Question:
Does anyone else fear that insurances will stop covering the surgery?
I am a little over a year post op and was covered with no problems whatsoever. BCBS of Alabama is very good about covering this if you meet the requirements, but I am afraid that they will stop because of so many people qualifying. I work in a Dermatology Clinic, we found that for many people that chemical peels cleared acne completely. Many insurances began to cover those who qualified, this went on for a couple of years, and more and more people qualified, I was doing 20 to 30 a day sometimes. Then insurances started cutting it off, stating that it was cosmetic, but all other acne treatments that weren't as effective were still covered. Now there are no insurance programs that cover it at all in this state. I know that if you total the money for healthcare overall, it costs more for most to stay obese. This is a very expensive surgery, and I am not sure that they were aware that it was going to be "medically necessary" for so many. I have dealt with insurance companies for a long time, and I know that they are out to make money just like any other business. They may not stop coverage, but I believe they may bump the criteria up to qualify. I am curious about everyone's opinions on this. I love this site and the feedback you get here is priceless. — Karen E. (posted on February 1, 2003)
February 1, 2003
What a great question! I have been thinking about this alot lately, as
well. I am 8 months post-op and down 100lbs (from weighing 250) and am
very happy with my surgery, despite a complication. But i fear that
insurances will stop covering it as leniently as they have b/c so many more
people are getting the surgery. And especially with all the coverage on
media shows and in the news, WLS seems to be all the rage. I hope it stays
where it is, though, this surgery is needed for most people who are obese.
I highly doubt there are any people who are overweight and haven't dieted.
We all have, but diets simply don't work alone. I know in my case, yes I am
only 23 and dieted since I was 16, but I steadily gained atleast 20lbs.
every year. My parents are overweight, my grandparents, now my brother,
it's kind of hereditary. I think by the time I was 30 I would be 300+ and
would continue to gain weight, as well as other health problems! This isn't
cosmetic surgery despite what some people may think (who are usually
naturally thin and don't know anything about the problems of being obese),
it's risky, but it is here to put back years on our lives, not just to look
good. I mean honestly, how many obese old people do you see these days?
— Lezlie Y.
February 1, 2003
OMG---This is exactly the reason I did not wait until this summer to
schedule my surgery. I finally got my nerve up to realize that I needed to
have the surgery, and then I got really nervous that the insurance
companies would stop covering it or make the necessary requirements harder
to meet. This really started bugging me especially after the Al Roker
thing went public. Luckily I made my appointment before this (I'm using
his doctors by coincidence). Anyway, it's costing me a little bit since I
don't have enough time to take off from work, so I'll have to go on
disability for a week or two. I felt it was worth doing this, rather than
risking having to be a self pay later on if I waited and the insurance co.
policies began to change.
— Fixnmyself
February 1, 2003
My insurance company used to pay for this surgery for their employees, they
have since excluded it (about 2 yrs. ago.) Claim it did not work....I
believe it's because so many utilized this benefit. I am going as self pay
now because I really love my job.
— Meg L.
February 1, 2003
I am 3.5 months post op and my insurance paid so I don't have to worry
about it anymore, but my opinion is as long as they will pay to treat
anorexia they can pay to treat obesity. If not it is descrimination!!
— Angie L.
February 1, 2003
Actually this is my worst fear right now. I have struggled for the past
year, trying more diets, in an attempt to decide whether this surgery is
for me or not, and I have decided that yes it is. Recently there has been
so much media coverage on the subject, that I first thought GREAT! I hope
people really listen to what is going on and understand the amazing health
benefits and in some cases life-saving benefits of this surgery. However, I
began to think that now more people will apply, who are maybe not right for
this surgery and the insurance companies will want to weed them out by
making it even more difficult for people who are right for this surgery. Of
course insurance companies are in it to make money, everyone is! I often
think of insurance companies as having the same place in our society as the
IRS. Basically, even though there are state insurance commissions, they
will do what every they want, cover whatever they want and pay for whatever
they want. My insurance co. BCBS has been great so far, but what happens
when I ask them for this surgery? I worried about the passing of the New
Year, because this is the time that insurance companies revise their
existig policies, and honestly I don't think there is anything out there
that could prevent them from just stating "NO", Gastric Bypass
will not be covered anymore. So, to answer the original question, YES, I do
fear insurance companies will no longer cover bariatric surgery of any
kind!!
— Tara J.
February 1, 2003
In addition to what others have responded, I think frivelous lawsuits play
a part in whether surgery is covered or surgeons perform the surgery.
— faybay
February 1, 2003
This is the reason I went ahead and had surgery last year instead of
waiting until this year. . .my employer (150 employees) had already covered
2 RNYs last summer and I was afraid they would change coverage and not
permit them any more, to save money. I don't know about your employers,
but every December they meet with us to tell us how much more our insurance
is going to cost us, and what benefit is being cut! Higher deductibles,
etc.! I thought gastric bypass might be on the line so I went ahead and
had surgery 10/30/02, instead of waiting till this spring. I am glad I
went ahead and had it done instead of trying conventional weight loss just
one more time. Good question.
— Sarah S.
February 1, 2003
Maybe I live my life too optimistically, but I don't worry about this at
all....indeed, I believe it is going to become much easier to get WLS.
