denise wyatt
Member
hi Cindy we have the same surgery date lol, i am getting my system ready for what i am going to be going through. this week is my week of flushing my system, i just want eveerything cleaned out. good luck on the first.
Too much pre-op weightloss?
- Thread starter mergatroid
- Start date
I talked to someone and they said that BC/BS in some states requires that you have done cerrtain programs to lose weight that are monitored and have failed over a number of years, have a BMI of greater than 40 AND have comorbid conditions. They do not care about you, they care about what things cost and if they can see that the surgery in the long run will cost them less than your comorbid conditions. IF you are over 70, they do not want to do it either due to longevity, if you know what I mean. IF you ask me there is more longevity with the surgery but they did not ask me. IF you are on Medicare, then your insurance is secondary and Medicare is primary so you go by Medicare rules since the insurance only pays the remaining 20% that Medicare does not pay.
Pat99
Member
I have only Medicare for my insurance with no secondary coverage. My out of pocket cost for the surgery and hospital stay was reasonable. By my calculations my out of pocket costs were far less than what I would have paid for the 18 months of secondary coverage I would have had to have in order to make it past the pre-existing condition rules before the insurance would pick up what Medicare doesn't cover. But keep in mind there are additional out of pocket costs for things like doctor visits, blood work, testing, etc. I have still paid less out of pocket than what the secondary insurance would have cost me
Mergatroid
I started out at about the same weight as you are. My Doctor didn't want me to loose weight until I got my insurance approval due to my BMI...once they got the approvals, she told me to loose as much as possible before my surgery date. Any little bit will help at that point. It's not the Doctor, its your insurance. Something that dumb can make them not approve your surgery. I had Diabetes, High Blood Pressure and High Cholestrol before surgery. Although my BMI was low, they were able to get me approved due to my other medical conditions. 3 weeks post op, I was off all Meds! Good Luck!
I started out at about the same weight as you are. My Doctor didn't want me to loose weight until I got my insurance approval due to my BMI...once they got the approvals, she told me to loose as much as possible before my surgery date. Any little bit will help at that point. It's not the Doctor, its your insurance. Something that dumb can make them not approve your surgery. I had Diabetes, High Blood Pressure and High Cholestrol before surgery. Although my BMI was low, they were able to get me approved due to my other medical conditions. 3 weeks post op, I was off all Meds! Good Luck!
Pat99
Member
Thanks for the info Sandie. I'll have to get new quotes then since I last tried in late 2011. There were only 2 carriers in Michigan at that time for people under 65 and both were charging almost $400 per month for a policy that offered only 20% coverage with an 18 month waiting period for pre-existing conditions. One rep actually told me outright that they charge such a high premium "... to discourage people like me from buying medical coverage because of the high risk..." I can't begin to tell you how mortified I was at her comment. I even called my attorney to see if I could do something about the remark and was told it would be almost impossible to prove. I'm going to call my Medicare provider, Humana, later today to see if they offer a secondary policy for people under 65.
Obamacare- one good thing about it that has kicked in is that insurance companies cannot refuse to insure people with pre existing conditions. NOW I am not sure about people on disability insurance since that should cover everything you need I think but could be wrong. I am not an expert on Medicare for those under 65, or Medicaid etc. They did not refuse anyone with pre exisiting conditions since those conditions are what caused them to be on the disability insurance. What can occur is that the insurance they put you on can refuse the WLS outright which some do. Seems unresonable, it would cost us less as a country if those who are so obese that they have other medical problems due to the obesity are allowed to have the surgery. It is amazing that they let some clerk decide whether you "qualify" for the surgery. I think if the numbers are there, AND you are healthy enough to get through the surgery and walk, walk and walk some more, then you should be able to have the surgery but not twice and three times for revisions because you gained it all back etc. WE all need to take this really seriously and know we can only do this once. We are all getting a second chance, I am so grateful for that and for all the support that comes from this forum!!!
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Pat99
Member
Sandie-As far as I know my Medicare coverage (disability) is exactly the same coverage as it is for a retired person on Medicare. Both situations have to pay up to 20% of hospitalization costs, surgical costs, some testing, , X-rays, blood work etc. and both have the same co-pays and other out of pocket costs. The nice part about being able to get Medicare coverage through other insurance providers is that they offer "perks" for signing with them. For instance, I only had to pay 10% of my hospital and surgical costs because I was admitted as an in patient. If I had Medicare through the state of Michigan I would have has to pay 20%. Each insurer has different perks, co-pays, out of pocket maximums and one has to be extremely careful when selecting coverage because you are "stuck" with it for a year.
After I wrote my last post I went on-line to look at Humana's secondary coverage. Talk about confusing, geeze!!! I'm a mentally sharp person and I'm here to tell you my head was spinning half way through reading only one of the available plans. Looks like I'll be spending a whole LOT of time on the phone this week trying to find a suitable secondary policy. I want to make sure I make the right decision because I will be having a total hip replacement "soon" and don't need any surprises.
After I wrote my last post I went on-line to look at Humana's secondary coverage. Talk about confusing, geeze!!! I'm a mentally sharp person and I'm here to tell you my head was spinning half way through reading only one of the available plans. Looks like I'll be spending a whole LOT of time on the phone this week trying to find a suitable secondary policy. I want to make sure I make the right decision because I will be having a total hip replacement "soon" and don't need any surprises.
mergatroid
Member
Jules - Thanks. I'm getting a little nervous now that it's only 3 weeks away. I want to have something to lose. I've gained back 3 pounds and have mixed emotions about that. On another note,... Wow, I
can't believe how lengthy this thread has gotten. LOL
can't believe how lengthy this thread has gotten. LOL
Pat99
Member
Linda-Your cost will be different than what someone else will pay. Each surgeon and hospital charges different rates plus you have to factor in the cost of all of your pre-op testing and post op care. You can call your doctor's office and ask one of the administrative staff for the name and number for someone at the hospital who can provide you with a "ballpark" cost.
volkatwriter
New Member
My surgical center is very strict and I am still pre-surgery. As a result to show good faith and that you are committed, one of the requirements is that a patient must lose 10 percent of their weight before surgery. They also use the health history, diet history, co-mormidities to help qualify for surgery. My insurance does pay for surgery. However, they do not let anyone walk in off the street and get the surgery. The seminar is almost more of a scare tactic than a sales pitch. Because I had gone through supervised weight loss program already through them, I knew the PA well. Since they had more than six months of diet history without real weight loss, then it had a greater chance of approval.