Hello! New here - just starting journey

[AmandaD. 35]

Hello everyone - greetings from sunny Florida! Just had my first convo with my GP about how to get started with this journey… she said to start with calling insurance companies. Do I just start calling random companies and see their criteria?? I’m completely in the dark about this process. After the insurance process what would be next? Any help/your own process stories would be appreciated! Thanks 😊

[KimA-GA 540]

28 minutes ago, AmandaD. said:

Hello everyone - greetings from sunny Florida! Just had my first convo with my GP about how to get started with this journey… she said to start with calling insurance companies. Do I just start calling random companies and see their criteria?? I’m completely in the dark about this process. After the insurance process what would be next? Any help/your own process stories would be appreciated! Thanks 😊

Call your current insurance and see coverage and criteria. Many plans exclude bariatric, unfortunately. That will show what your options are or if you will have so self pay.

then research the pros and cons of each surgical procedure and decide which is for you.

[AmandaD. 35]

I use a third party insurance company that I know doesn’t cover it. I was thinking to research and then during enrollment period (November) switching to that certain plan & going from there… theoretically it seems like that could work but I’m not sure I guess.

[KimA-GA 540]

4 minutes ago, AmandaD. said:

I use a third party insurance company that I know doesn’t cover it. I was thinking to research and then during enrollment period (November) switching to that certain plan & going from there… theoretically it seems like that could work but I’m not sure I guess.

Good luck in finding a plan with coverage.. I am lucky, my insurance does not cover it, but my husband added me to his insurance which started covering the surgery this year.

[jenuinelygenuinely 80]

Welcome!!!

I say call your current insurance and get more information. If it doesn't 100% cover, I agree with you, research insurances and apply during open enrollment. I live in Minnesota and work for Blue Cross Blue Shield, wish I can help you over here!!! We cover bariatric surgery but under a criteria and the process is 6 months of education. I've heard other insurances only need you to do 3 months. After you have found an insurance that covers it, call the benefit customer service and get the criteria of what you need for insurance to approve your surgery at the end of the 3/6 month bariatric education.

How mine started I found a Bariatric program at a hospital/clinic and scheduled an appointment. They gave me all materials I needed and also a forum for me to ask my insurance questions. If I recall the questions were about the specific bariatric codes used for the surgery, the deductible/copays/maximum out of pocket. After the first appointment then starts your 3/6 month dietitian visits as well as visits to a therapist. Along the way of the appointments you may have to do required procedures like upper endoscopy, sleep study, and other blood work. It kinda sucks because you wouldn't know until the end if your insurance will approve/deny. Hope this helps!

Edited July 26, 2022 by jenuinelygenuinely

[Tami10 50]

I'm in California and my insurance covered it just had to pay copay. Had to jump through but I'm surprised that a lot of insurances don't cover it because when I was looking at insurances when we could change all the ones I was looking at covered it

Sent from my SM-A716U using BariatricPal mobile app

[jenuinelygenuinely 80]

46 minutes ago, Tami10 said:

I'm in California and my insurance covered it just had to pay copay. Had to jump through but I'm surprised that a lot of insurances don't cover it because when I was looking at insurances when we could change all the ones I was looking at covered it

Sent from my SM-A716U using BariatricPal mobile app

I agree!! I am super surprised some insurances don't cover it...it can be under a different procedure possibly? I feel like with the right doctor they are able to deem this a medical necessity for insurance to approve.

[Esi 179]

My insurance didn’t cover it, and neither did my husband’s. Had to do self-pay, which at least meant no red tape to do once I was cleared by the surgeon. Insurance did cover the pre- and post-op visits, including an outpatient visit due to a complication.

Still worth every penny! I sometimes think about how much money I am saving my insurance company by being healthier now…seems like they should be encouraging people to do WLS since it’s more than worth it to them in the end…

[Capri81 21]

I would call the surgeons office and see if they had recs on one that might cover. That would be a start point

[AmandaD. 35]

Thank you all for your suggestions! I actually found out my employers insurance (which I don’t currently have now) covers Bariatric surgery! So my plan is to enroll in Nov & start my journey in January! Anything I can do prior to get me ready? For the weight loss program is that something you wait for and your dietician gives you or can you pick one and do that ahead of time? Appreciate it!

[KimA-GA 540]

1 hour ago, AmandaD. said:

Thank you all for your suggestions! I actually found out my employers insurance (which I don’t currently have now) covers Bariatric surgery! So my plan is to enroll in Nov & start my journey in January! Anything I can do prior to get me ready? For the weight loss program is that something you wait for and your dietician gives you or can you pick one and do that ahead of time? Appreciate it!

Excellent! Find out the requirements from the insurance plan that you have and the surgeon you want to use. You may be able to tick boxes faster that way. Also, take time to work on any food related issues (overeating, unbalanced diet etc.). It will help!