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Insurance doesn't cover bariatric surgery...now what?



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I got Cigna at the start of this year as my job switched insurance companies. My surgeons office was preparing me with steps toward surgery when I got a call today saying that bariactic surgery isn't covered under my plan. I feel so disappointed. Now what? How can I get coverage? Anyone experienced this?

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Weird, I had Cigna and it was covered.

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1 hour ago, kcuster83 said:

Weird, I had Cigna and it was covered.

most insurance companies will cover it, but it's usually not part of their "core" coverage. In order to offer it, employers need to buy a rider for it. So although her company uses Cigna, they probably decided not to have their policy include the optional bariatric surgery rider.

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Is self-pay an option? I found a great surgeon in Alabama because bariatric surgery was excluded from my insurance as well. I had very few pre-op requirements and the cost was $8995. You could always go to Mexico too which is the cheapest but I was too nervous to go that route.

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My primary insurance thru my employer (united healthcare) does not cover it. Im fortunate my husbands new insurance (Aetna) does have bariatric surgery coverage. But before he got this insurance I was seriously looking into going to Mexico for my surgery. There's some financing options available too.

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So frustrating! I'm so sorry. Maybe see if an appeal is possible? Sometimes the squeaky wheel gets the grease....

I did self-pay in Mexico and had a WONDERFUL experience. Feel free to read some of my other posts for additional info. I know that's not an option for everyone, and many don't feel comfortable going that route, but it's worth looking into.

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Mine didnt cover either... I paid cash. Used my savings and ended up selling my jetski which was the saddest day of my life lol i loved my jetski... But so worth it. Otherwise you could look at loans. Just be careful with high interest rates.

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My insurance didn't cover it either, as Catwoman mentioned, your employer needs to add it to their plan, and I was told no going around that. I ended up as self pay, and using my HSA savings. Because I have a high deductible plan, I figured even if I was able to go the insurance route, it would cost me 7K in my deductible, and I would lose months and months of time jumping through insurance hoops. There are clinics I'm sure all over the country that specialize in just bariatric surgery, I went through West Medical in LA and had a great experience, it was $10K and only took 3 weeks from 1st consult to surgery. Mexico clinics start around $5k, and while I know some have had great experiences that route, I just wasn't comfortable. It's very possible you have a local bariatric Dr. that takes self pay. There are also financing options with credit cards like Care Payment that offer no/low interest rates. Don't let money hold you back!

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On 3/3/2023 at 8:59 AM, catwoman7 said:

most insurance companies will cover it, but it's usually not part of their "core" coverage. In order to offer it, employers need to buy a rider for it. So although her company uses Cigna, they probably decided not to have their policy include the optional bariatric surgery rider.

This is exactly right. I have contacted my employer and crossing my fingers regarding a rider or them adding this. At the same time I don't want to hold my breath. Exploring my other options and trying to pick myself back up.

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On 3/3/2023 at 9:44 AM, lorlybeth84 said:

Is self-pay an option? I found a great surgeon in Alabama because bariatric surgery was excluded from my insurance as well. I had very few pre-op requirements and the cost was $8995. You could always go to Mexico too which is the cheapest but I was too nervous to go that route.

I am seriously considering self pay. Just trying to pick myself up from the let down as this mainly why my current insurance plan. I was told it was covered. I live in Florida and everything is over priced here but I truly am considering self pay at this point.

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On 3/3/2023 at 10:55 AM, Sleeve_Me_Alone said:

So frustrating! I'm so sorry. Maybe see if an appeal is possible? Sometimes the squeaky wheel gets the grease....

I did self-pay in Mexico and had a WONDERFUL experience. Feel free to read some of my other posts for additional info. I know that's not an option for everyone, and many don't feel comfortable going that route, but it's worth looking into.

It's very frustrating! I am considering an appeal or what my other options are. Its good to know that I am not alone. I am considering self pay at this point. I will check out your posts. Thank you!!

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On 3/3/2023 at 10:39 AM, kla7403 said:

My primary insurance thru my employer (united healthcare) does not cover it. Im fortunate my husbands new insurance (Aetna) does have bariatric surgery coverage. But before he got this insurance I was seriously looking into going to Mexico for my surgery. There's some financing options available too.

That is a good idea! I will look into switching over to my husband's insurance if it is covered. Did you have to wait until a new enrollment year to switch? I kind of don't want to have two insurances for myself on mine and my husband's.

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On 3/3/2023 at 6:13 PM, Bandedbut said:

My insurance didn't cover it either, as Catwoman mentioned, your employer needs to add it to their plan, and I was told no going around that. I ended up as self pay, and using my HSA savings. Because I have a high deductible plan, I figured even if I was able to go the insurance route, it would cost me 7K in my deductible, and I would lose months and months of time jumping through insurance hoops. There are clinics I'm sure all over the country that specialize in just bariatric surgery, I went through West Medical in LA and had a great experience, it was $10K and only took 3 weeks from 1st consult to surgery. Mexico clinics start around $5k, and while I know some have had great experiences that route, I just wasn't comfortable. It's very possible you have a local bariatric Dr. that takes self pay. There are also financing options with credit cards like Care Payment that offer no/low interest rates. Don't let money hold you back!

How hard was it to get your job to try to get a rider? I honestly don't want to get my hopes up .

Like you, I hear so many great experiences in Mexico but don't feel that is the right path for me. I prefer to stay in the states. I live in Florida and everything is so financially inflated but I honestly don't want to lose more time. Thanks for the encouragement!!

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9 hours ago, LMorales said:

How hard was it to get your job to try to get a rider? I honestly don't want to get my hopes up .

This is something you would need to talk to your HR dept about. My understanding (and I could be wrong) is that each company negotiates their rates with the insurance company, and there are things they can choose to not cover in order to keep the costs down for ALL employees. They can't just add it for one person. Bariatric surgery is getting more common, so maybe your employer might choose to add it durning the next open enrollment period, or, to cut rising costs, eliminate services. Unless you have a life event (like loosing your job, marriage, birth of a child etc) your husband can only add you to his plan during open enrollment. And your company's plan can't change until the next open enrollment. Most companies that wouldn't be effective until Jan 1 2024 (but not all, my company has open enrollment in the spring) Find out first if your husbands plan even covers it, and what the deductible/co-pay would be. You could start all the presurgery requirements now, as that usually takes about 6 months. Sounds like IF, everything works out, the soonest you could have the surgery under insurance (and a lot of things could go wrong to not align) would be Jan 2024. Or, do self pay and you could be recovering in a matter of weeks. There are low to 0 interest medical financing plans, and you can even pay those bills with an HSA or FSA card. It all depends on your financial situation and patience.

I totally understand your disappointment, I felt the same way when I found out it wasn't covered under my insurance. I had determined the VSG was the right path for me and had my hopes up, and was crushed. I didn't want to wait any longer, and self pay was the best option.

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On 3/5/2023 at 3:29 AM, LMorales said:

That is a good idea! I will look into switching over to my husband's insurance if it is covered. Did you have to wait until a new enrollment year to switch? I kind of don't want to have two insurances for myself on mine and my husband's.

Yes, during open enrollment I added his insurance as my secondary insurance

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