Hi!

[Brooke]

Good morning! I am 48, 5' 1" and am expecting/hoping to have the DS however, insurance has been an issue. My surgeon thinks the DS will work best because I have a loss of mobility and I will benefit more from the malabsorption aspect of the DS.

I have a BMI of 53 and have degenerative disc disease in my spine and severe Osteoarthritis in my hip which has led to a loss of range of motion and mobility and has left me relying on a walker. I have always struggled with my weight but the last three years that I have dealt with the rapid onset of the arthritis and loss of mobility I have gained over 50 lbs. I need a hip replacement if I ever want a semblance of normal mobility back but my orthopedic surgeon wants me to have bariatric surgery and lose some weight first as the possibility of infection and complications are significantly greater the higher the BMI. I also have sleep apnea, non-alcoholic fatty liver disease, and gastroparesis, all of which could be helped by bariatric surgery. Unfortunately, I am finding that insurance will not cover the procedure.

I feel like I am missing out on so much of mine and my family's life and am just at a loss as to how to find meaning anymore.

 

[southernlady]

Welcome @Brooke
To fight insurance, you need a copy of your EOB, it’s a fairly good size document. Your employer has it, so contact HR, and by good size, likely well over 100 pages detailing everything you get with your health plan.

Has your bariatric surgeon submitted for the traditional DS yet? If not, you need him to do so you have the denial on record. If so, you need a copy of that denial.

 

[Brooke]

Welcome @Brooke
To fight insurance, you need a copy of your EOB, it’s a fairly good size document. Your employer has it, so contact HR, and by good size, likely well over 100 pages detailing everything you get with your health plan.

Has your bariatric surgeon submitted for the traditional DS yet? If not, you need him to do so you have the denial on record. If so, you need a copy of that denial.

I have the EoC and it does state that they will cover the employee(husband), but not the dependant(me). Because of this my surgeons office, who I've seen a couple years ago when I first tried to start the process, won't even schedule me for an appointment. The woman I talked to in the financial office said, "it would just be a waste of time". So I don't have a denial from the insurance themselves. And Medicare says that they will not cover the procedure as a secondary insurer if my primary denies it. You mentioned switching to an advantage plan, but you have to have both part A&B to do that. Since we have insurance through my husband's employer, I dropped Part B trying to save money and cannot sign back up for it until next year. This has just been one headache after another!

 

[JackieOnLine]

Hi, Brooke!

 

[Brooke]

Hi, Brooke!

Hi Jackie, and thank you for the welcome!!

 

[southernlady]

@Brooke
Post a new thread here: https://bariatricfacts.org/forums/general-medical-topics-insurance.46/
Then I will tag our two resident insurance specialists to see if they can help.

 

[Brooke]

@Brooke
Post a new thread here: https://bariatricfacts.org/forums/general-medical-topics-insurance.46/
Then I will tag our two resident insurance specialists to see if they can help.Ijust posted!