Dreams STOMPED by my insurance company

[mami2two 1]

I have been researching the sleeve with serious intent and excitedly for the past few weeks. I had come to the decision that I definitely wanted to do the surgery.... signed up for a information seminar and called my insurance (as the seminar instructions told me to do). It is to my dismay that my insurance company doesn't cover any gastric surgery. I reached out to customer service who said it is a no go... then I talked to Human Resource who referred me to contact my companies rep and he reached out to the BCBS rep who stated that I could basically be laying on my death bed and that if this was the only surgery that could save my life, the insurance company still probably wouldn't cover it. There is no way that I can afford to pay out of pocket for this as I am a single mother with 2 kids to support. I am feeling very frustrated, I don't understand all the ins and outs of insurance, but I find it highly unfair that I pay to have insurance and can not utilize that insurance to benefit my health.

[JamieLogical 8,684]

I am so sorry for you. It's definitely frustrating that insurance companies don't cover WLS or have such ridiculous requirements for you to qualify. I ended up having to self-pay, because my insurance wouldn't cover WLS unless I had been at a BMI of 40 for the past 5 years. Well, I actually lost weight on my own 3 years ago and then regained it over time. They were basically punishing me for having at least TRIED to do it on my own. So unless I wanted to stay fat for at least 2-3 more years, they wouldn't cover it. And who knows what kind of toll staying that fat for another couple of years would take on my health!

I went to Mexico for my surgery. I know that seems really scary to a lot of people, but it was an incredibly positive experience for me and I was able to have the surgery for a price I could afford, with one of the best surgeons in the world. However, even if you travel for your surgery like I did, it's still thousands of dollars out of pocket and that can be tough for normal people unless they have access to financing. I personally was able to borrow against my retirement for the money.

[BLERDgirl 6,417]

I have been researching the sleeve with serious intent and excitedly for the past few weeks. I had come to the decision that I definitely wanted to do the surgery.... signed up for a information seminar and called my insurance (as the seminar instructions told me to do). It is to my dismay that my insurance company doesn't cover any gastric surgery. I reached out to customer service who said it is a no go... then I talked to Human Resource who referred me to contact my companies rep and he reached out to the BCBS rep who stated that I could basically be laying on my death bed and that if this was the only surgery that could save my life, the insurance company still probably wouldn't cover it. There is no way that I can afford to pay out of pocket for this as I am a single mother with 2 kids to support. I am feeling very frustrated, I don't understand all the ins and outs of insurance, but I find it highly unfair that I pay to have insurance and can not utilize that insurance to benefit my health.

It may be because it's new. They likely cover the bypass. Have them send you their policy in writing. Find out specifically what type of weight loss assistance they do provide whether it's dietitian classes and a medically supervised diet or what. Exhaust every possibility before giving up. You may have to actually submit a request and get denied then go through appeals. Never accept the first "No" as final

[LipstickLady 25,682]

I have been researching the sleeve with serious intent and excitedly for the past few weeks. I had come to the decision that I definitely wanted to do the surgery.... signed up for a information seminar and called my insurance (as the seminar instructions told me to do). It is to my dismay that my insurance company doesn't cover any gastric surgery. I reached out to customer service who said it is a no go... then I talked to Human Resource who referred me to contact my companies rep and he reached out to the BCBS rep who stated that I could basically be laying on my death bed and that if this was the only surgery that could save my life, the insurance company still probably wouldn't cover it. There is no way that I can afford to pay out of pocket for this as I am a single mother with 2 kids to support. I am feeling very frustrated, I don't understand all the ins and outs of insurance, but I find it highly unfair that I pay to have insurance and can not utilize that insurance to benefit my health.

It is VERY frustrating and I understand what you are going through. My bestie desperately needs this surgery and she's not covered by insurance either.

Just remember, this is NOT the fault of your insurance company. The company you work for selects what plan they are going to purchase and they can elect to be all inclusive or deny coverage for certain procedures. I would suggest that you campaign within your company to change their coverage options with the next insurance renewal.

