Question:

How can I find an insurance company that will cover gastric bypass surgery for my mother?

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To sum this up as briefly as I can: My mother, in just the last year, has become a medical disaster. A significant health-deteriorating weight gain being the main issue. Prior to that, besides being somewhat overweight, she was healthy as a horse. She developed pneumonia last year and was very sick for several months. She was placed on steroids that sky-rocketed her weight and in the months to follow subsequently developed asthma, hypertension, and now the last straw..diabetes. Her physical last week revealed that she has a polyp in her uterus with post-menopausal bleeding. She also has blood in her stools so she has to have a colonoscopy. Her diabetes is not high enough where she has to be put on meds yet so she will be seeing a diabetic educator to learn how to control with diet and also check her blood sugars. The frustrating part in all of this is that we just lost my dad to cancer 1 1/2 yrs ago, so instead of being on a Group Ins policy, she is now on a Single policy. She weighs >300 lbs at 5'5" and has tried diet and (to her capability), exercise. She is an excellent candidate for a gastric bypass surgery, however this insurance company will not cover her since she is on a Single policy (which baffles me, because they would cover her if she was on their Group). She is a medical wreck....it pisses me off because her insurance will not pay for the surgery, but they will pay for ALL of these medical expenses that are a primary reflection of her weight. Can anyone tell me if there is an insurance company out there that would cover a gastric bypass surgery for my mother (on a single policy)? I don't want to lose another parent. She is only 57 years old.

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8 ANSWERS


  1. My ins company won't cover it UNLESS it's a medical neccessity...had a co-worer who wanted it done...called the ins co and they said if you could have your Dr. submit a request because it's medically neccessary than chances are they would...


  2. Most health insurance plans won't cover you for pre-existing conditions that you had when you signed up for the coverage. A better choice might be to have the procedure financed.

    Info on gastric bypass insurance:

    http://www.yourbariatricsurgeryguide.com...

    There is also a link on that page which provides info on financing.


  3. This may help you . I would appeal the decision on behalf of the insurance company.  I swear they come up with lots of c**p never to pay out even though one pays in for years on this stuff. You don't have to take no for an answer.  Your doctor can deem it medically necessary.  If not, they are going to have to pay the long term effects on her health and it will exceed the price of barriatric surgery, so some reall threat for them!   Also if you should have to find something more affordable,  You might want to consdier Mexico for surgery.  A lot of people go there for half of the price to have it done.  I knew someone who did this.  I unfortunately don't have the source handy, but I am sure you could do a search and find it.  Best wishes for your mom.  I know how she feels.  I need to make some decisions too.  

    http://www.ehow.com/how_2056164_know-ins...

  4. If your dad was in the military or government service at any time while married to your mom, she is qualified to become a member of USAA (United Services Auto Association).  In addition to car insurance, they have home, health and life insurance policies, as well as banking services through USAA Federal Savings Bank.  I have been a member since 1977 and have never been disappointed in their service.  You can go to their website for more information:

         www.usaa.com

    I'm not sure what their health coverage would be, since I haven't had the need for it, but I do know that they have policies for it.  I do have home and car insurance and their banking services as well as discounts for things like ADT home security services.



  5. It looks like you feel really screwed up by this problem. Hope you may found helpful here.http://health-insurance.tips4free.info/h...


  6. Some county hospitals have weight clinics and they go by income and your ability to pay.  It might be worth looking into.  It takes a while to get into these clinics but it is worth the wait.  Each hospitals have their own criteria to get into these clinics.  Good Luck

  7. You could always try getting the surgery in Mexico. I am not kidding. There are lots of resources out there for how to get there, payment options, etc. Much cheaper than paying without insurance in the US.

    The important question is: does SHE want GBS? If she is not willing to do all that is required, which is a LOT of supplementation and diet control, it could end up with disastrous results.

    She also has to be healthy enough to survive the surgery.  

  8. I'm not sure about any of that sorry, but I do know one thing - Unless the person is overweight for 5 years or has a history for that 5 years with doctors you can't actually get the surgery. They even state it on the bypass websites.

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