Insurance woes, Appleton area doctors

on 1/1/11 2:40 pm
New here and wondering how many of you were covered by insurance plans that had strict exclusions for weight loss surgery/treatments....  I have United HealthCare through work and they have and exclusion.  How does one go about appealing or fighting this type of exclusion or is that even possible?  Any advice would be appreciated.  I looked into this once before about 7 years ago, was all ready for surgery and Humana told me my policy changed at midnight before the final approval met and the surgery was no longer covered.  Needless to say I was devastated.  Need to do something though, I am 40 and over 300lbs.

Also anyone recommend a surgeon or program in Appleton area? 
on 1/2/11 2:41 am - WI
I have Blue Shield Anthem. They will not cover any surgery for weight loss. I have serious back issues due to my weight and they will cover my 6th back surgery, but not for weight loss. I REALLY DON'T want anymore back surgery so I have opted to pay myself. If I can get back to work and my normal life it will be worth it. The total cost is $6,700 for the gastric sleeve. I'm having it done out of the country so the cost is much less then in the USA. I did a great deal of research before I made my decision and am quite confident I made the right choice for me.
Nic M
on 1/3/11 3:28 am
May I ask where you're going to have your sleeve surgery done? I'm looking into having it, as well, after a failed band surgery. My insurance is also one of those that should skip over the benefits covered in their info and just have a big "NO." That's about the extent of what they cover! 

Are you planning on Mexico?


 Avoid kemmerling, Green Bay, WI


on 1/3/11 6:38 am - WI
Hi Nicci,
Yes, I am having it in Mexico. I have researched the Dr and the hospital and have faith in both of them. It is with Dr. Jose Rodrigues at INT Hospital in Tijuana. The price is less than half of what it would cost here. Dr. Rodrigues is listed on this web site. The total cost is $6,700. It's a lot of money for me because I've been off work for over a year with a neck injury. Now my lower back is bad because of the weight. What I want more than any thing, is to get back to work. Losing 80 lbs would take the pressure off my back and several other  issues caused by my weight so I can go back to work. I'm schedules for the 21st of January.
Nic M
on 1/3/11 2:05 pm
Hi Ina,

I'm a goober... I just noticed your doc's name under your avatar!

I've been looking into Dr. Aceves in MX. A friend on this site recommends him highly.

I'm so sorry you have a neck injury and bad back. Hopefully the WLS will help in relieving some of the pain. I wish you the very best of luck with your surgery. I hope it goes perfectly well for you!

I had a very bad lapbanding experience and have regained all the weight I lost. I think the Sleeve seems like a much better option for long term success.

Thanks for the info. It's good to have as much as possible! 



 Avoid kemmerling, Green Bay, WI


Lori P.
on 1/17/11 8:48 am - Chilton, WI
Call Midwest Bariatrics and talk to Julie Scott, she is the insurance gal and can answer any and all questions.  They are in Neenah very close to Appleton 920-725-4527 - I highly recommend them......
Nic M
on 1/18/11 5:35 am
I just got off the phone with United Healthcare All Savers Insurance Co. They are my insurance company, as well. It appears that they don't take it on a case by case basis... comorbidities play no part... it seemed as if it would be nonproductive to expect anything from them, unfortunately! The lady I spoke with was very nice but said that they never cover WLS. I asked, "Never, no matter what? It doesn't help to appeal?" And she said, "No, we never cover that."  I don't know... do they always say that, hoping that you WON'T appeal? Or would be wasting our time if we did?

I'm now looking into getting a surgical loan because I am not really sure what else to do.


 Avoid kemmerling, Green Bay, WI


Lori P.
on 1/18/11 8:26 am - Chilton, WI
Never say never - this is insurance companies ploy.  Call MW Bariatric office and talk to Julie, it sure does not hurt to try no matter what!!!!  It really can pay to check out every option!
Nic M
on 1/18/11 12:22 pm
Thank you, Lori. I think I will keep trying with the insurance company... at least a time or two yet. Who knows? Maybe it will fall on the "right" person's desk... it happens in movies! 

I would like to have my surgery with Dr. Santiago Horgan in San Diego. He's the doctor who saved me when my lapband almost killed me. I trust him completely and I've contacted him to ask for any advice he can give me.

If that doesn't work out, maybe I'll look into MWBariatric. I appreciate the info very much.



 Avoid kemmerling, Green Bay, WI


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