Newbie

[Sarah Vanderburg]

hello,
I am in the beginning stages of my weight loss surgery venture. I am considering the DS with dr Dennis Smith in Florida. My biggest anxiety is insurance, any helpful hints? Open enrollment starts in 3 days and I'm curious as to how I find out whether my current insurance will cover the procedure or whether I should switch during open enrollment. Or if I'm jumping the gun. I have made my appt with my pcp to start a 6 month medically supervised diet since I know most insurances and doctors require that. I haven't even had a consult with the doctor, my anxiety about the insurance is holding me back.

 

[southernlady]

I'm curious as to how I find out whether my current insurance will cover the procedure or whether I should switch during open enrollment.

Best thing to do is ask. They might not know but they CAN find out. Is it employer based?

 

[Sarah Vanderburg]

Yea I will be giving my insurance info to them in the next week (I have to do an online seminar first) but then I can at least know and if my current insurance is a no hopefully they can help me pick from the others to move forward. The insurance is through my husbands work. It's bcbs anthem of Florida.

 

[southernlady]

Yea I will be giving my insurance info to them in the next week (I have to do an online seminar first) but then I can at least know and if my current insurance is a no hopefully they can help me pick from the others to move forward. The insurance is through my husbands work. It's bcbs anthem of Florida.

Then it really depends on his employer. They may chose an option that does not cover any WLS.

 

[Sarah Vanderburg]

Yea I spoke with someone last week from the insurance company who says our employer does offe a plan that covers Bariatric surgeries but our current one does not. I am hoping either a) she was mistaken and our plan does infact cover it or b) I can quickly change to the plan that does cover Bariatric surgery since open enrollment is next month and I'm so early on in my search

 

[Larra]

Welcome!
Get a copy of your EOC (evidence of coverage) and read it for yourself. This is not a short summary of benefits, but a long (like maybe 100 pages) document that will either say you have coverage and for which operations and what their criteria are, or will list bariatric surgery as an exclusion, meaning you have no coverage for it at all regardless of medical necessity. It's good that you called, but low level insurance company and/or HR employees often provide misinformation, esp when you get into the details. The person who cares most about your welfare is you.
You should be able to get the EOC from your husband's HR. If the first person you speak with has no clue (we see this a lot) speak with a supervisor. Go up the food chain until you get someone with a clue, and if you have trouble, document each and every contact you have with name, job title, phone number, date, time, and a brief summary of the conversation.
The folks at Dr. Smith's office may also be helpful. He's a very experienced DS surgeon with an excellent reputation.

 

[galaxygrrl]

And also find out how much they cover. I have Aenta and they would only cover about $8,000 and my surgeon charged $35,000. So, it was a lot out of pocket. I ended up going to Mexico and saved quite a bit even with the insurance payment. (Yes, I know Mexico sounds crazy and I thought so too, but it's not). We have lots of people that went to one specific Dr in Mexico, so he is well vetted.

 

[Munchkin]

About the diet... Don't assume. Yes, it's a common delaying tactic but it is NOT required all the time. Get that EOC and READ it. Don't just talk to them and accept what they say. Sometimes you can fight it or submit alternate information, like proving you were heavy for X time. The ASMBS has said the diet is not necessary. And yes, this is work. The insurance companies want you to give up and go away!

Welcome to the group!

 

[Susan in Tennessee]

yes, get the EOC. Mine was available online to download. Do you have a website you can log in to for your insurance matters? Also the 6 month supervised diet stuff varies greatly. My BCBS I used to have said I needed a 6 month supervised to show that I was UNABLE to lose weight. Others read you do the 6 month to show that you CAN lose weight. It's just crazy! Read carefully. I'm a Mexico self pay DSer too and am extremely happy with my decision and my surgeon and care.

 

[Sarah Vanderburg]

Thank you all for your replying am very very green (started researching last week) so all of your info is extremely helpful

 

[DianaCox]

Many BCBS plans cover bariatric surgery - but many don't. It depends on YOUR specific plan. You have to see the EoCs for the various plans for yourself. And you need to take into account deductibles and other limitations on coverage to understand the ACTUAL cost. AND you need to be sure Smith is in-network with your plan.