Question:
I am all set for my surgery, but my sister needs help!
Hey all! I am moving right along with preparing for my surgery, but my sister needs help. Her insurance does not cover WLS for ANY reason (it is a strict clause in her work policy). Is it possible that she can buy a policy (mabye from BC/BS or somethink like that) so that she can be covered? And-if she is able to find a policy that covers the WLS surgery, should she be upfront with them about her plan to have the surgery when she applies for the policy? Any help will be greatly appreciated. Thanks! — Wendie G. (posted on August 30, 2002)
August 30, 2002
Wendie,
It dose sound like a good idea, How-ever my sister did the same thing,
after seeing me having surgery, my older sister wanted to have surgery too,
Her current insurance threw her employer has an exculsion on the WLS
surgery, so she thought she would contact Blue Cross / Blue Sheild, after
sending in the money and getting her hopes up way high, they sent her money
back and a reasoning from the Insurance company: that they see her as a
liability, due to her weight, she's 5'8 and weighs in at about 360 pounds.
She came over my house last night and started to stress over all of this
bad news. I told her if she was really determined to have the surgery, she
would find the time, and get hired in at either Starbuck's or Home Depot,
She's currently working (2) jobs, 1 has insurance and the other the
exclusion, so I told her to drop one and get hired at a place we know that
covers it.....
She's looking into it..... I'm hoping she doesn't loose the determination.
I love her dearly and would like to see her when she's old and gray.....
Me I'm post op 3 months and down 74 pounds
— tannedtigress
August 30, 2002
I know how she feels. I can't get my insurance company to pay for my
surgery either. Fortunately I'm in a position that I could pay cash for my
surgery. (well, not really but I'm going to do it anyway. That's a problem
with overeaters we always need instant gratification!) My surgeon does the
entire surgery; including all pre-ops, 90 days post-op and 5 day hospital
stay for 17,500. I know that's still crazy money, but it is cheaper than
what most insurance companies have to pay. Also, my surgeon doesn't, but I
did find some who have financing through outside companies. I know it's a
little creepy financing surgery, but if your sister is in a position to do
that, then maybe that's a solution. One more thing, be careful trying to
get an outside insurance company to cover you just for the surgery because
most plans off the street want one year in plan because they consider it a
pre-existing condition. Hey, but one year is better than never. It's so
unfortunate that people have to go through this, it makes me so mad. Tell
your sister to keep fighting and it will all work out in the end. Good
luck!
— denisel
August 30, 2002
You asked if she should be upfront and mention wanting the WLS surgery.
Well, if you were an insurance agent, would you write a policy on a
"burning house". I think not! ;)
Whatever you do DON'T tell them.
— Danmark
August 30, 2002
She can apply for another policy; however, if she has already gone through
the WLS process she may be denied due to a pre-exsisting clause. She may
have to wait a full year before she is covered. I hope is does cover her.
Best of luck to both of you.
— Sarah K.
August 30, 2002
When she applies for insurance make sure she doesn't even discuss it with
the insurance rep. I filled mine out by mail and noticed in the section
that the rep fills out that company specifically asks (in fact REQUIRES)
the rep to disclose any information about the applicant, like medical
conditions, plans for surgery, etc that they may have knowledge about, been
told about, etc. To me that seems a lot like "hear say" to have
a rep add things on by themselves after the individual applicant has
already completed the application, but that's what they do.
— Shelly S.
August 31, 2002
I am at the same place your sis is , and I contacted ins co online and one
called me , a very nice lady and I thought oh well I can be upfront with
her and tell her I might be looking into getting this wls , well then she
got cold and told me they do have a policy that covers part of that surgery
, and when I asked if she could send me out info on that policy she said
she had none . That was a crock . then she gave me a fake web address and
phone no , she told me that if I had any questions to call her. So the
answer is NO DONT ASK THAT QUESTION . But do tell your sis that Im in the
process of going thru my first appeal and I called my ins which is with my
hubbys job and ask why I was denied , they said it is because they do not
pay for wls at all . But she told me I could talk to the company my hubby
works for and have them remove the excullison from the policy . Also I got
on line under wls , and docs and noticed there are a few people that have
had the wls with the same ins as I have. So I believe it all falls in the
hands of the employers . They can have that removed if they want . Tell
your sis good luck and don't give up !
— Rhonda B.
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