Why would a company deliberately exclude bariatric surgery from their benefit plan?

[Lynnsey2121]

Why do some companies exclude bariatric surgery from their insurance coverage? I was so shocked when I called CIGNA to ask if my husband's insurance covered surgery and my jaw almost dropped to the floor when they said no. He has excellent insurance....I mean, they have UNLIMITED infertility coverage (IVF, no age limit, etc). Imagine my shock when they told me it bariatric surgery and obesity coverage is excluded. Sigh.....

Just venting. But also curious. My company which is a non profit has okay insurance, but does offer coverage for bariatric surgery. But I opted out of mine to go on his since his had out of network benefits and mine didn't. Also, my company gives me an opt out benefit payment every month for not being on our insurance. So, it was a no-brainer to go on his coverage since a couple of my doctors are out of network. But now, I'm looking at Mexico, but hubby is super unsupportive about that and it is scary to me to think if I have a complication, will CIGNA cover it back in the states?

I just feel so stuck.

[Lynnsey2121]

I mean, obviously it could be a cost cutting measure, but it just doesn't make sense with the other generous benefits his plans offer. I mean, UNLIMITED infertility coverage is unheard of these days.

[HGfromOmaha]

Unfortunately, they consider any bariatric surgery to be both "cosmetic" and also "optional". They don't see the urgency that some people have when it comes to needing to lose weight but being unable to do so for a myriad of reasons. Some people can simply say I want to lose 5 pounds and they can do it. Some of us can say, I want to lose 2 pounds, workout like crazy, and gain weight. So insurance companies look at "normal" people and say "if you're not like this, then we won't cover you."

Sad but true.

[Toopie2Seater]

The easiest answer I can give you, is money. The sicker you are or become due to obesity and it's related co-morbidities, the more money insurance companies make off of you. More doctor appointments, more tests, and more prescriptions equals more money. Just that simple. Disgusting, isn't it?

[Little Verbena]

I don't think it is the insurance company themselves, it is the company. The insurance companies offer all kinds of plans for companies to buy. The employer company decides what plan they want. I know people with Cigna that do have baratric coverage so it isn't just the insurance company but rather your husbands company that didn't buy a plan that covers baratric.

[dyberrah]

Toopie2Seater, wouldn't that actually cost the insurance company more money? They have to pay for all the expenses caused by co-morbidities...

[Lynnsey2121]

Yes, it's my husband's company that decided not to add that rider onto the contract.

But they have no problem paying for my sleep apnea equipment, Metformin, mental health visits, depression meds. And that's just for now. Soon enough, it will probably be high blood pressure meds, insulin, cholesterol meds, etc.

But I work in Human Resources, and I know that the decision resides with the company to offer it. We've always offered it in our plans before my time so I never thought about it until I actually looked into it for myself by calling CIGNA. They told me his company chose not to include it.

[char602]

I agree. I also work in HR on the Benefits Team. I am fortunate, my employer does cover it. However, I chose the HMO option and they have only 1 (yes ONE) contracted bariatric surgeon. So even after jumping through all the hoops, the process takes 10 months to a year. I haven't been approved by my insurance yet, but my primary doctor has referred me and is supportive. My other problem is, my BMI is 35, so the insurance may not approve me anyway. So that leaves me with Mexico.....I digress. To answer your question, typically if the surgery is excluded, any treatment related to the surgery would be an exclusion as well (i.e, complications).

[amandajane]

When I was going to my pre-op classes, there was a woman in the class with me who found out literally at the end of all of the pre-op classes/testing that her company's insurance excluded bariatric surgery. She was heart broken and I was heart broken for her. She said the only way to get it covered would be to go to her HR dept. and explain to them that she needed to have the surgery and ask them to write a letter to the insurance company approving the exception. She was hesitant to do this b/c she didn't want her business to go all around her workplace, but that was the only way. If you don't mind trying- perhaps your husband can go to his HR department and request an exception? It doesn't hurt to try...

[Lynnsey2121]

Yeah, I'm thinking he would not be cool with that---asking if his company would make an exception and cover his surgery. He's a private persona and I'm sure he doesn't want everyone know how I've let myself go. I accuse him of being embarrassed of me, but he assures me he is not. But I'm embarrassed of me, why isn't he embarrassed of me then? Either way, he doesn't even want me to have the surgery and gets angry when I bring it up, so asking him to ask his HR department for help is probably not going to happen.

Thanks for sharing that experience with me though, Amanda.

[Joy48]

I understand your frustration, when I was told my insurance company did not cover it (AETNA) because my company opted out, I looked into other options and went with belite weight and my Dr was in Mexico and I can say my experience so far has been pretty good and I got with my GP before I went and he said he would see me for any follow up if necessary so far haven't had to. As far as your hubby being unsupportive you have got to let him see you how you you see yourself ,communicate ,share the procedure with him on youtube. You have got to convince him otherwise your journey is going to be rocky. Good luck and stay positive ,alternatives are out there.

[Toopie2Seater]

@Lynnsey2121, exactly my point. The matter is not as simple as it appears and when it's all said and done, your employer (or spouse's employer) and the insurance company makes more money the sicker you are. The worse your health is (if you have private, employment based insurance), the more you pay for insurance. The more you pay, the more you balance out what your company pays to the carrier. They can't collect as high of a premium from young, healthy folks, so your high premiums due to medical problems sort of balances out the equation. Why would they want to take money out of their own pocket when sickly people do it for them. It's about money.

I hope something works out for you, and I wish you the very best on your journey. =)

[BillyJ]

I agree. Your husbands company opted out NOT CIGNA. It was more cost effective for them.

[BillyJ]

Question. Is your husband unsupportive of the surgery or unsupportive of Mexico? My Cardiologist begged me not to go to Mexico and I didn't. I paid for it myself here in Texas and yet I read several success stories about Mexico on this site. Yes your insurance will cover any complications after. At least my research of that on this end says it will.

[Lynnsey2121]

BillyJ-my husband is unsupportive about the surgery in general (he thinks it's the "easy way out" and I haven't tried enough.....ARGHHHHH!!)

However, he is even more unsupportive of it being Mexico.

I'm 41 years old, have lost 100's of pounds in my life (and gained them back and more....same old story I'm sure most of you are familiar with). It's not going to work any other way for me to get healthy and start living my life and being a good mom to my two boys (aged 2 and 1). This I am convinced about.

If the surgery was covered by his insurance here in the states, I'm sure I could "wear" him down enough for him to support me. He even went as far as to say that if I get myself some life insurance, he would consider it. Now, even if someone would cover me for life insurance (5'3", 260 lbs, pre-diabetic, sleep apnea, fatty liver, depression, etc), I'm sure the rate would be incredibly high). He's worried that if something happens to me, how could he take care of the boys only on his salary? I understand that, but I was hoping to apply for life insurance AFTER I lost weight and got my blood work up to snuff and was (hopefully) be able to get rid of the CPAP.

I just feel so stuck. Part of me just wants to schedule the surgery by myself in Mexico and just GO. Let him worry about taking care of the boys while I'm gone. But I know that isn't fair to him or the boys. Maybe if I was married with no children, it'd be a different story.

Sorry, I'm rambling. I'm just at a loss as to where to go now, what to do. And I keep getting more and more depressed and hopeless feeling.

Thanks for listening guys....I've been lurking here for a few weeks and you guys are a great group and I'm so impressed with your stories and how hard you've worked with the awesome tool that surgery has given you. I'm even a bit jealous too.