Question:
My Insurance is thru my husbands union- self funded....need help.

My husband's Union is a self-funded type insurance. I called to ask them what was needed for this type of surgery. They told me is was not covered. This was on the phone. Today I composed a letter telling them of my health problems and showing them that they are paying $612.00 per month for meds. Is there anything else I can do to help convince tham that this surgery would benefit both of us via my health and our expense?    — Cindi H. (posted on May 9, 2002)

May 9, 2002
Where you denied due to an exclusion? You need to find out why you were denied and address the problem from that point. If you do not have a benefits booklet request one so that you can check what their policy is or call and ask them what their policy is on wls and ask for it in writing so that you can proceed with an appeal if necessary. Much luck to you. I got denied by my insurance company due to an exclusion that does not address morbid obesity or gastric bypass surgery. I have retained the services of Walter Lindstrom and have mailed my "packet" to him for help with my appeal to the Board of my husband's employer which is also self-funded. I hope to hear more about it soon. Much luck to you.
   — Mari T.

May 9, 2002
Hi Cindi, I had the same problem as you did. My insurance coverage is with the state and is a self-funded program as well. Weight loss surgery, programs, or medications were/are all written policy exclusions for me. I talked to "them" numerous times and never got anywhere. I guess I could have taken a chance, hired an attorney and tried to pursue it that way but my co-morbidities had gotten so bad that I felt I could not wait anymore. We took out a bank loan and I became a self-pay patient, had an open VBG in Dec. 2001 and so far am down 76 pounds, needless to say my co-morbs are much improved! I do know that more and more insurances are covering WLS because the costs of medicines and other treatments for the morbidly obese are so high. Do everything you can to try to get your insurance to pay. Sometimes the old saying "The squeaky wheel gets the most grease" is really true. Best of luck to you!
   — esthjb