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

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



Recommended Posts

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?

Sent from my SM-N970U1 using BariatricPal mobile app

Share this post


Link to post
Share on other sites

Weird, I had Cigna and it was covered.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!!

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!!

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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

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?
      · 2 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..

    • 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

    ×