What insurance do I get? I am about to buy insurance and need WLS

FatManTX832
on 8/15/18 10:41 am

I would appreciate any help I can get. I used to think Blue Cross was the absolute best insurance, but from doing some searching I see they give a very hard time with covering weight loss surgery.

Can anybody point me in the right direction? What insurance works best with WLS (and HMO/PPO) I am totally uneducated in what these mean.

I am 50 and have a BMI of 56 so I don't think they'd give me a hard time. Also I really don't want to wait 6 to 9 months to get approved. With a BMI so high and other medical problems is there a way to speed it up?

Also, when it comes to "out of pocket expense max" does that mean I have to pay the $2500 first, then the insurance kicks in or do I get billed by the hospital?

All help is appreciated.

hollykim
on 8/15/18 1:11 pm - Nashville, TN
Revision on 03/18/15
On August 15, 2018 at 5:41 PM Pacific Time, FatManTX832 wrote:

I would appreciate any help I can get. I used to think Blue Cross was the absolute best insurance, but from doing some searching I see they give a very hard time with covering weight loss surgery.

Can anybody point me in the right direction? What insurance works best with WLS (and HMO/PPO) I am totally uneducated in what these mean.

I am 50 and have a BMI of 56 so I don't think they'd give me a hard time. Also I really don't want to wait 6 to 9 months to get approved. With a BMI so high and other medical problems is there a way to speed it up?

Also, when it comes to "out of pocket expense max" does that mean I have to pay the $2500 first, then the insurance kicks in or do I get billed by the hospital?

All help is appreciated.

every insurance company covers weight loss surgery.

The real question is did your employer buy the rider from the company that pays for WLS?

If your employer doesn't but the rider, no insurance company is going to cover it.

Mad to out of pocket max, yes you have to pay the deductible before insurance picks up. Some hospitals want payment up front, som will do a payment plan.

 


          

 

Teresa G.
on 8/15/18 1:13 pm
VSG on 06/07/18 with

Many if not most insurance companies will require a 6-month pre-surgical program that includes 6 consecutive meetings with a bariatric dietitian, along with a psych-eval, and various other medical tests. They also require a BMI of over 40, or over 35 with co-morbid conditions (high bp, diabetes, sleep apnea, etc) I believe that Medicare isn't quite as stringent as most private insurance companies.

I think the best option for you would be to contact each insurance company that you're considering and asking them what their coverage and requirements are. Either that, or check out self-pay. There's a Mexico surgery board here at OH where you can find out a lot about the various centers down there, and the experiences of others.

Good luck! I know how hard that 6 months leading up to surgery is, but once I started it, it really seemed to fly by and it gave me a good start on working on my mental and emotional issues that directly led me to morbid obesity.

Teresa (WA State)

VSG on June 7, 2018 (At age 59)
Start of Program (1-1-18): 303 n Surgery Weight: 260 n CW (10-16-18): 203.4 n GW: 175 (first goal)






Grim_Traveller
on 8/15/18 2:15 pm
RNY on 08/21/12

What hollykim said.

It's like car insurance. Every single car insurance company has coverage available for collision, theft, glass, rental car, etc. But not every POLICY they sell includes all of those things. You can buy the cheapest policy they sell, but it won't cover theft, or a rental car, etc. If you want each of those "extras," you have to pay extra.

Health insurance is just like that. Some Blue Cross policies include weight loss surgery, and they can be great to work with. But it costs extra. Same for every other company.

The law mandates that every insurance plan cover something like dialysis. But there is no mandate for WLS. It is a very expensive extra.

It will take a lot of research on your part to figure this out, if you are buying your own plan. If you will be covered by an employer, they may only have one or two options, and none of them may include WLS.

I'm sorry there is no easy answer.

6'3" tall, male. Maintaining a loss of 280 pounds.

Highest weight was 475. Consult weight 04/12 was 411. RNY on 08/21/12 at 359 lbs. Current weight 195.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

FatManTX832
on 8/15/18 6:13 pm

So basically make 100% sure that the insurance I buy COVERS WLS and does not exclude it?

Is Blue Cross better than Aetna or any specific name to go with or stay away from?

I'd love to do a self pay, but it's impossible. Credit is in the toilet (400ish) and don't have enough to pay for it out of pocket. Can't travel to Mexico, on Federal Probation for 4 years, seized my passport. White collar stuff, generally a good guy but can't be trusted with large amounts of money.

