Hey guys, I am new here! I recently found out that I have what is called a complete heart block, where by electric signals are working as they should in my heart. I am over weight with a BMI of 38.4, I have high blood pressure, i am pre-diabetic, high triglycerides and cholesterol (hereditary), fatty liver, acid reflux and I am getting a sleep study done for sleep apnea. My heart doctor said it is 100% nessesary for me to lose weight or I won't make it to see my kids grow up.

My insurance is United healthcare choice plus and my employer doesn't have weight loss surgery on our plan and my HR said they never have and won't add it to our plans, so it is obviously going to be denied.

My question is being that it willow sure be denied and I don't have coverage for it on my plan, if I appeal it and have my doctor write a letter stating that it is very medically nessesary for me to have this surgery would that change anything? Or is there zero chance of it getting approved because I don't have the coverage?

Just had Dr sergio quinones do my VSG $5300. I paid a few $$ for the upgrades

I recommend you call the hospital billing department and ask what the self pay price is. I know it can be a discount compared to the insurance price.

Yeah the surgeon I used has a self pay price of 10k as I recall. He’s in Oregon and is very experienced, I had about a half dozen people recommend him. I would have used him again in a heartbeat and if my insurance hadn’t covered it I would have paid out of pocket.

On 2/4/2021 at 2:58 PM, JMJames92 said:

Just out of curiosity, how much did the surgery cost you out of pocket? Feel free to tell me to beat it if you are uncomfortable telling me. I just know that my insurance paid ~$80,000 for my surgery. It was definitely one of the best decisions I have ever made but I couldn't imagine dropping that kind of money.

That is a huge number rigth there!, i paid 18,000 out of pocket

Our insurance plan did not include wls, and there was no way they would cover it, even if I tried to appeal that it was medically necessary. Unfortunately, I had to pay out of pocket.

Also, it was totally worth every penny. I paid 21, 800 out of pocket.. My surgery was 6 months ago. I started at 393 lbs. and a bmi of 69.9. I'm am 272 now and I think my bmi is 49.8. I still have a long way to go, but I am so happy I chose to pay out of pocket.

49 minutes ago, Bookkeeper bariatric said:

That is a huge number rigth there!, i paid 18,000 out of pocket

33 minutes ago, STLoser said:

Also, it was totally worth every penny. I paid 21, 800 out of pocket.. My surgery was 6 months ago. I started at 393 lbs. and a bmi of 69.9. I'm am 272 now and I think my bmi is 49.8. I still have a long way to go, but I am so happy I chose to pay out of pocket.

Wow!! Back when I had my surgery (honestly even today but more so back then) if my insurance wouldn't have covered it then it may as well have been $10,000,000, I would be just as unable to pay it haha!

On 2/6/2021 at 11:05 AM, It's time. said:

See a cardiologist immediately. With complete heart block you need a pacemaker.

This was my first thought as well. Heart blocks are some scary stuff.
OP- hopefully you find a solution that works for you and that you’re on the path to health soon.

There’s a 0% chance they would cover it if it’s not in your plan. Insurance companies don’t actually care about their clients’ health. My insurance won’t cover it either (my secondary actually covers 100% but won’t pay unless my primary covers it which it doesn’t ?) so I’m paying out of pocket for mine. I did some searching for clinics in my area and found one that does it for $11,000 or $250 a month for 5 years. That’s about what I’ve spent on diet food and diet plans per month in the past so it’s not too bad. They also have programs in Mexico for like $5,000 which have good reviews, I’d do that if my boyfriend and I wouldn’t have to quarantine and miss work for 2 weeks afterwards. How much do you pay in medication and doctor bills now? Even if you have to pay for the surgery it will negate some of those costs which will make it worth it too. Good luck!

There’s a 0% chance they would cover it if it’s not in your plan. Insurance companies don’t actually care about their clients’ health. My insurance won’t cover it either (my secondary actually covers 100% but won’t pay unless my primary covers it which it doesn’t [emoji21]) so I’m paying out of pocket for mine. I did some searching for clinics in my area and found one that does it for $11,000 or $250 a month for 5 years. That’s about what I’ve spent on diet food and diet plans per month in the past so it’s not too bad. They also have programs in Mexico for like $5,000 which have good reviews, I’d do that if my boyfriend and I wouldn’t have to quarantine and miss work for 2 weeks afterwards. How much do you pay in medication and doctor bills now? Even if you have to pay for the surgery it will negate some of those costs which will make it worth it too. Good luck!

Unless you have a job that requires no physical effort, you will need to recover for minimum 2 weeks anyway, so you don't hurt your procedure.

$9990 is what i have been quoted in Alabama @ Alabama Weight Loss. That includes the outpatient surgery, post op visits and surgery complication insurance. I have my consultation the 15th and will have more details. I will be self pay because my insurance has bariatric coverage but there is a 6 month waiting period and my BMI isnt high enough even with the comorbidities I have.

Edited February 8, 20215 yr by LindsayS0917

Wow!! Back when I had my surgery (honestly even today but more so back then) if my insurance wouldn't have covered it then it may as well have been $10,000,000, I would be just as unable to pay it haha!

Yes, I understand. I wanted the surgery for many years and never had insurance that covered it, so I never planned to get it. When the surgeon who took my gallbladder out told me my liver was so bad he didn't think I'd make it to 60 if I didn't lose weight, I decided to get the money out of my 401k. It wasn't something I'd ever considered doing because I wanted to save that money for retirement, but hearing that surgeon's words made me realize I would never be able to use that money if I was dead anyway! There's no way I could have come up with that money if it weren't for the 401k, though.

I went to Dr Shillingford in Boca Raton (or West Palm) and paid $10,800 out of pocket. I financed it with Care Credit, at about 14% interest...which seemed like a lot, so I paid it down as quickly as possible!

On 02/08/2021 at 10:12, Miamibigjr said:

Unless you have a job that requires no physical effort, you will need to recover for minimum 2 weeks anyway, so you don't hurt your procedure.

I know, I meant my boyfriend would have to take off work for an extra 2 weeks if we did it in Mexico and wouldn’t if we did it here. My job is very physical so I plan to take off for a month

On 02/08/2021 at 12:29, LindsayS0917 said:

$9990 is what i have been quoted in Alabama @ Alabama Weight Loss. That includes the outpatient surgery, post op visits and surgery complication insurance. I have my consultation the 15th and will have more details. I will be self pay because my insurance has bariatric coverage but there is a 6 month waiting period and my BMI isnt high enough even with the comorbidities I have.

That’s where I’m getting mine done as well!