Insurance Advice PLEASE!

Hi, I live in Spartanburg SC and need weight loss surgery. I am 36 and have extremely high blood pressure, type 2 diabeties, sleep aphnea, and now my left kidney is hurting very bad, the doctor thought it was stones but after ct scan he now thinks it is damaged from the sugar and high blood presure. My insurance is Humanna Choice care and it will cover the surgery, however, the company my husband works for is Swift Transportation, at big trucking company, and they say that they wont cover it. It is a overwrite or something. Does anyone know if there is any thing I can do about this? I have lost a little over 10 lbs, but when you have as much as I do to lose that is nothing. I have 4 young children that I want to be around for. I just feel so desparate. Thank you for any advice and all prayers! Sincerely, Tonya

Okay, do you have a copy of the benefits booklet from your husband's job? If you don't have one, get one if you can. Each employer selects what they want to put into a contract with an insurance company. The employer can choose certain things to include or exclude. Some companies choose to exclude any treatment for morbid obesity, including but not limited to surgery, diet programs, etc. The benefits booklet from the employer should detail what is or is not covered.

Hey Tonya, My insurance Aetna Choice POS II did not cover it either. However, when I called them asking if there was anything they could do to help me I was then told about Clinical Policy Bulletins they had on their website. All I had to do was to go to that site and print off the requirements and read it over and I meet all their requirements. However, when Dr. Byrne's office sent it in the first time I was rejected and had to do a 3 month PREOP program and then I appealed it and was approved. You said your insurance will cover it. So even if your husbands wont, please don't let that stop you. I was even looking into the possibility of paying for it all myself. By the way, Dr. Byrne has negotiated with MUSC and they have a set price of about $20K for the surgery no matter how long you stay in the hospital or if you have complications. I am ending up paying $2K+ out of my pocket even with my insurance. Good Luck. Jen