just beginning...Insurance question

f66bs
f66bs Posts: 15 Member
Hi all! II've been reading through so many of these questions on this forum and I love to see all the support. I am extremely interested in having the surgery. I have looked up a few places but need to fill things out first. I wanted to get an idea on how it works payment wise. I know every place is different and every insurance company as well. I'm in texas and have united health care. I know I need to call to verify everything, just wanted to know if anyone was able to use insurance or is it 100% out of pocket.. Thank you in advance!

Replies

  • rpyle111
    rpyle111 Posts: 1,060 Member
    Hi all! II've been reading through so many of these questions on this forum and I love to see all the support. I am extremely interested in having the surgery. I have looked up a few places but need to fill things out first. I wanted to get an idea on how it works payment wise. I know every place is different and every insurance company as well. I'm in texas and have united health care. I know I need to call to verify everything, just wanted to know if anyone was able to use insurance or is it 100% out of pocket.. Thank you in advance!

    Most of the folks in the US use insurance (I believe). A lot of the pre-op discussion here centers around jumping through hoops to get insurance approval. Call your insurance and see what their program is.

    Most programs have an Bariatric Orientation, which is generally free, and can give you an introduction to the process. If your insurance points you to a particular program (mine had only one option at their main hospital) go there and see what's up. The folks in that program are likely very familiar with both the insurance rules and the reality of meeting them.

    Rob
  • pawoodhull
    pawoodhull Posts: 1,759 Member
    I attended a free Orientation session at my bariatric surgeon's office. Once I made the decision to go ahead with it, they contacted the insurance company and got all the approvals in place. They are the experts, so if you can leave it all up to them, do so. I had my surgery in July so almost all of my deductable had been met for the year and my costs were minimal. At 386 pounds, my weight alone qualified me. The high blood pressure and joint damage with arthritis I had were not considered because the weight itself qualified me, but those co-morbidity items sometimes come into play if the weight isn't high enough to qualify all on it's own.

    I had my sleeve 3 years ago and I have to tell you, I love my sleeve! The ONLY regret I have is in not doing something about my weight years ago.

    Pat
  • f66bs
    f66bs Posts: 15 Member
    Thanks all! I filled out info today and I have seminar next week. And Pat, I feel same way. I've been researching this for about 6 to 8 months and I wish I would have done it sooner. This group helps so much on making me feel so much better on the decision :)
  • tcdouglas
    tcdouglas Posts: 11 Member
    I am in Texas as well and have united healthcare and had no problem getting approval... It actually was very quick (about a week or so) and the insurance company did not have any pre-requisites before approval...
  • f66bs
    f66bs Posts: 15 Member
    I am in Texas as well and have united healthcare and had no problem getting approval... It actually was very quick (about a week or so) and the insurance company did not have any pre-requisites before approval...

    Awesome, I hope it goes by fast! I have the seminar scheduled for next week!! I already provided them with all my insurance info today so I'm supposed to find out that day also! Thanks again!!
  • JxAAA
    JxAAA Posts: 87 Member
    Call your insurance and find out what their benefit is. Some insurances require a 3 or 6 month medically supervised diet. Many require you have a certain BMI (typically 35 BMI w/2 comorbidities or 40BMI w/out comorbidities). Also the weight loss benefit is an extra option that employers can pay for and many opt out of the benefit to save money. My surgery was covered at 100%, all I had to pay was $200 for a psych eval.

    Good Luck!
  • lbrown1428
    lbrown1428 Posts: 116 Member
    Every insurance is different. I have blue cross blue shield of illinois. Mine I only have to pay what I haven't met out of pocket for my $2,000 out of pocket expense. So I will be paying a lot less than the out of pocket since I have met most of it already.