Question:
my insurance co does not cover this because the employer doesnt want to pay
is there somewhere I can get coverage myself from insurance co. I was told there were attorneys that maybe could help send a letter to co . I need this surgery but cannot afford it — braada (posted on February 21, 2008)
February 21, 2008
If your company has not purchased the required rider for WLS, or put in an
exclusion for WLS (and make sure the exclusion applies -- an exclusion for
the treatment of obesity does NOT mean an exclusion for the treatment of
MORBID obesity), then you're probably hosed -- it won't be covered. The
only exception to that is if your insurance plan is self-funded rather than
fully-funded; in that case, your employer is actually paying the bills, and
if they want to pay for it, they can -- you can appeal to the company
directly to pay for it (having evidence in the form of a letter from your
PCP and surgeon that WLS is medically necessary.
Otherwise, your only choice is self-pay. You are unlikely to be able to
purchase a separate policy that you can use to cover WLS. However, some
people are finding that working at Starbucks provides insurance that covers
WLS -- can you work there parttime?
— [Deactivated Member]
February 21, 2008
Hi, My insurance had an exclusion for all obesity related things. However
I contacted Obesitylaw.com. They are wonderful and with fighting got me
approved. I HIGHLY recommend them. They will be honest with you and tell
you your chances. Its worth it.
-Pam
— Pam_B_OR
February 22, 2008
A friend of mine had an exclusion on her policy so she got self-pay
insurance policy through the state. I am sure every state is different, but
IN considers obesity a disease and covers this. Also, you can always appeal
the company's decision. Good luck!
— juliebelle0402
February 22, 2008
Been there, done that, got the T-Shirt. I was told that you can have your
Dr's office appeal to a special board of Doctors and Nurses that is a panel
of the insurance company. Does it work? I don't know. But don't expect the
process to be fast.
If you can, try and get your own insurance policy. You may also want to
consider finding a new job. Or maybe a part time job--just to get a better
insurance benefit. If you can't, you may want to look to other financial
resources if you feel that you need the surgery badly enough. Maybe you
can borrow from your 401K or take a 2nd mortgage or sell financial
holdings. Again, drastic moves, but none of these things will matter if you
are not alive! Also, talk with your Doctor about the financial situation.
Talk to the hospital. Talk to any other doctors that you see in the
process. They want to help. Believe it or not, if they can work with you on
payment plans or discounts, they would probably be getting more from that
than what the insurance would pay, anyway. Good Luck to You and keep us
posted.
--Dani
— zandeldm
February 22, 2008
Hello Dan,
I tell you -- we find out more and more good stuff to share everyday. I
have to have an orbital ultrasound (eye thing) and it's not covered by my
insurance. The rep even called several hospitals to see if they performed
the procedure -- nope. So what she advised me to do was to contact my PCP;
have them contact the insurance company and request a Network Exception --
meaning the procedure would be included for a limited amount of time.
— the7thdean
February 22, 2008
when I looked into it with my insurance they said that it was not a covered
item because my employer did not choose it but it would be on a case to
case basis . So I submited all my stuff and wala I got aprroved go figure.
So give it a try
— biglou
February 22, 2008
My insurance company approved me with conditions and after meeting thos
conditions changed my policy the first of the year to exclude Baratric
coverage. I got finacing through Capital One, and what I save on food
makes the payments each month. All I can tell you is that think about what
is important, and figure out how to extend your life with WLS. I never
felt better and wished that I had not waited to do the surgery. Good luck
to you. The law firm is on the web under the name Obesity law, I beleive
www.obesitylaw.com.
— William (Bill) wmil
February 24, 2008
My boyfriend is going through this right now. He call Cennecticare and told
them his name group # Id # everything they asked before he shelled out a
lot of money and did everything he had to with the Dr. Well the ins.
company told him he would be approved if he did the 6 month medically
monitored diet. He did it and they denied him. We sent an appeal letter
stating that he payed all this money, did 6 months of going to the dr and
they are denying him something can save his life. They wrote back and said
they had a registered nurse look over all his medical records and she
decided it want medically necessary. Well he has 3 doctors saying it is
but an RN can say its not. And the stupid girl at connecticare should have
nver told him he was going to be approved. Who has the money for self pay
surgery and who has the money to pay for this lawyer on the web site. He is
very expensive. This is ridiculous. I have friend who has cancet and her
insurance doesnt cover radiation. Can you belive that. I love these
insurance companies who can say what medical care you need or dont need and
you want to do something or need to do something to save your life and they
deny you. It ludacris and I am so mad over this.
— Joanc
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