Hello all

I am BMI of 37, with AETNA, and without the specified co-morbidities -  I have pre-diabetes and not diabetes, I have high cholesterol which responds to high levels of medication (not refractory as required), I have GERD (not on the list) , and over the past year put on the 15 lbs  that put me over the 35 BMI.   I'm afraid I won't be covered, so I'm saving pennies etc in case I need to cash pay.

My question - if I cash pay, will insurance cover any complications of the surgery?
 

I had to do 6 months of supervised program, but it was NOT required by my insurance company. I have Anthem BCBS of CA.,  but I live in Maryland and surgeons have to follow BCBS requirements for pre-authorization in said state, and Maryland requires 6 months documented diet within the past 2 years (2, consecutive 3 months or 6 consecutive months).  Before finding out about the state requirement, I actually posted about the 6 months requirement when I first started out and one member suggested I could file a grievance, here’s part of the response: Second, if it is your insurance, find out whether your insurance policy is fully funded, and if it was "issued, amended, delivered or renewed" in CA.  If so, your plan should be covered by the DMHC rules.  You can file a grievance with the DMHC and they will order the insurer to waive the requirement.  http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf

See also http://www.asmbs.org/Newsite07/resources/ASMBS%20Position%20 Statement%20on%20Preoperative%20Supervised%20Weight%20Loss%2 0Requirements.pdf

You could call the Human Resource department of your employer and find out if it is covered or not.  I would also call the insurance company and ask for a copy of the bariatric surgery requirements.  for example, I have Aetna.  It is their clinical bulletin 0157.  I printed a copy of that and went through it with a fine tooth comb to make sure I met all the requirements. 

Good Luck to you!