Crappy thing is, a major oil driller here in Texas has offered me an amazing job once I get healthy. Machinery Maintenance Supervisor at 250K per year. Got a really nice physical I have to pass. Lots of stair climbing with back pack, long walks in mud, serious car/plane travel to off shore rigs, checking equipment, etc. Something I did for 25 years, but started my own company and got really REALLY out of shape in 10 years. I really want this job, 5K a week really tickles my pickle. Offer is good for one year (I can extend it if need be) and I get three attempts for the physical. No weight restrictions, just me going through the motions and checking me throughout the process. No way I can do it now, physically impossible.

Mary Gee
on 8/15/18 5:07 pm - AZ
VSG on 05/14/14

It appears you are purchasing an individual plan, so you can go thru an insurance broker and tell them what you need. It will be super expensive.

If you have insurance thru your employer, be very careful. I thought all policies written by Harvard Health care and included WLS. It wasn't until someone here told me about employers excluding that coverage to save money. Also, be careful about timing. The process thru your surgeon and insurance company generally takes about six months. If your employer has WLS now, they may drop it at the end of the year. That's what happened to me. So many employees were getting WLS the premium increased so they excluded that coverage.

It took me two years to get the coverage thru Medicare.... and everything was smoother sailing after that.

       

 HW: 380 SW: 324 GW: 175  

 

 

 

 

 

 

 

FatManTX832
on 8/15/18 6:02 pm

I am purchasing an insurance policy myself, I am currently unemployed/disabled yet don't qualify for medicare or disability (fighting for it tho).

Because of the low income insurance shouldn't be that high. I did own my own company, but because of legal problems I sold my company to my son and put him in charge. Technically I still run the show but don't receive a paycheck. Complicated but it all works out.

One insurance broker told me that if I make under 10K a year, I can get good insurance for like $110 a month. So for the past few months my son is putting me on payroll for $200 a week.

I don't want to get into a policy then have 50 hurdles to jump through. But the more I read, it's something I have to do.

With a BMI of 56 with some other complications, is there a way to speed it up?

Why the hurry? Something about turning 50 made me realize ..."Oh **** I'm 50 and 400+ pounds." For a guy my size, I am still somewhat healthy. For now.

Janet P.
on 8/17/18 5:51 am

Grim made an excellent suggestion. Do you have a primary doctor? Have to talked to a WLS surgeon? Start having your weight loss efforts documented. Make sure you identify (document) any co-morbidities. Anything you do now will help the process once you get insurance.

I think this has to happen through a doctor (sorry I didn't have these requirements when I had my surgery). Not sure if something like Weigh****chers or Jenny Craig or something like that also counts toward the 6-month supervised weight loss program.

Another thought might be to find a weight loss surgeon and talk to them about insurance (honesty don't know if this is possible - anybody??). They will have someone who specializes in dealing with insurance and may have suggestions. However (big however), most weight loss surgeons charge a program fee (that is not covered by insurance and you would be 100% responsible for paying). I've heard this amount can be in the thousands so that's something else to consider.

There are definitely things you can do while you're shopping for insurance.

Good luck.

Janet in Leesburg
DS 2/25/03
Hazem Elariny
-175

NHPOD9
on 8/16/18 4:46 am

While you figure out the insurance, I'd contact your PCP and start a medically supervised diet. That way you may not have to wait an additional six months after you obtain insurance. Plus, you'll be on your way to earning the job you want.

~Jen
RNY, 8/1/2011
HW: 348          SW: 306          CW:-fighting regain
    GW: 140


He who endures, conquers. ~Persius

Grim_Traveller
on 8/16/18 5:43 am
RNY on 08/21/12

You're just going to have to check policies, and see if any offer WLS. I'm willing to bet the premiums will be sky high, and there may be very high deductibles and copays as well. For the insurance, deductible and cop at costs, you could probably have paid cash in Mexico and saved money, though I know that isn't an option for you right now.

I wouldn't worry about how many hoops you have to jump through. You might not even find a policy that covers it, hoops or not.

Good luck, and let us know how it goes.

6'3" tall, male. Maintaining a loss of 280 pounds.

Highest weight was 475. Consult weight 04/12 was 411. RNY on 08/21/12 at 359 lbs. Current weight 195.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

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