Self pay- insurance doesn’t cover WLS

[Changenprogress 7]

My insurance doesn’t cover WLS. I am making arrangements to be able to pay out of pocket and started the process at Duke in NC but then the surgeon said she wouldn’t do the surgery since my insurance wouldn’t cover the surgery due to risk of complication and high medical bills. Has anyone else experienced this???
I have an appointment with WakeMed BARIATRICS on May 10th, I explained to them what happened at Duke and they seemed surprised by it and said they except self pay. I am just terrified that I am going to be be crushed again for the 2nd time in 3 weeks and don’t know if I can take it.
Any advice??? I have checked in to ACA insurances and multiple agents said none of the policies cover WLS.

[liveaboard15 1,294]

that is odd... I am self pay as well. My surgeon required a special insurance that i bought from the doctors office which covers anything that may go wrong for 6 months. It was like $1,200 but others in my area do not require it. My whole gastric sleeve was $18,000

[liveaboard15 1,294]

Also from my research i thought the affordable care act covers bariatric surgery in North Carolina. I would double check. Tho idk if What you have on your profile would get covered that Duodenal Switch thing.

[Changenprogress 7]

Thank you for your answers. I will keep asking and also see what the new surgeon/ office says, they may be more helpful I hope.

[Queen ApisM 427]

I was self-pay as well, and it was never an issue at any of the practices I consulted with. Now, I will admit I was really stressed out about any complications happening since insurance probably wouldn't cover them but the risk of staying as overweight as I was at the time of surgery was definitely going to land me in the hospital at some point.

Definitely talk to other practices and see what they say.

[catwoman7 11,274]

11 hours ago, liveaboard15 said:

Also from my research i thought the affordable care act covers bariatric surgery in North Carolina. I would double check. Tho idk if What you have on your profile would get covered that Duodenal Switch thing.

it might not cover the DS. A lot of insurance policies that DO cover WLS will only cover sleeve and bypass (some will cover DS - but not all).

[liveaboard15 1,294]

29 minutes ago, catwoman7 said:

it might not cover the DS. A lot of insurance policies that DO cover WLS will only cover sleeve and bypass (some will cover DS - but not all).

That is what i was thinking too. Probably going to have to choose the sleeve or bypass if they want insurance to cover.

[SleeveToBypass2023 2,680]

On 4/27/2022 at 6:10 PM, Changenprogress said:

My insurance doesn’t cover WLS. I am making arrangements to be able to pay out of pocket and started the process at Duke in NC but then the surgeon said she wouldn’t do the surgery since my insurance wouldn’t cover the surgery due to risk of complication and high medical bills. Has anyone else experienced this???
I have an appointment with WakeMed BARIATRICS on May 10th, I explained to them what happened at Duke and they seemed surprised by it and said they except self pay. I am just terrified that I am going to be be crushed again for the 2nd time in 3 weeks and don’t know if I can take it.
Any advice??? I have checked in to ACA insurances and multiple agents said none of the policies cover WLS.

Is it possible to do a bypass instead of a DS? Sleeve and bypass are the most common, and insurance tends to like to cover those versus a DS. If you switch, you may find you have much better luck.

[Changenprogress 7]

My insurance does not cover anything at all dealing with weight loss at all, meaning surgery and medical weight loss programs. But I went to a new surgeon and they have a program for self pay people and I will be having surgery in the next few months. I will be having the SADI-S procedure.

[ShoppGirl 5,072]

On 5/11/2022 at 2:00 PM, Changenprogress said:

My insurance does not cover anything at all dealing with weight loss at all, meaning surgery and medical weight loss programs. But I went to a new surgeon and they have a program for self pay people and I will be having surgery in the next few months. I will be having the SADI-S procedure.

Some places that do self pay offer an insurance that will cover if you have any complications.

[Changenprogress 7]

Yes I found the perfect place and will be having surgery in a few months. Thanks!

[Kbuzz 1]

My insurance BC/BS of North Carolina does not have any WLS benefit- I am trying to change jobs. I am going to ask the surgeon if they have a self pay option- thank you

[Sunshine Princess 203]

If your insurance doesn’t cover it and you have insurance through your workplace, your employer has decided to not provide the benefit. It is not the insurance company, but your plan design. Call BCBS of NC and ask if your plan has an exception program where you can see if your employer will make a one time exception to the plan and cover this.

But please, it’s not the insurance company dictating you can’t have the surgery. It’s your employer’s plan design.

[SleeveToBypass2023 2,680]

On 5/12/2022 at 6:37 PM, Sunshine Princess said:

If your insurance doesn’t cover it and you have insurance through your workplace, your employer has decided to not provide the benefit. It is not the insurance company, but your plan design. Call BCBS of NC and ask if your plan has an exception program where you can see if your employer will make a one time exception to the plan and cover this.

But please, it’s not the insurance company dictating you can’t have the surgery. It’s your employer’s plan design.

THIS!!!! I have BCBS of Illinois, and it is offered in the higher level plan tiers. I have the diamond plan because of my other health issues and needed ALL the coverage. But they cover it on the gold, platinum, and diamond plans automatically (as long as you qualify) or on the lower level plans if your employer opts for it. At least, that's how my insurance company explained it to me.

[Happy Stylist 86]

I was self pay. I live in KY but had my surgery in TN. (Only a hour and 45 mins drive) I had zero problems. My plan even covered complications up to $25000 for 90 days after surgery.