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

Self pay- insurance doesn’t cover WLS



Recommended Posts

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.

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

states.png

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

states.png

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).

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

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

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×