Health Ins Question, newbie

Hello.  I've just sted this process, you can look at my profile to see my intro.  I live in Leesburg and just thru Googling I found this Dr at Johns Hopkins who I have a consult with.  I looked into this surgury 5 yrs ago but then never followed thru.  Well here it is 5 yrs later and this time Im gonna get it done one way or another. Is there any insurance in VA that pays for some of this surgury?  I have Anthem Blue Cross Blue Shield and they told me over the phone they don't pay for any of it.  The Dr's office said they would try with the insurance, but I doubt they have any luck.  So I will pay my own way I guess. My Dr at Johns Hopkins says its gonna cost about $18,000.  Who are you using and whats it gonna cost you?

In most if not all cases, whether or not an insurance company covers it depends upon whether or not your employer has chosen to cover the surgery as a benefit. Companies must purchase "riders" for bariatric surgery, and many choose not to purchase the rider in order to save money. You may want to check with your company's HR department (if you are enrolled in your employer's insurance) to determine if they have purchased the rider and if not, why and can they do so. Many folks on OH have successfully petitioned their employers to cover the surgery, or have gotten jobs where the employers have covered the surgery. If you have a personal plan as opposed to a group health plan through an employer, bariatric surgery is typically not a covered benefit under those plans. My husband's employer purchased the rider, so I am on his insurance and had my procedure covered. My employer, however, did not purchase the rider so I did not opt to be enrolled.

I just sent my HR dept the question and we'll see what they say.  I also asking if I could buy the rider at my additional expense. Thanks.

There are a lot of good docs in the No VA Area, Dr Anez, Dr Halimi, a guy in Reston and ofcourse my surgeon... Dr Elariny.  Just to save you some mileage.  I have Aetna for insurance and I think they cover 90 - 100%. So we'll see. Dr E takes Cash patienets and I think he said for his cost its below 10K, but then you have the hospital bill etc etc.

Can you send me your Dr's info where he is and what his numbers are.  Have you had the surgury and would you recomend him to others?

Hiya - I had BCBS Federal and it was covered but I know different Blue Crosses cover different things.   Also even though they say they do not cover it you need to make sure they really don't - it can often depend on what kind of weight loss surgery you plan to have - ie RNY, DS, Lapband.... I had Dr Halmi in Woodbridge who I would recomment 100 times over - also I believe his office offers financing if you have to self pay. His web site is http://www.virginiaweightlosssurgerycenter.com Hope this information helps....... and welcome to the VA Board! Jackie

I have Aetna and they covered all but my $250 Hospital deductible after I was approved.

Welcome to the VA Board!! I have Aetna and they covered all but the deducitble and 10% of my Drs. preferred anetheiologist (sp?) who was "out of network."  I used Dr. Anez out of INOVA Fair Oaks and would recommend him highly. He does the mini-incision RNY. I believe another Dr. in his office does lap RNY, but I'm not 100% sure. His website is: www.obesitysurgerycenter.net He is considered a Center of Excellence as is Fair Oaks Hosptial for bariatric surgery. He has a wonderful Physicians Assistant and Nutritionist that he works with for pre and post op care. The staff is great about the insurance stuff too. Like others said though, it depends on what your company has done with the WLS riders.  Best to you...if you have any other questions feel free to post or PM someone!

My BC/BS pays a max of $7500.  My dr has a package deal (his cost, anesthesiologist and hospital) for $18,200.  I elected to get the package and submit later to ins myself because no one could tell me how much I would pay out of pocket if I went with ins. 

I am really encouraged by all of your posts.  I am hoping I will find out some insurance info this week.  The Dr is going to put my insurance through to see what happens.  I'm talking with my company about a rider and if all esle fails I will take a loan out.  I really feel this is the only way for me to go and need to get this done. Thanks for all the support.