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Hello.. Anybody out there?

This_IsMyRIHality

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This_IsMyRIHality    7

This_IsMyRIHality
Posted

Hey loves,

My name is Alexandria and I am currently looking into getting the Gastric Sleeve Done. I've struggled with weight all my life, and now at 26 I currently have diabetes along with high blood pressure. Hell, I may even have sleep apnea (going to my first appointment for that next week).

Since I've been looking into getting the surgery done, I contact UHC to see if my plan covers it. Unfortunately it does not via my employer. I'm so upset and honestly just bummed out. The agent that i was speaking to a UHC told me the surgeon could write an appeal if they feel that its detrimental.

I've been doing a lot of research, and I've seen so many people say "You can't appeal coverage, if its not covered because of employer." Is this true? If so, why would the agent advise me of that?

I've also seen how people have talked to HR to see about adding it to the plan. HOW long can this take?

I haven't even went to the seminar yet and I'm already stressed OUT! Everything runs about $19,000 here in Oklahoma City.

HELP!! lol

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nerd_is_inferred    13

nerd_is_inferred
Posted

Hi there! I am in the same boat and I've chosen to have my surgery done in Mexico. The cost including airfare will be around 6k.

I have UHC here in GA, and it is not covered .

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garciagiss    23

garciagiss
Posted

Hi, I was in the same boat as you a couple of months ago ... My insurance through my provider specifically stated that any type of weight loss surgery or consultation is not covered... I even went to HR and asked why?! They said because of the cost .... I sat on my decisions for months. I even applied through a company called prosper for a loan to get the surgery and they wanted to charge me an interest of 30%... Anyways don't give up! A couple of months later I applied with a credit union and got approved at a much lower rate.. I went to Mexico for my surgery and it was the best decision I have ever made . I'm only two weeks out but my experience with Mexico was wonderful!

Good luck and don't give up xox

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Sparkles!!    77

Sparkles!!
Posted

Like many of the other ladies here, I've chosen to go to Mexico because My employer didn't cover it either. I'm currently on day 4 of my liquid diet, and I fly out in exactly one week! I'm looking forward to doing this and finally getting a stamp in my passport :-)

I'll admit that Mexico wasn't my ideal first option, but once I started to look into things and find a surgeon I felt I could trust, I started to feel pretty good about it. There are some great self-pay options in my area that definitely cheaper than what the insurance would pay, but it would still cost at least $5000 more than my entire trip to Cancun. So I'd suggest exploring your options and see what works best for you!

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This_IsMyRIHality    7

This_IsMyRIHality
Posted

Hi, I was in the same boat as you a couple of months ago ... My insurance through my provider specifically stated that any type of weight loss surgery or consultation is not covered... I even went to HR and asked why?! They said because of the cost .... I sat on my decisions for months. I even applied through a company called prosper for a loan to get the surgery and they wanted to charge me an interest of 30%... Anyways don't give up! A couple of months later I applied with a credit union and got approved at a much lower rate.. I went to Mexico for my surgery and it was the best decision I have ever made . I'm only two weeks out but my experience with Mexico was wonderful!

Good luck and don't give up xox

Sent from my iPhone using the BariatricPal App

where did you go? I'm looking at that idea but family and my partner are not very supportive. They don't want me going to Mexico in fear that something could happen. Aghhhhh smh

Sent from my iPhone using the BariatricPal App

Like many of the other ladies here, I've chosen to go to Mexico because My employer didn't cover it either. I'm currently on day 4 of my liquid diet, and I fly out in exactly one week! I'm looking forward to doing this and finally getting a stamp in my passport :-)

I'll admit that Mexico wasn't my ideal first option, but once I started to look into things and find a surgeon I felt I could trust, I started to feel pretty good about it. There are some great self-pay options in my area that definitely cheaper than what the insurance would pay, but it would still cost at least $5000 more than my entire trip to Cancun. So I'd suggest exploring your options and see what works best for you!

who are you going to?

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Hi there! I am in the same boat and I've chosen to have my surgery done in Mexico. The cost including airfare will be around 6k.

