Question:
Should I continue?
I have seen the doctor. Qualified for surgery. Need to get letter from PCP, letter from pyschologist, etc. to send to insurance for approval. I know they don't cover 100% so I called for self mind to find out what % I will need to cover. My insurance company tells me they don't cover any! Should I stop now or have the doctors fight for coverage? Do insurance companies tell you this but will cover later after the doctors letters for approval? Need Help! — Alisha R. (posted on August 13, 2004)
August 13, 2004
If your policy has an exclusion against WLS, your changes of getting that
overturned are slim and none. However Blue Cross is changing their policy,
I've heard and is across the board discontinuing WLS effective 1/1/2005.
Check your policy to see if it's just not covered via an exclusion or
you're getting a line.
— Cathy S.
August 13, 2004
Alisha,
Insurance sucks. (Well, except when they cover something that I want them
to!!! LOL!) I went through denial with TWO insurance companies - and
ended up self-paying. You know - it's up to you - to fight or not. We did
- ended up asking an attorney who specializes in this very thing - and he
told me to save my $$ and self-pay - I didn't have time to lose to get
surgery. He was right, and I'm so thankful for his honesty. I ended up
going to Spain and Dr. Baltasar for my surgery - it was the best thing that
ever happened to me - getting denied by insurance that is! Hey - if you're
anywhere near Houston - there's a group that has gone (or is going to) to
Dr. Baltasar for surgery that meets. In fact, I live in Oregon - but will
be visiting there for a get together Sept 13th. Let me know if you want to
meet up with these guys - they're great!
Blessings,
dina
— Dina McBride
August 13, 2004
DO NOT GIVE UP! If you are serious about persuing this, try
www.obesitylaw.com. I live in CT they are located in California. I spoke
with them on the phone, after speaking with them they felt I would not need
to hire them if I followed their advice and I have since been approved and
had surgery. While I realize everyone situation is different and I am by no
means telling you they can get it approved for you, there really is no harm
in talking to a lawyer there. I spoke with Kelly Brown. Her husband
started the firm after having been put through the ringer himself for WLS
surgery. Read their website, very informative. I say you have nothing to
lose...ustilize every option.
Good Luck to you!
Sherry S
— sac287
August 14, 2004
Please don't give up so easily. Insurance companies are notorious for doing
nefarious things to protect their profits. Think about it this way. If a
customer service rep telling you the surgery isn't covered stops you from
purusing the procedure, that ~ $20 or $25 thousand dollar a year employee
just "saved" the insurance company amount equal to or greater
than their annual salary. If you were the insurance company, what would you
instruct your customer service people to tell people who called about the
surgery? Fight your way through the whole process; jump through their hoops
and force them to deny you. There are many many situations where the
insurance companines can be compelled to pay for the surgery. Don't give up
until you've exhausted every possibility. Check out the obesity lawyers
others have recomended here. I'm in the same boat, and my policy has an
exclusion; I look at it this way, we are fighting for our lives. If we
don't fight for it, who will?
Best wishes, and don't let the insurance company off the hook so easily;
that is what they are counting on.
Fitz
— Biggestfitz
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