1.012 steps forward, 1 step back...

So I'm starting to get used to the idea of *really* having an opportunity for a brand new life, and I get off my duff and start making some phone calls to a Dr. I'm impressed with.  (FYI it's Dennis Smith in Marietta GA).  They're encouraging and helpful and so on, and Dee (the office mgr.) tells me "the next step is to call your ins co, ask them SPECIFICALLY if they cover "gastric bypass surgery for morbid obesity and its complications". I do, They don't. Spefically Excluded. No way, no how... Question one: should I take this at face value, and plan on self-pay? Or is this standard operating procedure for ins co's to weed out any who are not committed to running their gauntlet? Silver lining: My wife has BCBS of AL and we can choose that as primary provider enrolling in Aug to begin in Oct '08, and I've seen a BUNCH on this forum covered by BCBS of their respective states. So, in conclusion, (harumph harumph)    I'm rather philosophical about this whole bailiwick into which I find myself engaged... Wishing y'all a great holiday weekend! The big Fig newton

I don't believe they would tell you you have a exclusion if it weren't accurate, could be wrong. But the same with BCBS some and I say some policy also have exclusions. Ask for a copy of your insurance policy in writing also with your wifes at least then you have all the info on hand to make your decision. If you decide to pay out of pocket most WLS hospitals can direct you to who they commonly use for loans. Sorry to be the negative person on such a emotional subject. Take care C'ya Bob

An Exclusion is sort of the deathnail for coverage. But, BCBS of AL? They are a little odd. We have a lot of folks (a few dozen or so) from Alabama cross the stateline And have their surgeries here in Mississippi, Because, for some weird version of their policy, BCBS of Alabama, WILL cover them if they have their surgery here, But not if they have it there. Could work in your favor. I'll ask some folks at my support group on the 10th If they have some more specifics on that, And pass on anything I find out. It sounds like you are going about making this life change the right way. Treat it like a full-time hobby. Stay on top of every possible lead, And something is bound to work for you. (I tend to take the shotgun approach to challenges.  Even if I'm a little off, I'm likely gonna hit the target with some of it.) Hope you get some breaks along the way. Best Wishes- Dx

All insr co handle it a little different... But,, its not the company to worry about its your policy... I ran into that same problem the first time I got into all this..BCBS while working in social services and I gave up right away.............. Later I talked to some people about it who adv me not to give up so quickly..... I have heard of people who have been down this road who have gotten approved for surgery so it might be worth it to investigate it further. The question you might want to ask is IN WHAT SITUATION would this type of surgery be approved.. You may want them also tell you where in you policy it explanes such and exclussion exists. If its not in writing I dont think they can enforce it. You might get the same answer but it might be worth it to ask in that manner. I have also heard of people in that situation who got approved because their Doctors were willing to contact the insr co personally and plead their case.  I dont know if any of that will help you.. But, good luck I know it an awful thing to go threw.. Especially has much sole searching you had to do just to get to the point of asking.

Thanks for the words of encouragement and support, guys! Dx, that doc I'm looking at's in GA across the line, so that might play right into the scenario you describe.  I feel like Dr. Eeevyil in Austin Powers, rubbing my hands together, biting my pinky (okay, that's a little...creepy), and conspiring towards World Dominance. Anyhoo, treating it like my current hobby is about right.  I'll just keep learning, making inquiries, and throwing mud on the wall to see what sticks.  Something's BOUND to, eventually. I'll just hold on, keep playing the chess game with 'em one move at a time.  Sooner or later, it's Checkmate.  Bwahahahahaha!

Don't give up to easy is really good advise and so is asking your ins co under what conditions they will pay for it. While the ins co won't specifically lie to you it gets to be a word game. They won't pay for WLS but they might pay for treatment of co-morbidities. 

It took me 2 years to get mine done. 

My suggestion is to see if you can get your insurance to cover your surgery or switch to another insurance policy for coverage.  The Bills for my surgery came to about $50,000.00 according to the bills of what was paid that my insurance company sent to me.

Good Luck!  I have seen many posts from people who took on their insurance company and got their surgery covered.  Just be the "squeaky wheel" and see what happens.

Jim 

It might not be your insuracne that has the exclusion, it may very well be your employer. Alot don't want to pay for the WLS option, so they exclude it. I fought with my HMO for over a year before I switched to BCBS PPO was approved in 9 days. It can/will be a long frustrating journey but well worth the payoff in the end.

The employer chooses what coverages they want to buy here in Ohio. Our employer excluded WLS specifically in all shapes and forms about 2 years ago in all the policies. You might check to see if your wifes employer policy does the same or if you have a different insurer with your employer if they cover it. We had a choice of coiverage at one time but now they all exclude it. This has been a trend here in Ohio among employer and many of the larger employers are excluding WLS from their coverage. Sad really because they would rather pay the long term cost than give people a shot at being healthy.

Never give up, it as taken me four years to get an approval. for a number of different reasons. The best thing you could do is investagate your wifes insurance see if it has coverage and what you need to have to get approved. If you need a six month doctors supervised diet start it now so then you can have that done and get in before the insurance changes. This happen to me a number of times. by the time I finished my diet my insurance changed and wls was no longer covered. Good luck and never give up the fight. With all the good that this surgery does it is bull pucky that insurance won't cover it. If you end up going with self pay look around and make sure you find one that you are comfortable with. MrBill