The only reason that insurance companies pay for WLS is because in the long
run, it saves them money. Our cholesterol goes down, our risk of heart
disease, joint trouble, apnea, etc., etc., etc. Smart insurance companies
have realized that what costs them 25 grand now will save them hundreds of
thousands of dollars in the long term. The more people that have it, the
more money they're saving. So, again, maybe I'm just way too optimistic,
but this doesn't worry me at all.
— Tamara K.
February 1, 2003
Karen--I also have thought that insurance companys may either completely
stop covering this surgery or make the criteria more difficult to get
approved--but I think they will grandfather care for patients who have
already had the surgery--I would think they would have to--my question is
what happens if you have to change insurance companys?
— Marie R.
February 1, 2003
We've had the same insurance through our employers for years-each year they
whine and moan about rising costs of health care, raise our deductibles,
cut benefits, and raise our premiums. Insurance companies are there to make
money. Many insurance companies do not cover smoking cessation
programs/medications, how many health issues coud be avoided and money
saved for the insurance companies if they did? Yes, I am afraid that with
the ever growing number of people wanting WLS that it will become big
business and at the least the insurance companies will create even more
hoops to jump with their approval criteria making it more difficult for
people who need these procedures to get them.
— Angela S.
February 1, 2003
I am not worried that the surgery won't be covered. I am very proud to say
that my husband was denied because his BMI was less than 40, BUT we
appealed and the denial was reversed, AND the insurance company changed the
criteria to INCLUDE people with a BMI 35-40 with co-morbids! I know we
opened the door for more people to qualify for WLS. Yes, insurance
companies are in business to make money. In his appeal letter, we talked
about the fact that it would be overall much cheaper to cover the surgery
than to pay for obesity related diseases down the road (particularly heart
disease and diabetes). WLS has a low morbidity rate and good outcomes. A
strong argument can be made that it is not cosmetic, because it the surgery
has positive effects on every system on the body - not just appearance.
(Now in the case of the acne treatment, that does seem to be purely
cosmetic, and I can undestand why they stopped covering that.) On another
note, my insurance company wrote in an exclusion for covering pannectomies
or any other plastic surgery related to weight loss, this year. So many
people have had WLS over the past couple of years, that now they need
pannectomies and abdominoplasties! I do understand that this is cosmetic,
and I don't like it, but I understand why they did it. (It may not be
attractive, but one can live with it.) With obesity an epidemic, I think
more employers and insurance companies may start looking at this more
closely. Like I said, WLS is expensive, but much cheaper than open heart
surgery or treating any complication of diabetes, like dialysis for kidney
failure or amputations!
— koogy
February 1, 2003
Yes, you are right..alot of insurance companies don't pay for the surgery
now and more and more are and will stop covering the surgery in the future.
Blue Cross and Blue Shield of Florida is one. They have covered the
surgery as long as it was medically necessary....however, starting 04/01/03
they will no longer cover the surgery PERIOD!! I think it is very sad that
so many people could benefit from the surgery will now not get the chance.
I wish they would look it as a cost savings...because as time goes on the
patient get much healthier and the amount of medication is reduced. More
and more American are overweight (60% of Americans) more have high blood
pressure and are diabetic...are they going to stop covering those
medications because more people are having to take them? I DON'T THINK
SO.
— Sharon H.
February 2, 2003
I go for my consult in 17 days. I am fearful that the surgeon won't
operate on me or my insurance will not cover it. I have called my
insurance company numerous times and they have told me that they will cover
it as long as it is medically necessary. I wish that I could have the
surgery now instead of waiting for July, but I am a teacher and I do not
want to leave my students with a sub for couple of weeks. Its not like I
can tell my Principal that I am taking 6 weeks off to recover. If I have
it in the summer, I know that I don't have to tell anyone what I am doing
or have to ask for the time of. I get 8 weeks off and I get paid while I
am on vacation . I am happy that Al Roker was so successful, but with him
telling everyone that he had this, it gets me scared with the insurance
companies.
— Lisa N.
February 2, 2003
So far, I have not been able to get coverage for surgery based on an
exclusion in my policy. When I asked my surgeon how insurance companies
could continue to deny something that is obviously medically necessary and
more cost-effective over time than treating the comorbidities, his response
was that insurance companies deal with statistics. In their view,
statistically adults change jobs an average of once every 5 years and the
insurance company is gambling on the fact that they will not be covering
you for a period long enough to make the cost of treating the comorbidities
greater than the cost of the weight loss surgery. I do believe that all of
the media attention given to wls has resulted in many more surgeries being
performed. At some point it will become too costly for the insurance
companies that now cover wls to continue. I also believe that there will be
more surgeons who will accept only self-pay patients in the future. Self
pay patients are pure profit without the hassles and reduced physician
reimbursements due to managed care contracts.
— gvlgal
February 2, 2003
So far, I have not been able to get coverage for surgery based on an
exclusion in my policy. When I asked my surgeon how insurance companies
could continue to deny something that is obviously medically necessary and
more cost-effective over time than treating the comorbidities, his response
was that insurance companies deal with statistics. In their view,
statistically adults change jobs an average of once every 5 years and the
insurance company is gambling on the fact that they will not be covering
you for a period long enough to make the cost of treating the comorbidities
greater than the cost of the weight loss surgery. I do believe that all of
the media attention given to wls has resulted in many more surgeries being
performed. At some point it will become too costly for the insurance
companies that now cover wls to continue. I also believe that there will be
more surgeons who will accept only self-pay patients in the future. Self
pay patients are pure profit without the hassles and reduced physician
reimbursements due to managed care contracts.
— gvlgal
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