Insurance
Hello Everyone!
I am a newbie to this site and forum. I wish I had known about this site years ago!! First off, let me apologize for the long winded summation.
I have been looking into bariatric surgery for about 4 years now. I am 44, single female, 5'11", 400#, live in Illinois. I did a consult with a very good bariatric surgeon in the Chicago NW burbs four years ago, *****commended a RNY. His office said my insurance would not cover the procedure. I believe I looked it up in my plan and confirmed WLS was an exclusion to my policy. I gave up on the thought of WLS as I could not afford to pay out of pocket and even with a medical loan - the monthly rates were just too high for my salary.
In the past three months I started researching the subject again and have looked at the option of having the surgery (gastric sleeve) done in Mexico since the out of pocket costs might be somewhat reachable for me. I called my insurance again today and spoke to a customer rep. who again said bariatric surgery is excluded and that even if my Dr. recommended the surgery, ti still would not be covered. She also said that if I had my surgery (regardless of it being in or out of the country) and developed any complications that these would not be covered by my insurance - I am thinking of leaks, etc.
I don't want to have to wait another 20 years to be covered by Medicare - I will be dead by then due to obesity anyways. Blue Cross/Blue Shield of Illinois has started to covery bariatric surgery without requiring a 6 mos. diet plan program first. Cigna and Aetna cover bariatrics - so alot of huge insurance companies are covering it. I work for Coventry Health Care and my insurance is Coventry Health Care/ Coventry National.
Has anyone had any experience with this insurance company? Any suggestions? If I took out insurance on my own and not from my employer - would they cover it or would they say it is pre-existing and deny? Any thoughts? I have never had to deal with getting insurance approval before outside of a colonoscopy and that was just a simple pre-approval through utilization review so I have no idea how an appeal works or is possible if your policy clearly states bariatric surgery is not covered. Any advice would be helpful. Thank you.
Pamela
I am a newbie to this site and forum. I wish I had known about this site years ago!! First off, let me apologize for the long winded summation.
I have been looking into bariatric surgery for about 4 years now. I am 44, single female, 5'11", 400#, live in Illinois. I did a consult with a very good bariatric surgeon in the Chicago NW burbs four years ago, *****commended a RNY. His office said my insurance would not cover the procedure. I believe I looked it up in my plan and confirmed WLS was an exclusion to my policy. I gave up on the thought of WLS as I could not afford to pay out of pocket and even with a medical loan - the monthly rates were just too high for my salary.
In the past three months I started researching the subject again and have looked at the option of having the surgery (gastric sleeve) done in Mexico since the out of pocket costs might be somewhat reachable for me. I called my insurance again today and spoke to a customer rep. who again said bariatric surgery is excluded and that even if my Dr. recommended the surgery, ti still would not be covered. She also said that if I had my surgery (regardless of it being in or out of the country) and developed any complications that these would not be covered by my insurance - I am thinking of leaks, etc.
I don't want to have to wait another 20 years to be covered by Medicare - I will be dead by then due to obesity anyways. Blue Cross/Blue Shield of Illinois has started to covery bariatric surgery without requiring a 6 mos. diet plan program first. Cigna and Aetna cover bariatrics - so alot of huge insurance companies are covering it. I work for Coventry Health Care and my insurance is Coventry Health Care/ Coventry National.
Has anyone had any experience with this insurance company? Any suggestions? If I took out insurance on my own and not from my employer - would they cover it or would they say it is pre-existing and deny? Any thoughts? I have never had to deal with getting insurance approval before outside of a colonoscopy and that was just a simple pre-approval through utilization review so I have no idea how an appeal works or is possible if your policy clearly states bariatric surgery is not covered. Any advice would be helpful. Thank you.
Pamela
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