname companies think fat people are lower than drug addicts on the risk scale?

[highdesertblue 70]

I missed out on getting the surgery a few years ago for the same reason. I have Medicare now, because I am on disability, so I finally got the nerve to start the process again. JenJen 1653, I truly feel your pain. Sometimes there are ways to get around the clause, but you would have to talk to the WLS surgeon and your primary care physician to see if they can help you. My daughter is going through the same thing. She works for the local school district, and every year they beef up their "wellness" campaign, but refuse to include the weight loss option in the insurance. Instead of holding mandatory wellness fairs, and not allowing birthday cupcakes, or teachers to drink coffee, they could offer the option to those willing to pay a little more for their health insurance. Getting loans or going to Mexico is not an option for my daughter. You might want to check with the Weight Loss Surgery Foundation. They have "scholarships" for people who cannot afford the surgery. They are on Facebook, and they have a website. You can get the details from the website. I wish you the best!

[jjinWA 511]

My daughter and I just booked her surgery with dr. A Ortiz. When I told my oldest daughter that the date was set, she said include me! So both are booked for the same day and will be in the same hotel room. (BTW nice discount since they are sharing the room).. I am so excited for them to both join the losers bench! Reasonable Self pay is possible if you are willing to go to Mexico and have insufficient funds to have the surgery in the US.

[JamieLogical 8,684]

My daughter and I just booked her surgery with dr. A Ortiz. When I told my oldest daughter that the date was set, she said include me! So both are booked for the same day and will be in the same hotel room. (BTW nice discount since they are sharing the room).. I am so excited for them to both join the losers bench! Reasonable Self pay is possible if you are willing to go to Mexico and have insufficient funds to have the surgery in the US.

@@jjinWA Great to hear your other daughter has booked surgery as well! That's fantastic!