Bad News Today

Well I have been so excited about getting WLS to improve my life. I went and talked with my doctor, she recommend me to a WLS surgeon. I met with the surgeon and he recommend I attend a WLS seminar. My wife and I attended the seminar the other day and decided the RNY is the right WLS for me. So we contacted my insurance today and found out I do not have coverage for WLS ...  Turns out my employer elected to a go with a plan that cost less. The disturbing part is my premium stayed the same and I now have less coverage / benefits. I am so frustrated and bummed out right now !!

 I am so sorry that you found that out after you had gone to all the trouble of finding a surgeon and attending a seminar.   Have you thought about appealing this process??   I believe that some have won the appeals and gotten their WLS covered.   It certainly wouldn't hurt to try.   If you won't be able to get it that way....there is always getting a medical loan and paying for it yourself.    Trust me it is so totally worth it.

Hugs and blessings ~~~ Vivian

Is there any way that you can Self Pay?  Dont give up. Next year you might be able to have your boss go with a better plan. Start documenting what your doing to lose weight and all visits to your pcp. Make sure your pcp documents that you went in for  wieght loss visits and what was discussed. This way when you are able to get the better insurance you will have the correct documentation. I know things are very frustrating right now, just dont give up.

Dani

I did check into the appeal process, unfortunately the plan we have with medica does not allow for appeals. So my next move is to find out what the cost is and try to get a loan. 

 

 Compare it to buying a new car that will depreciate as soon as you start driving it.  Your new healthy body will be there for the rest of your l,ife.

Does your wife work? If so, maybe her insurance would cover WLS. You would need to wait until her open enrollment period and you would go on her inurance but it would be worth it.

Rather ironic that they would rather pay up to thousands of dollars/year...sometimes a month for health care maintenance when we are obese, but not a surgical intervention that could, and probably would restore good health!!!

Unfortunately this is all too common these days with companies trying to keep their costs down.  You did ask your HR department, correct?  I was originally given wrong information from my insurance company and HR verified that it was bad information. 

I am sure that you are very disappointed, however, I also agree with the other posters about your self-pay option.  At least check out the option and maybe the payment arrangement will be do-able for you.

I dealt with this in the US, too. Unfortunately, it's much cheaper to go with insurance that doesn't cover WLS, so many companies do just that. My understanding is that there really is no appeal process in these cir****tances. Any chance you can get a part-time job at Starbucks?

Don't give up on having surgery.  My insurance didn't cover it either, so I ended up being a self-pay patient.  My cost to have RNY in the US was $20,000 and it was the best money I ever spent.  I would do it again in a heartbeat!