Insurance?

**pattie_jo** · 02-06-2016 03:26 AM

Are insurances MORE likely or LESS likely to pay for the sleeve surgery?
If not, for those who were self-pay, how much (ball park) was it.
I know I will be so disappointed and depressed if I find out my insurance won't cover this.
Feeling so anxious about it.
Thanks everyone.

**Canuimagine** · 02-06-2016 06:55 AM

From my experience, it just depends on the policy. For example, mine covers the sleeve and lists every criteria for having it. However, I STILL was a wreck for the two plus weeks it took them to actually approve it.

**Teriona** · 02-06-2016 08:52 AM

Mine was approved but my employer plan only covers for 50% and I still would have to meet my deductible. My out of pocket cost was 11 thousand all together. I am doing self pay in Mexico with Dr. Almanza. $4200 if you bring cash. Starting a few weeks ago, they are running a special for a thousand less.

**Aydensmomma** · 02-06-2016 09:47 AM

I was covered....you would think more insurances would cover....in the long run they save money because we will be healthier

**Teriona** · 02-06-2016 10:31 AM

Yes! I was shocked when I learned how much they pay. Anyway, one way or the other they will be paying because I will be out on disability for a full month with full pay.

**MClark** · 02-06-2016 11:00 AM

My plan is Tufts Health Plan and they paid for 90%.
Feeling lucky!

**Teriona** · 02-06-2016 11:18 AM

I have Aetna. They told me that some employer plan pays for 100% so it is based on the employer.

sraebaer · 02-06-2016 01:40 PM

I'm a teacher and we have a flat "No bariatric surgery" policy, no reasons, no exceptions. I paid $14,000 in Missouri 2 years ago. This included pre and post visits and testing, etc. SO very worth it!! I figured it was about half a new car.

**ProudFather** · 02-08-2016 03:43 PM

It seems each insurance company has their own qualifications, but today I would think most cover it because of the benefits, and saving the insurance companies money in the long run. Now, the requirements for the surgery will be different depending on the Insurance company. Some have a mandatory diet for 5 months, some longer. I guarantee this is to see if you are ready to make lifetime changes to the way you eat and live. No use in getting surgery if you care not 100% committed. The insurance companies know this, and I am sure they don't want to waste money on people that will go right back to old habits. Good luck!

**DBarringer58** · 02-09-2016 04:39 PM

That's right they want to see dedication and determination. I had to do 4 mos weight loss and just had my surgery 2wks ago. Good luck. Oh and they want to see high BP or sleep apnea, or high cholesterol. Thanks!

**paradoxcowgirl** · 02-09-2016 06:19 PM

Originally Posted by Teriona

I have Aetna. They told me that some employer plan pays for 100% so it is based on the employer.

My plan is through my husbands Union, Aetna POS II, and they paid 100% as I'd met my deductible and out of pocket for 2015 literally days before the surgery. They pay 80% of allowed charges on everything and 100% once you meet the $1000 out of pocket for the calendar year. They did require a 6 month supervised program prior to approving though. I'm forever thankful for it being approved!