I have UHC here in GA, and it is not covered .

when are you going?

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dklentz01983    21

dklentz01983
Posted

Hello there. Im sorry to hear that your bariatric surgery is an exclision on your policy. I work for BCBS and I know all insurances are different. But in my professional opinion I think appealing it would be a waste of your time. Your employer has chose not to cover that procedure therefore no matter how bad you need it it wont be approved. Im so sorry.

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dklentz01983    21

dklentz01983
Posted (edited)

Y'all who are going to Mexico please please do your homework on the surgeon

My grandpa did the same thing and never made it home alive. Breaks my heart thinking about it.

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Edited by dklentz01983

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teacherjen    18

teacherjen
Posted

Y'all who are going to Mexico please please do your homework on the surgeon

My grandpa did the same thing and never made it home alive. Breaks my heart thinking about it.

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I'm so sorry for your loss. Was your Grandpa having weight loss surgery? Who was his surgeon?

I've heard outstanding things about the programs for this in Mexico.

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This_IsMyRIHality    7

This_IsMyRIHality
Posted

Hello there. Im sorry to hear that your bariatric surgery is an exclision on your policy. I work for BCBS and I know all insurances are different. But in my professional opinion I think appealing it would be a waste of your time. Your employer has chose not to cover that procedure therefore no matter how bad you need it it wont be approved. Im so sorry.

Sent from my SM-G935P using the BariatricPal App

No worries, no need to be sorry. It's not your fault. It does make me sad though :( But i talked to my HR manager. I suggested adding it. we will see how that goes.... I'm pretty sure I will be going to Mexico.

I'm not sure how much you know about this, but I spoke with some supervisors here at my job and they have advised that several people here in the call center has done the surgery and our insurance has covered it. she advised that it may be something that they need saying its "for my better health" basically. Wouldn't that be something that UHC would have told me?

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dklentz01983    21

dklentz01983
Posted

What is your grp/id # i have access to ok policies i should be able to access your pred even though i work in tx. I can see why it denied and what steps you need to take if any.

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Amurillo04    109

Amurillo04
Posted

Normally you can't appeal if it's an exclusion but many insurance reps are not knowledgeable in the matter. I called three times and every time I got a different answer one lady even saying it is completely not covered because it's "cosmetic". But low and behold I have been approved. It may be best to see a surgeon and speak with their insurance coordinator to see if it's actually excluded.

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MissKate    5

MissKate
Posted (edited)

Hi Alexandria!!

I'm a bit late to the game, but I'm new to the website and trying to get approved for VSG as well.

If you haven't contacted HR yet, the following website provides a TON of ammunition to your case. Most importantly being that Oklahoma is one state that REQUIRE WLS coverage under obamacare [employer, group, and individual plans].

http://www.bariatric-surgery-source.com/obamacare-weight-loss-surgery.html

I wish you luck!!

Hey loves,

My name is Alexandria and I am currently looking into getting the Gastric Sleeve Done. I've struggled with weight all my life, and now at 26 I currently have diabetes along with high blood pressure. Hell, I may even have sleep apnea (going to my first appointment for that next week).

Since I've been looking into getting the surgery done, I contact UHC to see if my plan covers it. Unfortunately it does not via my employer. I'm so upset and honestly just bummed out. The agent that i was speaking to a UHC told me the surgeon could write an appeal if they feel that its detrimental.

I've been doing a lot of research, and I've seen so many people say "You can't appeal coverage, if its not covered because of employer." Is this true? If so, why would the agent advise me of that?

I've also seen how people have talked to HR to see about adding it to the plan. HOW long can this take?

I haven't even went to the seminar yet and I'm already stressed OUT! Everything runs about $19,000 here in Oklahoma City.

HELP!! lol

Edited by MissKate

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Go To Topic Listing Insurance & Financing

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    • Doughgurl

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      1. Phil Penn

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        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

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        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

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        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

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    • Doughgurl

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      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

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        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

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        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
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      · 1 reply
      1. LeighaTR

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        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

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