• American Bariatrics is a free online Bariatric Support Group. Register for your free account and get access to all of our great features!

Hi everyone!

L

Ladybug777

Member
I’m a 26 yr old, 300+, 5’0 woman and I have my consultation appointment 4/12. I have suffered with obesity since a child. I have a toddler of my own and I realized I wanted to change my life when I get out of breath when doing simple things with them. I’ve always embraced my shape when I was younger but since I’ve became a mom it’s hard to get the weight off. In 2019 I lost 60 pounds then got pregnant in 2020.

That’s just a little intro on me lol I did plenty of research and I want to get the gastric sleeve. My MIL had the bypass & had so many issues that terrified me (but she doesn’t follow her diet so that’s prob a big reason). But anyway, looking at the sleeve procedure, I think that will be best for me.

My insurance has WLS listed as an exclusion so I’m trying to figure out if it worth moving forward. Has anyone’s dealt with this? The surgery is costly out of pocket. Any info will be helpful.

- Peace & Love ☮
 
Last edited:
I can't believe your insurance excludes a life-saving procedure. Can you check with Medicare, or your state's Medicaid?

You might check with your hospital's ombudsman to see if they have a scholarship program. That's not the right word, but my hospital underwrote the 20 percent that government programs and insurance didn't cover.

It's worth a try.

Also, my hospital enrolled me in a 7-year program to track my weight loss and related issues. It was great. This happened because my hospital is a campus of the University of Washington Medical School. I know because of reading the federal bariatric journal that there are always interns and med students who are looking to do studies on bariatric surgery clients. It was really helpful for me, post-op.
 
dianeseattle said:
I can't believe your insurance excludes a life-saving procedure. Can you check with Medicare, or your state's Medicaid?

You might check with your hospital's ombudsman to see if they have a scholarship program. That's not the right word, but my hospital underwrote the 20 percent that government programs and insurance didn't cover.

It's worth a try.

Also, my hospital enrolled me in a 7-year program to track my weight loss and related issues. It was great. This happened because my hospital is a campus of the University of Washington Medical School. I know because of reading the federal bariatric journal that there are always interns and med students who are looking to do studies on bariatric surgery clients. It was really helpful for me, post-op.
Click to expand...
Right! I said the same thing. Cigna sucks for that but I’m pretty sure it’s the plan my employer selected It’s funny because I just found out that I still have Medicaid last week. I just searched and it’s covered where I am (VA)! Thank you for your post because I didn’t even think of that!! Hopefully I can get the ball rolling next month ☺️
 
Ladybug777 said:
I’m a 26 yr old, 300+, 5’0 woman and I have my consultation appointment 4/12. I have suffered with obesity since a child. I have a toddler of my own and I realized I wanted to change my life when I get out of breath when doing simple things with them. I’ve always embraced my shape when I was younger but since I’ve became a mom it’s hard to get the weight off. In 2019 I lost 60 pounds then got pregnant in 2020.

That’s just a little intro on me lol I did plenty of research and I want to get the gastric sleeve. My MIL had the bypass & had so many issues that terrified me (but she doesn’t follow her diet so that’s prob a big reason). But anyway, looking at the sleeve procedure, I think that will be best for me.

My insurance has WLS listed as an exclusion so I’m trying to figure out if it worth moving forward. Has anyone’s dealt with this? The surgery is costly out of pocket. Any info will be helpful.

- Peace & Love ☮
Click to expand...
Back in 2020 I worked for a company that listed itself as “fully insured”, I learned that that meant it excluded what they chose to exclude meaning gastric bypass. I actually went back to work for the previous company I’d been with before. Medical insurance that’s good is worth it’s weight in gold these days. I had my surgery almost 2 weeks ago and the whole process has been worth it however I don’t know how I would have personally paid for it. I’m happier at the company I’m now at, but that doesn’t mean anyone else should just quit thier job either. Keep looking for answers, you won’t ever regret the surgery, I know where there is a will there is always a way. Good luck!!
 
Hi Ladybug, you mentioned you still had Medicaid. I saw on the news that the government was requiring everyone in the USA receiving medicaid to reapply for it by a certain deadline date. I don't want to alarm you, I just want to share what I saw (and read) on the news so that you take any actions you may need to in order to guarantee you still have your Medicaid insurance. Requiring medicaid holders to reapply this year was an act of Congress. Happy Easter.
 
It's true. I actually got a phone call from a caseworker fulfilling most of the requirements. A letter with a document will come in the mail soon and that requires certain information from my landlord.

You should check. You can do it online by going to your state's DSHS site.
 
