Anyone out there get denied through insurance because of where you work?

I was told my insurance covered my sleeve surgery as long as I did my pre cert which included the 6 months of medical supervision. I am in my 4th month and found out today that insurance will not cover.

My workplace is self insured so they get to come up with the "rules". They say they will not cover any bariatric surgery or any weight loss plan.

I am so heartbroken!! ????

Anyone else have a problem like this? If so what did you do.

I am ready for this awesome change in my life!!! ????

My insurance does not cover any weight loss surgery. However, I also had a hernia that I didn't know about. So I had both procedures done at the same time. My insurance only covered the hernia repair. I ended up paying around $6,000 out of pocket for the sleeve. I was told that if I had the sleeve only, it would have cost me around $12,000.

To find out if you have a hernia, they will preform an EGD. It's a simple, quick procedure. If I remember correctly, that cost me $635 after insurance payment.

Technically, my work insurance covers it, but the restrictions are so tight and the amount that they will pay is so small that it might as well not. What I ended up doing was finding a surgeon who checks you for a hiatal hernia. Many people have them. If you have one, then they file with your insurance to cover the hiatal hernia sleeve repair and you pay out of pocket for them to do the sleeve while you're in surgery. That way, you don't have to meet any of your insurance company requirements for qualifying for the sleeve as you're not using them to cover it.

I ended up total out of pocket paying approximately $6,000 for everything.

My insurance does not cover any weight loss surgery. However, I also had a hernia that I didn't know about. So I had both procedures done at the same time. My insurance only covered the hernia repair. I ended up paying around $6,000 out of pocket for the sleeve. I was told that if I had the sleeve only, it would have cost me around $12,000.

To find out if you have a hernia, they will preform an EGD. It's a simple, quick procedure. If I remember correctly, that cost me $635 after insurance payment.

Thanks. I might have too look into this!!

Technically, my work insurance covers it, but the restrictions are so tight and the amount that they will pay is so small that it might as well not. What I ended up doing was finding a surgeon who checks you for a hiatal hernia. Many people have them. If you have one, then they file with your insurance to cover the hiatal hernia sleeve repair and you pay out of pocket for them to do the sleeve while you're in surgery. That way, you don't have to meet any of your insurance company requirements for qualifying for the sleeve as you're not using them to cover it.

I ended up total out of pocket paying approximately $6,000 for everything.

I appreciate the reply. I am for sure going to check this out.

I appreciate the reply. I am for sure going to check this out.

I was almost positive that I did not have a hiatal hernia. I had some heartburn from time to time but hadn't thought much about it. They repeatedly told me that almost everyone has one. They were right about me. It was small but it was there.

Anyone out there get denied through insurance because of where you work?

I was told my insurance covered my sleeve surgery as long as I did my pre cert which included the 6 months of medical supervision. I am in my 4th month and found out today that insurance will not cover.

My workplace is self insured so they get to come up with the "rules". They say they will not cover any bariatric surgery or any weight loss plan.

I am so heartbroken!! ????

Anyone else have a problem like this? If so what did you do.

I am ready for this awesome change in my life!!! ????

My insurance didn't cover any form of Bariatric surgery so I paid out of pocket $4250 plus airfare and went to Tijuana Mexico through Medical Tourism. Best experience ever!

Michelle

Another alternative is to buy your insurance via healthcare.gov and chose a plan that covers bariatric surgery.

Self-funded plans can determine benefits outside the "norm", depending on which state you're in. I did have one County employee plan I managed for that didn't cover any bariatric surgery. They considered it a cosmetic procedure, despite being one of the counties in CA with the highest obesity rate. Go figure. They self-administered.

I'm in a self-funded, but not self-administered, plan. It's a school district. They bought health plan coverage and administration from Blue Shield, but my pharmacy plan differs from other Blue Shield plans. A lot of school districts are self-funded, at least here in CA.

Yes, my company doesn't pay for that option hence the excluded coverage with the last 2 insurance companies we had, I even thought about going on my wife's policy from employee but found there policy have the coverage excluded.

I'm not looking at different self pay options.

Edited November 1, 201510 yr by atlmag

My insurance didn't cover any form of Bariatric surgery so I paid out of pocket $4250 plus airfare and went to Tijuana Mexico through Medical Tourism. Best experience ever!

Michelle

Thanks Michelle!! I have started the process to go to Tijuana also through Bariatric Pal. Things are looking up!

Another alternative is to buy your insurance via healthcare.gov and chose a plan that covers bariatric surgery.

I looked into this but nothing in Kentucky includes in their plans. I am going to go to Mexico.

Yes, my company doesn't pay for that option hence the excluded coverage with the last 2 insurance companies we had, I even thought about going on my wife's policy from employee but found there policy have the coverage excluded.

I'm not looking at different self pay options.

I didn't find a single health plan in Kentucky that covers it. Seem to be sticklers. I am going the Mexico route.

I have been VERY impressed with Dr. A in Mexico and I think you made the right decision for you!! Congrats and good luck!!!

I have been VERY impressed with Dr. A in Mexico and I think you made the right decision for you!! Congrats and good luck!!!

Thanks!! I think I did too!!!