Insurance question.

I have medical and they covered everything. My aunt has no insurance and cannot get medical. She does work and is looking to get the gastric bypass as well. Now I've heard of people getting insurance but the insurance not covering it because it was an existing problem before they signed up. So my question is, what insurance will cover it even thoe you were obese when you signed up for it, if any. And about how much does it cost?

This is kind of an ambiguous question because we don't have all the facts.  Is your aunt able to get medical insurance through her work?  If no, is she looking at an individual policy?  Individual policies are notorious for excluding WLS no matter what the reason.  Some group plans (through work, usually) also exclude WLS.  I have never heard of one that uses obesity as a pre-existing condition for excluding the surgery, but I'm sure it is possible.  There is always the option of going to Mexico as a self-pay patient, where the surgery can cost anywhere from $5,500 to $12,000.  My insurance company was billed over $66,000 for my surgery (4-day stay in hospital), but only paid about $30,000 for it (negotiated rate).

Most independent insurance policies (rather than group policies offered by employers) simply don't cover  WLS at all and it has nothing to do with a pre existing condition (obesity).  No one can tell you which insurance will cover it because there is a variation even within plans since many employers dictate what things they want covered and what things they want excluded.  For instance, someone with Aetna medical insurance may be able to have a RNY (that is who covered mine) but some Aetna plans exclude it completely because the employer specified it as an exclusion because of the cost of the surgery itself AND the cost of follow-up care.  So you really have to know what a specific employer's plan covers (and you don't know that until after you get the job).

The bill for my surgery 6 years ago was over $50,000 but many people who are paying cash get a much lower price.  Many people go to Mexico because it is MUCH cheaper there.  You have to have a physician here, though, who is willing to monitor your blood work and do follow-up care if you have complications (which may be simple, such as severe nausea when eating, but still require a visit to the doctor and probably medication, or serious such as a stricture which requires a procedure to go in and stretch the stoma and will be expensive).  Normally people get a full set of blood work at eat twice during the first year. So for someone with NO insurance at all, paying for not only the surgery, but the routine blood work and follow-up visits is going to get expensive very quickly.  

Lora

I work at a Bariatric Center and do the insurance prior authorizations for patients, this is not true, obesity is not a pre-exisiting condition, I think most insurances with cover her surgery if she has a BMI over 40 or 2 co-morbidities if under 40, she should check into Medical Assistance through the county, they cover it.  Good luck!!

Seeing as you work at a bariatric center...Im sure MOST of the insurances YOU deal with cover the surgery or those patients would NOT be there unless they are self pay (in which you wouldn't deal with them anyhow).

The truth is that Most insurances DO NOT COVER bariatric surgery. I don't know of an individual plan out there that does cover it. (although that doesn't mean they don't exist).... In fact it is quite the opposite. If you have a BMI that would normally qualify you for bariatric surgery the individual plans consider you a high risk and they jack your rate sky high or flat out refuse to insure you at all. PERIOD.  IF they agree to cover you at an astronomical amount there will most likely be a rider that specifically cites bariatric surgery or any kind of weight loss therapy WILL NOT BE COVERED and if you develop any kind of chronic illness within the pre existing waiting period, they WILL try to say that it is prexisting and you WILL have to fight with them to PROVE that it was NOT a pre existing condition.

The ONLY ones I have ever heard of covering it are GROUP plans either through EMPLOYER or through STATE or FEDERAL high risk insurance pools. Also MEDICAID or MEDICARE covers it. ALL insurances that do cover it have requirements that you must meet in order to be approved.  You have to be careful with employer sponsored group plans because some employers will specifically NOT cover WLS in order to keep the premiums down.  

As for Medical assistance through the county....you would have to financially qualify for that (basically be around poverty level income) and NOT everywhere has that type of help available. Not all states are like the state of Minnesota (which has one of the highest income taxes in the nation)

 

 

Here is an info link on insurance coverage and the affordable health care act. http://www.healthcare.gov/ From what I understand (and I could be wrong)  Enrollment begins Oct. 1st 2013 for the 2014 calendar year.