Question:
I have been denied ALL the way around....Help!
I dont know where to turn anymore. I promised myself if things didnt work out with my insurance I would not be upset.....well I was only fooling myself. I felt so let down and depressed at this moment. Its truly sad, it truly is! My husbands insurance denied me, BC/BS of Louisiana PPO. They have a written exclusion in there policy that is specific about NOT covering surgery, regardless of medical necessity. I am planning on writing a letter to his employer about changing policy but what can 1 spouse of an employee do out of 3000????? I feel so discouraged. THen I thought well I will just get a policy alone, individually, pay for it myself and be covered....what a joke that was! The company I called wont insure me because I am overweight and dont meet there guidelines! Other than contacting my husbands employer I dont know what else to do. How can an insurance company say they wont cover it regardless of medical necessity?? Thats like saying....regardless of whats wrong with you they wont cover it, we dont care. SO then I continue to be unhealthy and continue going to different doctors fro things that would be corrected once I had WLS??? I know there are many that feel my frustration....I just dont know where or what to do with it right now. And on top of that, my mom, who is only 58 and never been overweight in her life had a stroke Saturday. It has scared me to see her that way and it has scared me to what I have to look forward to if I dont do something about my weight.....I am feel so lost right now and I am normally a strong person. I would love to get response from people and encouragment, please email me. Thanks for reading my vent..... — lesleeloo (posted on December 5, 2001)
December 5, 2001
Hi Leslie...Don't give up yet. I was denied first and have an appeal in
and my husband's company also had an exclusion. What might save me though
is that Maryland adopted a law 10/1/01 saying that weight loss surgery must
be covered like any other surgical procedure regardless of exclusions.
So...my suggestion: call your State Insurance Commissioner and talk to
them about their knowledge of LA law in this regard, also ways to get
around this with medical necessity; if you hit a dead end, go to the
Attorney General and talk to your legislators and work to get the law
changed. Thats what happend in Maryland and this AMOS site is a great
place to get support to do that. If you find a light in any of those
places, write a strong letter of request from YOU stating the importance of
this surgery to your health, longevity, comorbidities, diet history
etc...use buzz words I'm told like: You are not doing this for appearance
or cosmetic reasons but to live; Get your bariatric Dr to write a strong
letter, your Primary Dr., if you see a psychologist...anyone who can
support medical necessity. I'm still waiting to see if my efforts will
work but I'm not giving up even if denied again...good luck to you! Andrea
— AJC750
December 5, 2001
Without sounding really rude, Can you get a job at Walmart,or any other
place that has insurance? Most companies offer insurance after 3 months.
I looked for Aetna cuz I knew they USUALLY covered WLS. I changed jobs,
because I was denied and I had worked in the same place for 12 years. but
I really, really wanted WLS. so I up and left to find a company that had
Aetna insurance. At this point you need to do all you can do if you really
want WLS.
I even tried Walter, but he said he would TRY, and I probably would've got
denied again AND weighed 50# more.
Keep your chin up.
— Cindee A.
December 5, 2001
I know the previous poster was only using Walmart as an example---but it
was a poor choice. I have read several posts that Walmart is notorious for
NOT having WLS coverage in their insurance. The idea, however, is not
without merit. Just be careful of the type of insurance offered.
— [Anonymous]
December 5, 2001
Leslie, the answer is simple, contact the Lindstroms, Walter &
Kelly.They are a law firm that does nothing but make insurance appeals.I
had an HMO and just got back from surgery last week. Try their website at
obesitylaw.com, or call at 619-656-5251.They are swamped, so if you call it
may take a day or two for a response.E-mail is better for them.They have
reasonable set fees and are the only law firm recomended by the American
Bariatric Society. Be patient and it will pay out for you. Good Luck, Greg
— Greg S.
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