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Will Obamacare Affect My Ability to Get Surgery?

Lynda D.
on 9/18/13 2:06 pm

I haven't been here for awhile; I tend to come and go. Depends on how I'm feeling physically. So some here might know this and some may not. For those who don't, my husband was laid off a few months ago, and we no longer have insurance coverage. He's currently working a contract job, but as it's temporary, well, no insurance. And then my health is poor and I haven't been able to work...


I just found out about Obamacare and some of the changes that are due to take place, (I've been living under a rock apparently or I would have known about this sooner.), and I'm wondering if these new changes will help me to get coverage for the surgery I want/need. Anyone know anything about this? I haven't been able to learn a whole lot other than the fact that more info will be made available on October 1st. 

I could sure use some input. 

Thanks in advance!

First Surgery Date: November 5, 2005
Surgery Type: RNY--Proximal
Height: 5' 3"
Beginning Weight: 250 lbs.
Lowest Weight: 125 lbs.
Current Weight: 230 lbs. Seeking Revision to DS

on 9/18/13 4:45 pm

After reading quite a bit of it, it's my opinion that very few people know what's going on.  I think it will take some time to learn the plusses and minuses.  And of course, it could always change too...

on 9/18/13 10:53 pm - Nashville, TN
Revision on 03/18/15
The affordable care act should certainly help you and your husband to buy insurance from one of the exchanges. They are not allowed to not cover pre existing conditions like insurance companies can now.

Apparently anything that is deemed medically necessary should be covered. I would think medically necessary Wls would fall under that, but of course I don't know for sure.





on 9/18/13 11:29 pm

Some STATES are denying WLS coverage AT all. besity

What the ACA did was mandate a MINIMUM of services that has to be offered and while obesity TREATMENT is mandated, WLS is NOT mandated.


Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135


on 9/19/13 1:08 am - Nashville, TN
Revision on 03/18/15
Thanks for the clarification. I believe Tennessee has opted out ,is that correct?




Tracy D.
on 9/19/13 2:07 am - Papillion, NE
VSG on 05/24/13

Lynda - if you are income eligible, you will be able to go into the "marketplace" or "exchange" and choose from a variety of plans that are offered.   I don't know if your state is doing it's own exchange or will use the federal one, but either way, you will be able to see what the options are for coverage and choose a plan that you can afford and gives you the most bang-for-your buck. 

You'll have to take a wait-and-see approach to what options are offered to you and what they cover.  Each state should have some "navigator" agencies or certified application specialists set up to help guide people like you through the process.  They can't advise you on what plans to pick; you'll have to do your homework on those. 

Enrollment for this starts on Oct. 1st and goes through March 31st.  You can also go to this website to get more information:   I hope this is helpful to you!


 Tracy  5'3"     HW: 235  SW: 218  CW: 132    M1: -22  M2: -13  M3: -12  M4: -9  M5: -8   M6: -10   M7: -4

 Goal reached in 7 months and 1 week

 Lower Body Lift w/Dr. Barnthouse 7-8-15



















































on 9/19/13 2:17 am
DS on 12/19/12 with

Please check with your state first.  If your state uses the government exchanges, then it will direct you to those web sites for more info.  If your state is setting up it's own exchange, then it will have web sites to answer your questions.  The two can be very different in how things are handled.

My state will use it's own exchange, so I got my answers from the CA state exchange web site. 


on 9/19/13 2:12 am
DS on 12/19/12 with

Because insurance companies can't weed people out through their usual tricks (pre-existing conditions, denying coverage to any woman on personal policies, age discrimination, etc), they are going to be much stricter in what they will cover after 2014. 

And no one really knows how it will shake out at this point.  October is the first of the open enrollment for 2014.  You can start shopping plans then, and calling companies to ask this question specifically.  It's really a case by case issue at that point.  Some will cover it, some won't. 

And those companies that do cover it, they will be hiding the fact that they do cover it.  I found out my insurance company covered it, but didn't put that in print.  I called and asked a bunch of questions and then was told (begrudgingly) that the company covered WLS and what the guidelines were for it.  I had to ask that they send me this coverage info in writing – and waited a month for them to mail it!  So you will have to dig and call to find a company that will cover it.

And while you are dealing with all that, because you need to pick a plan by March of 2014 or you will be fined by the government, you should start checking on foreign surgeons.  I had Mexico all sourced out.  There are 2 wonderful surgeons there who have done tons of WLS with great results.  And when I checked on this, the most expensive was around US$16,000.   

I was seriously thinking about financing half of it on my credit cards, and then play the credit card game of rotating the balance around for cheap interest.


Valerie G.
on 9/19/13 11:26 pm - Northwest Mountains, GA

I wouldn't be holding my breath.  I looked at the prices for the basic (cheapest) coverage with a $12000 deductible, and it wasn't any cheaper than I can get today privately - even more expensive, and for just a little more than that deductible you can pay cash at for a world-renowned surgeon in Mexico, spain or Brazil.

 9 years post op DS 
There is room on this earth for all of God's to the mashed potatoes

Lynda D.
on 9/21/13 2:55 am, edited 9/21/13 2:56 am

Thanks for all the input! I'm in Utah, and so far the only information I could find was on Medicaid, Medicare, and CHIP. And the info is sketchy. It just seems like I'm going to have to wait till October 1st to get any real answers, and even then I'm sure there will still be lots of unknowns. The government is frustrating with all their rules and whatnot. 


Really, I'm praying that my husband can get a permanent job with decent insurance. I want, no need, to be able to work and help my family, and I need my health to improve to do so. I already have fatty liver disease because of my weight, which will eventually kill me according to my doctor. And I'm probably not too far away from diabetes as well. And then there is the heart disease that runs so strongly in my family. I have to get this weight off. Period. It's not a vanity thing anymore like it was when I was younger. 


I'll keep searching and asking questions and praying. And if there is a way to get this surgery, I will find it. If I don't find a way, it's because there is no way. 


Thanks for all your help and advice!

First Surgery Date: November 5, 2005
Surgery Type: RNY--Proximal
Height: 5' 3"
Beginning Weight: 250 lbs.
Lowest Weight: 125 lbs.
Current Weight: 230 lbs. Seeking Revision to DS