The Human Cost to Insurance Not Covering WLS Surgery in the US

[Inner Surfer Girl 12,015]

I just discovered some very bad news. I just found out a colleague where I used to work recently passed away. I knew her because we had the same insurance and saw the same therapist and attended some group counseling together.

At one time, the possibility of WLS was raised. Our insurance did not cover it (our employer excluded it). I was not yet ready to consider WLS even though I had family members offer to help. She despaired because she wanted it but did not have the same option.

Fast forward. The last time I spoke to her on the phone I was on disability and I told her I was having/or had had surgery (I can't remember which). She was still struggling with health issues and working.

It breaks my heart that for want of a relatively small investment a terrific person is no longer with us. She was a long-time employee with a wealth of knowledge and experience. Although there are no guarantees in life, I truly think that if she were able to have WLS she would still be with us.

The US insurance/health care system is so messed up.

This is not right.

[Christinamo7 4,042]

not just in the US, but everywhere.

I am sorry that the world has lost her. I am thankful that I had the surgery.

[KristenLe 5,980]

I'm sorry for your loss! It truly is messed up and priorities are backwards!

[Cervidae 2,389]

I think we can sometimes take for granted what a huge, mind-blowing gift we are given by having the means and opportunity to have wls. I think we sometimes forget, when all is said and done, that not only are we losing weight and becoming healthy, but most of us avoided death that had been lurking just around the corner. I'm so sorry to hear about the loss of this woman, and it grieves me to consider the enormous amount of people who never had the chance that I've been given, or never will. It's humbling. I'm going to cherish this gift and live my life remembering every day just how incredibly lucky and grateful I am.

[jane13 2,256]

@@Cervidae - well said

@@Inner Surfer Girl - sorry to hear you have lost someone whose life ended, by possibly not having WLS - sad.

[OKCPirate 5,323]

I just can't bring myself to support mandates and more government intervention into health care decisions is getting disastrous and in some cases fatal. In England if the government run health care system doesn't have the budget to perform a procedure you need, they will just tell you "there is nothing we can do" or "oh it's nothing" and you go home and die.

So there are a couple of solutions:

1) Get mired in legislative fights to make change, or

2) Get out of managed care.

I did the later. My insurance is a defined benefit plan. It pays for everything over $4000. I just give them the receipts, they pay. Cost is only $170 a month (I'm 53). What this means is I self pay everything. Which means I look for bargains, negotiate with the providers on price. Dr. Smith here is Oklahoma has been on the cutting edge of this for years: http://surgerycenterok.com/.

I'm now considering joining a concierge practice. Fixed costs, less wait, no hassles. I know what blood tests I want and need for my NUT (and I check with my GP doc). You can do self pay for those really cheap. If you can use the internet, I would suggest quit waiting for the government and big medicine to solve the problems and take care of it yourself. It's liberating.

[kaitlynm 335]

I don't understand why employers or insurance companies would exclude WLS. My insurance company did require me to go to a less than desirable hospital, however their negotiated rate for the surgery and one night's stay was only $1300. They paid the surgeon another $1200. So for a $2500 investment, they are saving over $3000 in costs for the prescription drugs I no longer need. It doesn't take much to see that everyone saves money.

I think the real problem lies with the cost to people who do not have the coverage. The bill submitted from the hospital was over $30000, and the surgeon was over 5000. If they are willing to accept so much less from the insurance companies, then why do they charge so much more to people without it. To me, that is the real problem with healthcare.

[Inner Surfer Girl 12,015]

I just can't bring myself to support mandates and more government intervention into health care decisions is getting disastrous and in some cases fatal. In England if the government run health care system doesn't have the budget to perform a procedure you need, they will just tell you "there is nothing we can do" or "oh it's nothing" and you go home and die.

So there are a couple of solutions:

1) Get mired in legislative fights to make change, or

2) Get out of managed care.

I did the later. My insurance is a defined benefit plan. It pays for everything over $4000. I just give them the receipts, they pay. Cost is only $170 a month (I'm 53). What this means is I self pay everything. Which means I look for bargains, negotiate with the providers on price. Dr. Smith here is Oklahoma has been on the cutting edge of this for years: http://surgerycenterok.com/.

I'm now considering joining a concierge practice. Fixed costs, less wait, no hassles. I know what blood tests I want and need for my NUT (and I check with my GP doc). You can do self pay for those really cheap. If you can use the internet, I would suggest quit waiting for the government and big medicine to solve the problems and take care of it yourself. It's liberating.

If you live in a state that does not require obesity services then it can be impossible to buy a defined benefit policy that covers WLS. I had a defined benefit and WLS was specifically excluded. That is the case for both my former employer's policies (whether HMO, PPO, or defined benefit) or what I had to buy as an individual.