mariamaria1070

Hello, I'm Maria. New to forum.

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I had lap band done back in 7/2012 & did great with it losing almost 70 lbs in 4 months.  But I was in a very controlled environment, new town, didn't know anyone, worked with 4 people 3 12 hr overnight shifts.  None of my favorite restaurants around so it was easy to stay in, not go out to eat and not drink.  But as good as I was looking & feeling, I was majority depressed. I was a very social butterfly and felt caged so I moved back home, to Orlando where my "friends" were & my social life.  I could walk to restaurants but didn't have to because I had all my friends to eat & drink with.  Didn't have insurance for 90 days, only to find out bariatric procedures weren't covered by my new insurance.  To self pay would cost hundreds of dollars to start and each month for a fill.  I gave up, then tried dieting, then gave up then I got sick & found out I have colon cancer.  That was the fight of my life after surgery & 13 rounds of chemo all while working full time.  I'd go to chemo Mon-Wed then work 12 hr shifts an hour drive to & from Thurs-Sat. I was tired after all was said & done and here I am.  I am in remission. I changed jobs to be closer to home but it's very inconsistent work.  I stasrted my new insurance in hopes I'd be able to switch from lap band to sleeve or something else only to find out it's not covered by FL Blue.   I looked into financing and I would never be able to afford the payments if I were approved.  I'm at a loss.  Does anyone know the exact steps you can take to get the insurance to show that this is medically necessary?  I need specifics & help if anyone had any advice or suggestions.  Thanks for listening, sorry for the long Hello! Lol 

Edited by mariamaria1070

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If you have the BMI and co-morbidities, insurance should cover it as a medical necessity. I would speak to your PCP and see what they say. It's covered by most insurance when it is a medical necessity. I had a friend who had it done while she was on Medicaid because she was out of work due to her co-morbidities. What are your current stats?

 

Oh, and welcome to the forum!

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Hi, my AHI is over 50. I do have sleep apnea, with High blood pressure & Diabetes running in my immediate family. If this is what you mean by my current stats.  I just need to know exactly what I need my PCP to do or give me so I can do.  Thanks & thank you! 

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I have BCBS and unfortunately my policy doesn’t cover any type of Bariatric surgery even though I have a higher BMI and do-morbidities. I wonder if there is anything I can do to help get the insurance company to cover my upcoming surgery? I sure would appreciate any input. 

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Welcome to TT! Your best bet is to call your insurance company and find out exactly what they require to cover bariatric surgery. It’s typically a BMI of 40+ (or 35+ if you have co-morbid conditions), 6 months of medically supervised diet, and various medical tests (psychiatric clearance, endoscopy, cardiac clearance, etc). There may be other conditions (mine required the surgery be done in a “center of medical excellence”). Alternately, you could also contact a bariatric surgeon’s office (if you have one in mind), attend an info meeting/schedule a consultation and see if their insurance coordinator can help walk you through your specific insurance’s requirements. 

But, if your insurance doesn’t cover bariatric surgery, I’m not sure there’s anything you can do. It doesn’t really matter if it’s medically necessary. I could be wrong, but if something is specifically excluded from your policy, then insurance isn’t going to cover it. If switching insurance companies/policies isn’t an option, you may want to consider self-pay as an alternative. Maybe check into CareCredit if you don’t have the cash/other ways to finance the expense. A couple of current posters had surgery in Mexico and had good experiences.  Good luck with everything!

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Welcome Maria!

6 hours ago, athenarose said:

Welcome to TT! Your best bet is to call your insurance company and find out exactly what they require to cover bariatric surgery. It’s typically a BMI of 40+ (or 35+ if you have co-morbid conditions), 6 months of medically supervised diet, and various medical tests (psychiatric clearance, endoscopy, cardiac clearance, etc). There may be other conditions (mine required the surgery be done in a “center of medical excellence”). Alternately, you could also contact a bariatric surgeon’s office (if you have one in mind), attend an info meeting/schedule a consultation and see if their insurance coordinator can help walk you through your specific insurance’s requirements. 

But, if your insurance doesn’t cover bariatric surgery, I’m not sure there’s anything you can do. It doesn’t really matter if it’s medically necessary. I could be wrong, but if something is specifically excluded from your policy, then insurance isn’t going to cover it. If switching insurance companies/policies isn’t an option, you may want to consider self-pay as an alternative. Maybe check into CareCredit if you don’t have the cash/other ways to finance the expense. A couple of current posters had surgery in Mexico and had good experiences.  Good luck with everything!

As usual, the advice from @athenarose is totally correct.

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I travelled to Mexico for my surgery and am quite pleased with the medical care I received. I am happy to talk about self pay options in Mexico. I know self pay isn’t for everyone but you may want to consider this option. 

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