That's OBSCENE. And that's why some people end up going to Mexico. I recently read an alarming article about surgery problems related to the shortcuts and lack of skills in many of these clinics south of the border. Here's something else I just saw, but unfortunately it won't help you:

5559


class action against insurance that won't pay for bariatric surgery - Google Search

www.google.com
 
Ladybug777 said:
Thank you so much for your kind words!! I have to find a way for sure. How was your experience with the surgery & doing the liquid diet? A lot of pain?
Click to expand...
The surgery went completely fine! I had had a number of other surgeries in 2018-2019 for breast cancer and reconstruction, so the surgery itself wasn’t something I was particularly nervous about. I will say that I’m very sensitive in my tummy area, (something I’m learning more about myself) so I feel like I had a harder time the first couple of hours after waking from surgery than I had from previous surgeries. That being said, that was the “hardest” part. I’ve had no issues taking fluid, no nausea or vomiting, and Tylenol has been just fine for discomfort since day 3. I did appreciate the gas tablets and meds for cramping, both were non-narcotic. The first week I was on a clear liquid diet, it’s an adjustment for sure, but I’ve not felt deprived or hungry. This Tuesday will mark my 2 weeks since surgery. My process leading up to surgery took about 9 months, in that time I drastically changed my diet, planned my meals, started drinking lots of water, etc… in total I’m down over 70lbs since the start of my entire journey last august. Don’t give up! This process and surgery is such a gift and an incredible tool, I look forward to hearing your process and rooting you on!
 
mam said:
Hi Ladybug, you mentioned you still had Medicaid. I saw on the news that the government was requiring everyone in the USA receiving medicaid to reapply for it by a certain deadline date. I don't want to alarm you, I just want to share what I saw (and read) on the news so that you take any actions you may need to in order to guarantee you still have your Medicaid insurance. Requiring medicaid holders to reapply this year was an act of Congress. Happy Easter.
Click to expand...
Thank you so much! Fortunately my plan is still active & I am in the process of completing my checklist
 
Christy0829 said:
The surgery went completely fine! I had had a number of other surgeries in 2018-2019 for breast cancer and reconstruction, so the surgery itself wasn’t something I was particularly nervous about. I will say that I’m very sensitive in my tummy area, (something I’m learning more about myself) so I feel like I had a harder time the first couple of hours after waking from surgery than I had from previous surgeries. That being said, that was the “hardest” part. I’ve had no issues taking fluid, no nausea or vomiting, and Tylenol has been just fine for discomfort since day 3. I did appreciate the gas tablets and meds for cramping, both were non-narcotic. The first week I was on a clear liquid diet, it’s an adjustment for sure, but I’ve not felt deprived or hungry. This Tuesday will mark my 2 weeks since surgery. My process leading up to surgery took about 9 months, in that time I drastically changed my diet, planned my meals, started drinking lots of water, etc… in total I’m down over 70lbs since the start of my entire journey last august. Don’t give up! This process and surgery is such a gift and an incredible tool, I look forward to hearing your process and rooting you on!
Click to expand...
You are so sweet ! My godmother is a breast cancer survivor so I am so happy that you kick cancers a**!!!!!! Thank you for your kind words I appreciate you sharing your experience
 
Many insurance policies exclude WLS... It is actually up to the policyholder to determine if they want to exclude it or include it. Most of the time this is the employer that makes that call, BUT, a lot of times employers don't actually know that they can elect to include the coverage. They are often focused on cost, and many agents will exclude this without fully explaining what is being eliminated. If you have access to coverage through an employer, Medicaid will not cover you. It is false to say that you cannot get care here if you have WLS in Mexico. Direct complications to the surgery will normally be excluded - think leaks, surgical site infections, etc. - but say you get an ulcer or GERD a year later, there is not a way to prove that is directly related and so you should be covered. If you have questions specific to insurance coverage, you should speak with the carrier, your benefits rep or a licensed agent to get clarification, not rely on comments from others. Every policy is SO different, every state is different, etc., so no one can really discuss the nuance of your specific coverage apart from those associated with it.
 
eladams2015 said:
Many insurance policies exclude WLS... It is actually up to the policyholder to determine if they want to exclude it or include it. Most of the time this is the employer that makes that call, BUT, a lot of times employers don't actually know that they can elect to include the coverage. They are often focused on cost, and many agents will exclude this without fully explaining what is being eliminated. If you have access to coverage through an employer, Medicaid will not cover you. It is false to say that you cannot get care here if you have WLS in Mexico. Direct complications to the surgery will normally be excluded - think leaks, surgical site infections, etc. - but say you get an ulcer or GERD a year later, there is not a way to prove that is directly related and so you should be covered. If you have questions specific to insurance coverage, you should speak with the carrier, your benefits rep or a licensed agent to get clarification, not rely on comments from others. Every policy is SO different, every state is different, etc., so no one can really discuss the nuance of your specific coverage apart from those associated with it.
Click to expand...
Thank you! Where I am located, I am covered for the surgery and will be moving along in the process. I appreciate your insight! I just wanted to ask generally.
 
You must log in or register to reply here.
Back
Top