Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

Yep, that's about right. It's insane how individual the requirements are. My personal insurance is through the school district but mandated by the state. I pay about $100 per month for just myself to be covered for medical, to the tune of $1200 off my paychecks each year. I didn't cover the family, as we are all covered by my husband's union insurance as well. He pays a percentage per hour, but it's paid by his employer over his hourly wage, so we never have seen it on his paycheck, so it never feels like an expense to us since it's negotiated and run by the union.

My insurance deductible is $200 per year. My husband's insurance deductible is $200 per year. Anything I'm billed goes first to my insurance, which pays 85% (leaving me responsible for 15%) and then to my husband's, which would have paid 80% so they cover the remaining 15% then put the leftover 65% they would have paid into a health savings account for me if I lose my other insurance. So basically once I meet those deductibles, I'm covered for 100% of medical charges. Up in the air are the co-pays my insurance has ($75 for Emergency visits and $200 for In-patient hospital, which are normally due at time of service). My husband's insurance doesn't have any co-pays upfront, so if I have to pay those things, I might have to submit reimbursements for those fees, such as when I'm admitted to the hospital for my VSG surgery.

The upside, neither of my insurances have any requirements for weight loss programs for bariatric surgery if I meet the BMI/comorbidity levels and they have very similar plans for what is allowed versus not allowed for coverage.

Share this post


Link to post
Share on other sites

My first consult was January 30th and dietitian Feb 6th. I needed an EKG, Labs and medical clearance from my primary. My surgery is May 13th, earliest date I could get because he is booked solid.

I do not have coverage for weight loss surgery BUT it is needed for a hiatal hernia. My doctors are confident what they can get it approved on appeal (we know it will initially be denied).

Share this post


Link to post
Share on other sites

Paying out of my own pocket and using insurance out-of-network benefits for a portion of it, so I scheduled literally the day after I submitted a consult application to the surgery center.

Share this post


Link to post
Share on other sites

My first consult was January 27. Insurance required 3 visits (90 days). Finished those last week of April. Insurance approved a week later. Surgery is scheduled for June 11. So overall about 4.5 months for me.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Recent Topics

  • Most popular:

  • Together, we have lost...
      lbs
    ×