Question:
Looks like no surgery for me
I had made up my mind last week after doing more research and talking to people who had surgery. I'd decided on Dr. Teng after finding him to be highly recommended in my area. I called up my insurance company to make sure everything would be covered and I was told yes. So I made my appointment for November 1st. I was nervous and excited. Then I got a call from Dr. Teng's office on Thursday letting me know that they had called my insurance company (I have Blue Cross Blue Shield of Washington) and they have a clause in their policy that NO bariatric procedures are covered period. I called the insurance company myself again and after speaking with TWO different people I got two different answers. So, I sent an e-mail to my HR department asking them if they could confirm with the insurance company what is covered and what isn't. I'm still waiting for hear back from them but at this point it's looking like no. Since I can't go the cash route, I'm thinking I'm SOL unless anybody else has a suggestion. Thanks! — Cameo M. (posted on October 21, 2006)
October 21, 2006
you could finance it if you really wanted the surgery..
— shortskirt_ky
October 21, 2006
Does your insurance company go with someone out of network or do they just
cover no bariatric surgery whatsoever??? I had NJ Horizon BC/BS and they
didnn't cover my surgeon and he took what they paid plus $3,000 from me. I
had my surgery 3 yrs ago, lost 157 lbs and the $3,000 OOP was worth every
penny to me!!!!! Keep checking...also....trying buying an individual plan
that will cover bariatric surgery. Most individual plans are around $500
per month. You may find this worth the money, if you can swing it. Good
Luck!!!!
— barefootgirl
October 22, 2006
Getting secondary insurance might be the best option-- many chambers of
commerce have plans that are available (it might take being a little
creative to become a member, but it just might be worthwhile).
The other option might be to call upon one of the attorneys who specialize
in bariatric insurance denials (on a personal and professional level, I
think the world of OH member and skilled attorney Gary Viscio).
Financing surgery might not be an option-- even among people who truly
want the proceudre (sorry that an earlier poster gave a kind of lunk-headed
response in that regard). First, some hospitals will not accept cash-pay
customers for bariatric surgery (because of the costs that could arise,
however remotely, from any complications). Secondly, if a hospital is not
going to finance the proceudre itself, and would accept a cash-pay
customer, it would want the $15,000 to $25,000 fee up front-- this is a
considerable loan to obtain. Third, there would always be the concern that
the current insurer wouldn't cover any of the follow-up costs (or treatment
of any longer term complications) which would result in even greater
expense.
— SteveColarossi
October 22, 2006
Do you have any health conditions that are life endangering like blood
pressure issues, heart issues, asthma, etc?
If you have anything that is dangerous to your health, and depending on
your state, you could always check into your employer going to bat for you
to get it covered based on secondary health issues that put you at a higher
risk.
Just a thought - if you go over to the insurance forum there is a lot of
people there that can help you by asking questions as well.
— Merredeth
October 22, 2006
I'd suggestion reading the exclusions of your policy. Two words you have
to look for "medically necessary" and also look to see if your
states health department has defined obesity. Search to see if you state
has made any legislation regarding the treatment of obesity in your state.
Some states are starting to pass legislation that companies have to provide
insurance for the treatment of obesity. Here in Maryland, if a person as
an HMO, the HMO can't deny them. All is required is the person is over 18
and mee the NIH BMI requirements. Although some insurance companies
require 6 month physician supervised weight loss program.
— the7thdean
October 23, 2006
blue cross is a pretty solid company. I'm sure if you put your mind to it
then you could really get switched over to maybe regular blue cross or
something. Listen, a DAY before my surgery, the doctor called me and said
blue cross wouldn't cover some 3,000 up front hospital fee that I knew
nothing of and they said I couldn't get the surgery. Simple as that. I
was soooo crushed! I cried like a sissy. I waited so long for a new life
and a day before! I was like oh hell no. I prayed on it and asked God to
help me then I called the hospital and talked to the adminastrator and he
made a way for me to make payments and I had the surgery and I love it. So
if you want to give up then you will but if you don't then you better get
it going! Because I was just looking at the bills that blue cross covered,
man it was like almost 100,000! So unless you rich, my advice would be to
pray and ask God to help you find a way to make them pay or transfer you to
another insurance that will!
— saraj
November 18, 2006
Hi, I'm somewhat new to this website. This is the first thing I'm writing
on it, otherwise I've just been checking it out. I'm feeling like you are,
I finally got into a bariatric seminar near orlando and everything sounded
good and the surgeon seemed nice and all, but after the seminar I asked the
surgeons insurance person about the insurance I have and she told me that
they cover everything except the surgeons fee. I'm on a fixed income and
can barely pay my monthly bills so telling me that is like telling me that
it isn't covered at all. Same difference, there is no way I could come up
with that kind of money, and I can't finance it because I would be unable
to pay the loan payments. So I know how you feel.
— mkerimlose
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