Question:
Run... Smack... Block Wall! Can ya relate?

Now I know how those pre-op's feel waiting for their insurance approval! My insurance won't even let my PCP put in the referral for me to see a surgeon unless they have 3 letters from weight loss sources (diet's), that I've tried & failed with. I've got to hand it to my PCP; she has really tried everything to go around it but, insurance won't budge! So... I've got one letter already and in order to get the other two, last night, I picked up a month's supply of Meridia & Xenical - total cost $289.99 and of course... insurance won't pay for any of it! Wow.. you should see all the side affects on these two! But.. I'm willing to give them a try and if the insurance doesn't accept the letters, I'll probably take a loan out and go for a cash pay.    — Peri B. (posted on July 28, 1999)

July 28, 1999
Before you try those side effect laden drugs out just to prove that you have tried something and failed, check your insurance policy carefully. It SHOULD provide coverage for WLS under certain conditions: ie. sleep apnia, diabetes, respiratory problems etc. If you have any of these medical conditions have your Doctor appeal to the insurance company. They are being quite unreasonable in demanding letters from weight loss sources since most insurance companies I know of accept the Physicians word regarding everything a patient has tried for weight loss. Besides, do they expect you to get letters from the makers of Slim Fast, the authors of diet books, or from the editor of a magazine that featured a popular diet plan??? C'mon now! How silly can you get? It Sounds like your insurance company is trying a "delay and stall" tactic to try to discourage you! If this doesn't bring positive results, contact the Independant insurance arbitor for your region and outline your case, medical history, personal declining health experience, and suspicions regarding your insurance carrier's handling of your case in a straight-forward and intelligent manner. Do not directly "bash" your insurance carrier, but criticize them subtlely, saying things like..."I know they are trying to keep costs low for all of their clients, but in this case it seems that they are more interested in their own financial bottom line than in providing adequate and medically necessary care for this patient..." You get the idea. The most important thing is DO NOT GIVE UP!!!! The insurance company is just trying to wear you down! I know from experience that they can be fought and made to comply since I have fought against my Ladyfriend's insurance carrier through an arbitrator. Not only did they compell the insurance carrier to provide her with WLS services but also gave them a scathing admonition against denying medically necessary benefits to obviously qualified patients. So it can be done, but sometimes not without a lot of hard work and persistance. Good luck to you, and keep us posted!
   — Frank W.

April 4, 2001
I have Health Net and I found out that they cover Xenical for the morbid obesity. You should not have paid the full price. Check your coverage in your health net book because they do cover it. good luck !!!
   — Laura G.