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

Devestated - Bariatric Surgery Not in Insurance Contract



Recommended Posts

I am so incredibly frustrated... Over the last 2 weeks, since going through the mental debate of going through with surgery, I finally decided to take the steps towards LapBand. The very first thing I did was call my insurance company. For various reasons, I have spoken to 3 different people - ALL of whom told me my benefits for weight loss surgery, the coverage criteria, etc. Every single one of them said it would be covered at 100% after a $350 hospital deductible. Sounds great, huh? I went to the seminar and everything- got home - and find a letter awaiting me from Health Partners stating that weight loss services, including bariatric surgery, is excluded from our contract. I called and explained that I have spoken to 3 different people and the woman said they must've overlooked it... that my husband's company opted out of these benefits. I am heart broken and angry.

Does anyone have experience with this? My husband and I considered buying a seperate policy for me for the rest of the year-- but if Im going to do that, I might as well to gastric bypass d/t the long term expenses that my insurance is not going to cover with LapBand....

I could just scream. :smile:

Share this post


Link to post
Share on other sites

So sorry to hear that the procedure isn't covered. That sucks. I too, am awaiting funding. Should it be denied I know that I would not be able to pay for it on my own with a young family and all. Praying that we both get the result we hope for.

Share this post


Link to post
Share on other sites

Well, then you have a decision to make.

If surgery is that important to you, then find other funding. I am uninsured, so I will be paying for my surgery for the next 5 to 7 years (I am listed as 7 years, but my wife says we will have it paid off in 5). For us, it was something that was worth the investment.

If the hospital won't extend credit, and you can't do credit cards or an independent bank loan, or borrow from friends or family (not the best suggestion anyway) then you need to decide if the surgery is the best route for you.

Whatever happens, just keep trying. Certainly, even if you don't have the surgery, hanging around groups like thic can give support to keep trying.

Share this post


Link to post
Share on other sites

I also am not covered under my benefit plan at all. The wait for me in Ontario is 1 yr to even get an appointment to see the surgeon etc then all the hoops to jump through after that. I am going with the Sleeve anyway. Too much after care and costs with band from my research and people getting revisions to the Sleeve after 3-5 yrs and paying more money anyway. I am looking at paying over 5 yrs and for me it is what I want more than anything. Not sure where your from but keep looking into options for sure and don't get too discouraged yet if this is what you need and want. Good Luck.

Share this post


Link to post
Share on other sites

Well, then you have a decision to make.

If surgery is that important to you, then find other funding. I am uninsured, so I will be paying for my surgery for the next 5 to 7 years (I am listed as 7 years, but my wife says we will have it paid off in 5). For us, it was something that was worth the investment.

If the hospital won't extend credit, and you can't do credit cards or an independent bank loan, or borrow from friends or family (not the best suggestion anyway) then you need to decide if the surgery is the best route for you.

Whatever happens, just keep trying. Certainly, even if you don't have the surgery, hanging around groups like thic can give support to keep trying.

I just watched your you tube video - that was great. You didn't sing! Looked like you had fun and did a great job! Congrats on your weight loss OMG awesome - where did you go etc...? I am self pay also and will be booking shortly. :smile:

Share this post


Link to post
Share on other sites

I didnt have insurance, so was self pay. I went to Mexico and had it done, no wait, just do it.

I decided my life was worth more than the cost of the surgery. Im going in for my 4th fill next Saturday. The cost is what it is, if you are not covered, then you have to decide if its worth it.

I personally wouldnt choose the type of surgery based on if insurance covered it or not. I wouldnt have a different kind of surgery just because its covered. My body is important to me as is my health. I am a little nervous when folks post they decided the kind of WLS based on insurance coverage and what they perceive as "long term costs".

Share this post


Link to post
Share on other sites

I didnt have insurance, so was self pay. I went to Mexico and had it done, no wait, just do it.

I decided my life was worth more than the cost of the surgery. Im going in for my 4th fill next Saturday. The cost is what it is, if you are not covered, then you have to decide if its worth it.

I personally wouldnt choose the type of surgery based on if insurance covered it or not. I wouldnt have a different kind of surgery just because its covered. My body is important to me as is my health. I am a little nervous when folks post they decided the kind of WLS based on insurance coverage and what they perceive as "long term costs".

That is also my plan - can I ask what you had done and by who? I have a surgeon I want to go to but appreciate feedback on any there. How was you full experience there? Thanks!:)

Share this post


Link to post
Share on other sites

I had the same problems apalmer79. So what I did was went to my HR person and together we put together a letter to give to the committee at work. The letter was about all the facts of the surgery and how I could benefit from having the surgery.

It took about 3 to 4 weeks for them to get back to me but they lifted the exclusion for me. It might be worth your time to try that. The worst they could do is tell you no. Then you could try other way.

I hope only the best for you. Good luck.

If you have any ? just ask.

Kimberly:smile2:

Share this post


Link to post
Share on other sites

I flew into El Paso TX where I was meet by a driver who took me into Juarez. We only went thru the good sections of town, where there was a 6 lane highway and I didnt spend the extra night in the hotel, just was ready to come home and a young guy and his mom were coming home so I called and paid to change my flight to come home the next day.

I paid $6,500, hotel was included. I never felt unsafe. I pay $200 for each fill but Im driving to Tyler TX from Dallas, which is quite a ways, but I get fluro and barium swallow with each fill so get that reassurance that everything is looking good. I had the choice of bands and seem to have chosen a 10 cc Realize band, even though I cant say it was a informed decision, some say you feel less restriction who post here with a Realize band, I dont know as unless you have had them both how could you possibly compare? My fills have been smaller than others here, 1.8 cc, 1.8 cc and .5 cc, so Im betting the one I get next Sat will also be tiny. I dont seem to be able to handle as much as some others here without being too tight. Everyone is very different thats why one size fill doesnt fit everyone. Dont know if age has anything to do with my losing slow either, Im 58 years old, so menopause has slowed down my metabolism. Had my surgery July 9th, last year.

I will add that I lost 9 lbs the couple of weeks pre surgery, so I started at 242 lbs the end of last June.

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

    • LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

  • 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

    ×