Weight loss surgery?

[Debbie Jean]

It isn't the insurance company that determines this.... mine is Horizon BCBS of NJ. It's the actual plan that you are subscribed to... in my case, the surgery and all related expenses were covered. Doesn't mean that all Horizon BCBS plans cover bariatric related treatments. If you have insurance through work, your company may have elected to exclude it. You need to call your insurer and ask.

 

[dashofsunshine]

It isn't the insurance company that determines this.... mine is Horizon BCBS of NJ. It's the actual plan that you are subscribed to... in my case, the surgery and all related expenses were covered. Doesn't mean that all Horizon BCBS plans cover bariatric related treatments. If you have insurance through work, your company may have elected to exclude it. You need to call your insurer and ask.

I specifically asked BCBS TN if I could pay more for a different plan and have it covered. They said no. They said any plan that I was under, I would have to have been morbidly obese (40+ BMI) for at least 3 years before they would cover it. I've been overweight my entire life (since I was 6 years old) and had been steadily gaining for the past 6 years, but my BMI recorded at the doctors office had only been over 40 for a year. So my choices were...

1) wait 2 more years for insurance to cover surgery - in the meantime, risk my pre-diabetes turning into full diabetes, heart disease, and more weight gain - possibly death
2) pay for the surgery myself.

It made zero sense to me that they would want me to be sicker in order to cover the surgery.

Also, I turned 26 a few weeks before surgery and was dropped from my Dad's government insurance (he works for USPS). The surgery would have been fully covered on his government insurance. Not a penny owed. So if you have a government job, you won't have any problems!

 

[princess barbara]

Good luck to the OP- with whatever you decide. Dashofsunshine- you look fabulous!

 

[njmom47]

Four of my coworkers have had some type of this surgery. One had GB, the others had the sleeve.
The GB girl (prob 5-6 yrs ago) is still obsessed with food and looks ok, but she is slowly gaining back the weight. The 3 sleeve girls (4, 3 and 2 yrs ago) all have lost weight...one has put about 30 lbs back on, another is still slowly losing weight, the third has lost a decent amount but eats poorly (according to what I see, I'm sure all that junk is not the right kind of food). I have also noticed 3 of them have lost major amounts of hair.

 

[RangerPooh]

Did you all find that your insurance companies have become very resistant to coverage?
Both my and DH's plans state no coverage for bariatric surgery

Mine was approved by insurance, however it required my doctors recommendation, a history of attempts with little success for weight loss, meeting with a non-surgical bariatric Doctor to attempt weightloss, and other health issues. Then there was the other physicians to meet with as part of the process. My friend had mandatory Doctor meetings for 6 months leading up to her insurance company approval. As elective surgery most don't cover it.

 

[JaxDad]

Wow @dashofsunshine ! Your story and the commitment behind it is fantastic!

 

[dashofsunshine]

Good luck to the OP- with whatever you decide. Dashofsunshine- you look fabulous!

Wow @dashofsunshine ! Your story and the commitment behind it is fantastic!

Thank you guys so much it has been a tough journey, but I am so thankful for this second chance.

 

[Julylady]

I had sleeve surgery 5 years ago next April. My insurance covered most of the costs but required a 6 month medically supervised weight loss effort prior to approving the surgery. That actually worked out really well since I had to examine my eating habits and change them. I lost 100 pounds in the first 9 months after the surgery. I then gained 30 back over the next two years. For the last 2 years though, my weight has been stable. I am still considered obese on all scales, but believe me....life at 200lbs is much better than life at 270lbs. I am very happy with the sleeve. Here is an example. Last night I met my Mom for dinner. We went to a local steakhouse and shared a 10ounce prime rib dinner which included a potato, cole slaw, and a roll. I was only able to eat 1/2 of my 5 ounce share of the prime rib plus half the cole slaw. I start sneezing when I have had to much to eat and once I sneeze, I know not to eat another bite!

A common saying is that "They operate on your stomach, not your head." Weight loss surgery isn't an instant cure for those who overeat for emotional or other reasons. At best, its a tool in a life long weight management plan. And don't let anyone tell you that surgery is the easy way out. Unless they personally have actually had the surgery, they have no right to offer those comments. And, I have never heard one person who had weight loss surgery say it was easy.

 

[leebee]

If you have any questions, PM dashofsunshine. I reached out to her before this thread was ever started, and she was very open- her story has helped me to choose between bypass and sleeve. She's amazing, and an inspiration! I find the topic of WLS a very sensitive one for many people; 2 of the women at work who have had surgery won't discuss it at all, as it's a very private decision for them. I really appreciate the openness of everyone here who's shared their stories- and to all of you who are working hard to be successful at regaining your health!

My insurance will cover my surgery, after my deductible costs are met (so everyone in my family will take care of health issues this year, as the deductible is $4000). They require you to have a BMI of over 44, or if it's 40-44 you have to have another complicating factor (pre-diabetes, diabetes, high blood pressure, sleep apnea, etc.). I just barely qualified when they measured me at 5'5" instead of 5'6"; I guess I shrank a bit between the doctor's office and the WLS clinic! Anyhow... it kills me that my insurance will cover viagra, gender reassignment surgery, smoking cessation therapies, etc., but it won't cover WLS until you are morbidly obese or reasonably sick. Seems wrong, but shows how much people don't understand the issue of excessive weight. It's so much more than calories in vs. calories burned.