LONG VENT ON INSURANCE EXCLUSIONARY POLICIES

  I have been a RN for 30+ years. Paid taxes, insurance etc.. In 2011 paid 23K cash for VSG.  And now need another 23K for the DS.  Now I hear go  to Mexico, I cannot because of heart, pulmonary medical issues and I have a brain tumor. Need to stay in St Louis near my team.  I am still working on cardiac clearance (more testing on 2/7/12)  But the hospital Des Peres Hospital (a Tenet hospital) will NOT budge or work with me on a payment plan , only want FULL cash or cashiers check to schedule my OR.  I have cashed in everything I can, save like a fiend, lived like a pauper (I have taped and re sewn clothing together) Drive a very old car etc... short of selling my home , which would be difficult in this market.  I can only come up with 18K.  I feel so hopeless, depressed I really do not want  to live if  this IS THE  best body/health I get in this world.  If you have insurance and they want you to jump through hoops feel blessed they will even consider paying for  your surgery.   I work for Coventry health care and they have an exclusionary policy and would not even discuss the DS and it value on my health.  Just hung up on the surgeon. Said "exclusionary policy"  Oh my oh my.  I worked so hard to get the first 100+ off and keep it off and it feels to no avail.  Maybe tomorrow will be a day filled with more hope.  thanks for listening. Maja

I am so sorry. =(

I am really sorry.  There are insurance gurus who have helped people but I'm not sure if even they know how to overcome exclusionary policies.  Are other WLS allowed?  Can you pick another insurance during open enrollment?  Can you get another job with insurance that WILL cover it?

I've heard that part-timers at Starbucks get this WLS covered.  I know for a fact that they get insurance I'm just not sure what it covers.

Hope.  Don't loose it.

~BJ

I am doing the only job I can physically do as a nurse. Starbuck? are you kiddingme? I can barely walk with my walker into the office building and sit down to work all day on the computer. No WLS is even considered, exclusionary mean NONE all is excluded as they put it if I had a stroke or lost a limb from diabetes they will pay for cardiac rehab or a artificial limb but no wellness program to stop the onslaught of heart disease or diabetes. They will give re imburse us for Weigh****cher $100 bucks and for that is all it is a program to watch my weight go up and up. No other choice of insurance with Coventry. You get what they give you.  Thanks for the reply Maja

Please, PLEASE go post this on the Main Board. Newbies still in the decision-making process need to understand how hard it can be to ever get a second WLS.

this is what your employer values.......it is the employer that decides what it wants to put in it's policy.  EXCLUSions are very difficult to overturn, pretty much impossible.   In an essence you have a contract that you have agreed to.  Essentially anything can be an exclusion, and if you the subscirber agree to it, you are agreeing to that binding contract.  Overturning this is almost impossible.  I would suggest getting a job that covers what procedure you are looking for, or seek an attorney that is familiar with obesity law, but I still think this is a losing battle.  Jan 2013 my insurance policy changed to EXCLUDE ALL obesity surgery, and it goes on to state all obesity surgery, so I competly understand, and it ****** me off.   this is the way of the future, I have seen more and more insurance cos put this exclusion in.  I wish you the best in doing what is best for you health....