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My insurance not paying for surgery



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I just received notice that my insurance is not paying for my surgery. I'm so depressed right now. My doctor told me that one of my test showed that I gave gallstones, so I hope he can do both at the same time and I just pay him. My doctor's office said the cost is 5000 for the doctor fee and 10,000 for the hospital. Now, I'm hoping that that the hospital fee can be charged for the gallstone surgery and not the sleeve. Keeping my fingers crossed.

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There are plenty of places who charge less if you're willing to travel. I'm going to Florida next week and it's$8899. I paid copays for preop testing, and a flat fee for the surgery and hospital. $400 for a hotel for hubby, gas money and that's all.

Don't discount Mexico either. Read reviews here and you'll be surprised. It costs as low as $4500, plus airfare to San Diego.

Sent from my XT1254 using BariatricPal mobile app

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Thanks for the advice. I just spoke to my doctor's insurance person and it looks like they can charge the hospital fee to my insurance for out of network. Now my doctor is charging 6,000 so it looks like it will be around 9,000


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1 hour ago, Missytee said:

Thanks for the advice. I just spoke to my doctor's insurance person and it looks like they can charge the hospital fee to my insurance for out of network. Now my doctor is charging 6,000 so it looks like it will be around 9,000

Why did your insurance say they aren't paying? It seems from this forum that there are a percentage of people who are denied and still get insurance to pay via the appeals process.

I'm assuming that it isn't an exclusion, and you were denied after they sent the paperwork.

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Why did your insurance say they aren't paying? It seems from this forum that there are a percentage of people who are denied and still get insurance to pay via the appeals process.
I'm assuming that it isn't an exclusion, and you were denied after they sent the paperwork.

No my employer opted out of Bariatric surgery. We thought by law that they had to pay, but that's not the case. I work for a small company that is for profit and that's the way they do things....


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15 hours ago, Missytee said:


No my employer opted out of Bariatric surgery. We thought by law that they had to pay, but that's not the case. I work for a small company that is for profit and that's the way they do things....

Yeah, I agree. It will almost be impossible to get coverage. As mentioned earlier in this thread, have you considered Mexico? They seem to do a good job, and most importantly have less hoops to jump through. You could probably have them do the gallbladder and WLS all for less than your $9k quote.

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I thought about it but I'm kind skeptical about going to another country. The time I pay for flight, hotel, and maybe a rental car I be payed the same-thing. I believe my doctor will come down some more on his price because he really want to help me...[emoji56][emoji56][emoji56]


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I thought about it but I'm kind skeptical about going to another country. The time I pay for flight, hotel, and maybe a rental car I be payed the same-thing. I believe my doctor will come down some more on his price because he really want to help me...[emoji56][emoji56][emoji56]




When you go to Mexico, you dont need a hotel or a rental car. They pick you up and drop you back off in San Diego. If you stay extra nights, its extra hotel fees, but normally a hotel is included for yourself and a companion for 2 - 4 days.

Sent from my XT1254 using BariatricPal mobile app

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What state are you in?

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When you go to Mexico, you dont need a hotel or a rental car. They pick you up and drop you back off in San Diego. If you stay extra nights, its extra hotel fees, but normally a hotel is included for yourself and a companion for 2 - 4 days.

Sent from my XT1254 using BariatricPal mobile app


Cool....that's really nice. I had no idea. Thanks for the info .


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Hey. I'm new here and I work for a small company as well so it's not covered. Right now I'm considering Mexico heavily. My only thing is my parents and friends are against it.

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I would say consider Mexico as well. Using allegiant air, I plan on flying from Memphis to Los Angeles for under $100 then will rent a car to drive to San Diego. It's like a 2 hour drive but wayyyy cheaper!!


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I was sceptical about Mexico too. In Canada WLS is covered by our health system (free), but there's a 2-7 year waiting period depending on how severe your case is. There's only 2 places in the entire country (!!!) that are private clinics (self-pay) and charge upwards of $20,000 Canadian (roughly $16,000 USD).
I did my research and frankly after all the excellent reviews I've read about Dr. Illan through BariatricPal MX I'm more than confident in his abilities. And they quoted me (as per their website) only $6100 USD. By no means am I advertising for them, just relaying what my plans are :)


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Now I've ran into another issue. I can only remove a certain amount from my 401K and they stated that depending on the reason, it may not be approved. I don't understand why I can't remove what I need to get it done and why they're so many restrictions on it.


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16 minutes ago, Natasha85 said:

Now I've ran into another issue. I can only remove a certain amount from my 401K and they stated that depending on the reason, it may not be approved. I don't understand why I can't remove what I need to get it done and why they're so many restrictions on it.

Did your company set the restriction? Because you should be able to remove as much as you want, it is just if you will be heavily fined by doing so. Do you have the option to take a loan against your 401K?

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        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!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

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        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

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        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
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