Paying out of pocket?

 After deciding on surgery (which is a big deal) I was prepared to document and go to battle with my insurance company but found out that surgery is not covered. Are there others out there that paid out of pocket?

I'm sorry. It's awful when you have decided to make a healthy change and there are roadblocks. A few thoughts...

* Is the exclusion (under no cir****tances or only "if deemed medically necessary") review your policy and look for loop holes like that. If it is only "if deemed medically necessary" that usually only requires a Dr saying it is. Usually with a 35 BMI (with comorbidities like diabetes, GERD, sleep apnea, high blood pressure, etc.) or 40 without you shouldn't have an issue getting a primary care Dr to do that.

* Can you ask your HR department if an additional rider to cover the surgery can be purchased.

* Can you get on a spouses or family member's policy?

* Contact someone like Lindstrom Obesity Advocacy ----> there's an add usually on the right side of this page to discuss your options.

I had some insurance issues too (I had RNY Gastric Bypass in 2006) and self paid (in Mexico) but I'm sure some US self payers will give you the 411 on self paying in the states.

Best wishes in your research. I hope you are able to get it covered.

~Michelle "Shelly"

I don't know where my actual policy is, but I requested to have a replacement sent the day I was told it was an exlusion. My BMI is high enough, I shouldn't need comorbidities. Never thought that would be a good thing to have a very high BMI.

I am on my husbands blue cross. I work part time and am considering looking into the possibilty of switching to my work plan, of course I never paid much attention to open enrollment as I have always just stayed on my husbands "good insurance", blue cross ppo.

I very much appreciate all of your comments and recomendations.

Going to Mexico, never crossed my mind, but maybe it should.......

Yes, I paid out of pocket because I had lost weight and the insurance company refused to cover me. I had health issues but my insurance company did not consider them co-morbid factors. I have a back problem and PCOS, united health did not cover it. They did cover blood work and my x-ray before surgery.

I was  in a fortunate position to be able to pay, it was the best gift I ever bought myself. It came to about 30,000 as I stayed in hospital a second night. 

I kinda-sorta did. My insurance would cover, but the surgeon I wanted didn't accept my insurance, so---I paid the surgeon's fee out of pocket and my insurance covered the hospital, anesthesiologist, etc. (This was 9+ years ago.)

I knew the DS was the best surgery for me, and in order to get a DS surgeon who would take my insurance (Medicare), I'd have had to travel almost 2000 miles, stay in a hotel, etc., which would probably have wound up costing me as much as my (reasonably local) surgeon's fees. I chose to pay the surgeon and only travel 2.5 hours from home, where I also had relatives.

I could have had an RNY at almost no out-of-pocket costs, but I didn't WANT one.

If you're paying OOP, have you considered Mexico? Dr. Ungson is a world-class surgeon, and last I heard he did a DS for around 16K. This includes a two-week stay in his hospice, too.

Thanks, Ms Batt,  Actually I didn't consider going to Mexico. Thanks for the input. I appreciate it.

Our insurance would not pay and my husband and I decided to self-pay - figured it would pay off in the long run with our different health problems:  me - heart disease and high blood pressure & my husband - Type II diabetic, high blood pressure and other problems associated with diabetes.

It was a hard decision to make but we decided we were worth it!  We are just beginning our journey - I'm 4 weeks post-op and my husband is one week out.  We are both already off of half of our medicines!

Good luck on your journey!

Keep up the good work, congrats for taking care of yourselves, great gift to yourself and each other.