Good luck to you!

[della street 213]

They very well may not cover the bypass either -- hubby's policy for many years specifically and categorically excluded any kind of weight loss surgery. And I was told almost word-for-word the same thing "you could be in danger of imminent death and it's still excluded". So I definitely feel for you -- What I did was this year, I purchased my own policy separately from husband's -- 23 states are required by law to cover weight loss surgery in the Affordable Care Act ("Obamacare") polices. Fortunately beyond all measure, my state, AZ, is one of them. Here's more info: http://www.bariatricpal.com/topic/292754-does-obamacare-cover-weight-loss-surgery/

[della street 213]

Lipstick Lady is right -- if it's a company policy, the company decides what w/be covered and what w/not -- that's why, for example, two different BCBS plans can be one w/coverage; one without.

[Nikkidoodlebug 120]

Mexico is a great option to go with. The only way I was going to have surgery was cash pay also. Mexico has some really great doctors that will do it for a reasonable price so you might want to check into it.

[Miss Mac 6,261]

I agree with the others, so while you are waiting this out, here are the basics that you can get familiar with:

1. Eat mostly Protein, and plenty of it. (gravy does not count as protein)

2. Eat more non-starchy veggies than you used to - the greener, the better.

3. Eat less fruit than you are used to. (apples, not apple pie)4

4. Try not to eat starchy and sugary foods. They make you hungry for more starchy & sugary foods. (bread, Pasta, rice, pastries, (usually white in color)

5. As much as possible, avoid foods made in a factory.

6. Drink Water until your eyeballs float.

7. Don't become part of the sofa. (You have no doubt heard of he saying "Dance like nobody's watching".......so at least do that. I crank up the music while I am doing housework - it helps)

One thing I noticed on the pre-op diet was that the best way to reduce salt intake was to not eat the foods that I had a tendancy to put salt on (partucularly potatoes and noodles)

I wish you the best. Delay is not denial.

[BLERDgirl 6,417]

• A question for the other posters; Legally could the OP drop her employers coverage and purchase insurance on the exchange?

To piggyback on what @@MissMac suggested. Try to decrease the amount processed foods you buy. The fewer items that come in a box or a bag, the better. For example Hamburger Helper might be more convenient but buying your own macaroni, cheese & ground beef and seasoning yourself will save you a load of sodium.

[della street 213]

@@BLERDgirl She'd need to check on open enrollment dates for the Exchange as well as with her HR department about it -- not sure, but purchasing on the Exchange sure as heck worked great for me -- yep, a little pricier than we were paying with me included on hubby's policy, but not so much that we can't swing it with some belt-tightening, no pun intended, lol. Of course, I have to pay the monthly premiums, but then after my out-of-pocket max, it's 100% covered.

[jenbaby75 283]

Depending on your emoloyer with BCBS, you can switch to ppo, and it is covered if medically necessary, with very few hoops. We have Boeing BCBSil, and had to switch plans, all I had to do was see a nut, a psych, and that is it. I just found out I was approved.

[LipstickLady 25,682]

Only if your employer opts for it. My bestie is BCBS as am I. Her employer won't do it, my husband's did. She's been fighting it for years.

[blondiebabs 214]

My insurance says in their handbook that they do not cover any kind of weight loss surgery, when you call them they say they do not cover weight loss surgery and even tried to talk me out of it, however the hospital where mine is being done was able to get preapproval based on if medical necessity could be proven and I met all the criteria then I would be eligible for it. So I did their 6 month diet, and had my dr sign a letter stating medical necessity and they approved it. They may have a similar "hidden" clause.

Edited January 14, 2015 by blondiebabs

[CountryGirl5584 115]

Unfortunately it is your employer that chooses your plan and it stinks.

[wannaBthinsoon 1,634]

I had BCBS of KC and they excluded WLS for any reason, even to save a life. I decided to take out my own policy this year which covers it. There's more than one way to skin a cat (sorry cat lovers, just an expression)