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Hbrittany99

Anyone know if it's hard to get insurance to pay??

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So my insurance is active on June 1st and I have contacted a surgeon about the initial consultation. I want to get the sleeve as opposed to the band and wondering if anyone has any input on if insurance will typically cover it. My BMI is 37.5. Does anyone else have experience with this and having to have a comorbidity?

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  1. Christie13's Avatar
    Every insurance plan is different even if they are the same company. Employers can add or take away benefits to the plans. There are also different requirements. So you would need to contact your insurance company and ask them to lay the requirements out for you. My insurance stated that I had to be 40 BMI or over if I did not have comorbidities. I could have had a BMI of 35+ if I had 2 comorbidities. To be honest though, I would have paid less and gotten it quicker if I had gone to Mexico. Knowing what I know now, I would have probably gone that route.
  2. Kindle's Avatar
    Get a copy of your policy and go over the WLS details with the company. Like Christie said, all policies have different criteria and requirements. Your surgeon's office likely has an insurance coordinator that could help, too. In general, you do need to have 2 comorbidities if your BMI is under 40.

    My policy was very easy to interpret.....apsolutely no WLS coverage under any circumstances. Went to Obesity Control Center in TJ and had an easy, pain free recovery from my VSG, performed by a Bariatric Surgeon of Excellence with far better credentials and experience than any surgeon within 200 miles of my home. Cost me just $1000 more than my deductible would have been even if it had been covered, and without all the insurance BS.
  3. kenson's Avatar
    My surgeon's team told me at the initial workshop that my health insurance would pay for the surgery. I also contacted my insurance company because I wanted to hear from them personally. Contact your insurance company and ask them.
  4. Gvn71's Avatar
    Call your insurance company. They all have different requirements and qualifications for the surgery.

    My BMI was under 40 but I had multiple comorbidities. My insurance paid for essentially everything. I believe that the cutoff for my insurance was BMI over 35 with 2 or more comorbidities or BMI over 40 with none.