trander27

I started this process on Aug of last year calling my insurance and emailing to see if Bariatric surgery was covered. We even re-checked after Jan 1st to make sure coverage had not changed. They said it was if certain condition ect.. I did their 6 month structured diet etc... My surgeon verified my coverage, I have it in writing from them. I just finished all my testing and requirements and I could visualize getting a date. Now when I went to find out why they denied my paying on my psych visit they say morbid obesity is an exclusion entirely ! Nothing is covered. They are really sorry that no one figured it out until now. They will pay for all the bills up to now for their error but that anything else will be denied. Of course I am beyond devastated. If anyone has any advice or has heard of something like this ? They are saying that's it !

Freaking Terrible ! I know you will win your fight too and I am sending you good thoughts and kick a_ _ vibes ! What I have re-learned and confirmed in this process is that nothing this important and worthwhile is usually easy and it will be that much sweeter for you. After having an amazingly easy and pain free surgery I am filled with such grattitude even to my horrid insurance company and all the rest has fallen away even as I continue to have to ride them since they are not paying the claims lol. Fight on sister, wishing safe and healthy travels

I feel you on this arrical8 Always great to read posts where people really go into this with head in the game and feet on the ground. Love the attitude !

They are going to make it right After 7 months of misquoted benefits CareFirst is going to honor their mistake and grant my surgery. I just want to thank all the people who take the time to post and write thier stories. You just don't know when what you write may change or save someone's life ( maybe a little dramatic but true in the case of morbid obesity). It was trending towards better news late last week. I found a really human CSR named Amber who was amazing and helped me, she was calling my surgeons office for codes etc... Anyway it can happen as you all have said. I was never covered and now I am getting surgery kind of crazy. The advice and the post I read where spot on and encouraging and that is so helpful. As a by product it also gave me voice with my VP of HR. Since waiting for surgery I developed pre-diabetes. I was able to ask her why they would make bariatric surgery a plan exclusion when it would cost them between $20-$25k a year if I become a full blown diabetic each year ! Why they would cover 90% of all fertility procedures and abortions but deny something that for many will be life saving. She had no answers for me but it felt good to express my concerns and I am writing a letter to our CEO as well.

So until this am I have been completing reqs for 7+ months for someone other person's policy even though I have from them 7 times in writing that my plan covered gastric sleeve. Anyway after the shock has warn off I have spent the day reading all your great post. I am still doing research but after looking at forums on 3 sites an getting stats I am leaning towards Cordova or Ortiz. My question is scheduling, because I have spent 7 months on this I cleared time and can have coverage at work as long as I have my surgery by early May, Is that do-able or wishful thinking ? I really can't tell you how much I appreciate this forum and the time you all take to post. I could have never learned this much this quickly on my own. Thanks

I continue to love this forum and the advice is so helpful. So I asked for everything in writing and responded back with 19 pages of documentation and the names and titles of 7 different associates at CareFirst that pulled my benefits and verified them to discuss my case. Just for good faith I got two extra names from my surgeon and a copy of their verification as well as from the phsyc eval. I have had 4 phone calls from CareFirst today and 2 emails The 1st just being another apology and stating that it was a mistake but that I was excluded. As suggested I used words like egregious error and system wide, epic failure for 7 plus months. I explained I now have two "almost" co-morbidities as I waited this 7 months which is true and documented in my file. That I made medical decisions that I would have made differently, I have other costs associated now not to mention the time and mental anguish. I now have adult onset asthma and pre-diabetes All advice from awesome forum I told them I would pursue this in anyway, I appreciate their kind response but an apology and addressing the issue with their associates was not going to be a satisfactory resolution and that I will be extremely diligent in pursuing this in and all ways available to me. This last call was better, moving in a more hopeful direction. They have a meeting with today, a tribunal of sorts she called it to discuss my case and how this could have continued to happen, they will be reaching out to my plan admin as well. I told her to read the email with a CSRII when I was getting frustrated trying to get "exactly what needed to be submitted for WW structured diet". The CSR responding shared with me she was going through the process of bariatric surgery as well and understood my concern to get all the documentation straight. I said ask her to imagine after 7 months this happening to her. The Supervisor said I don't have to because I had lap band last year and I know I would be devastated. You just never know do you sorry long post but just feel like I need to give back in case anyone else goes through this, had I not had all your posts to read I would have been lost

Thanks, good info. I am looking at Mexico after a 7+ month insurance nightmare

As I thought my surgeon's office said there is not much to be done, they are not much of a help. As I have said the surgery was never officially approved, it was being submitted today. I just had verification of my benefits stating it was covered based on requirements I have spent the last 7 months following to the letter. I think this forum is so helpful so I am posting more than I normally would in case this can help someone else avoid this issue or better prepare. I really admire that you all take the time to do that. I have 7 different emails from CareFirst documenting what is covered in my policy. I called as well on 4 other occasions as well as documentation from my surgeon. What they are telling me is that from Aug 24th 2014 on 7 different occasions through 1/19/2015 the reps did not pull my policy but a general policy. They did not check my plan specifically and my plan it excludes anything related to morbid obesity. I am finding all this very hard to believe of course but it's getting realer. Anyway the only not entirely helpful advice I got post drama from the insurance coordinator at the office is that I should have gone to my human resource office and gotten the info directly from them. My god I don't know about you all but my HR team is neither human nor resourceful and talking to them about something like this would not be my 1st choice. I read these forums, learn form you all and I made sure I had this all in writing after reading the crazy stuff that goes down. That said I wish I had gone down to my hr dungeon and dealt with the HR beasties, I was vain,embarrassed and worried they would think "oh great there goes are premium". Anyway still taking all the advice given and asked the surgeons office to submit so it could be officially denied. I have sent Carefirst emails asking them to reconsider and copied the 18 pages of correspondence between myself and their so called agents. I have my complaint ready to send to the GA Insurance Commissioner on stand by.

I can't thank you enough. Those are good idea's. I asked for the person I talked to put all this in writing and I will contact the state commissioner and see. I thought the same thing the denial was for the psych eval and that would be no big thing but it was for everything. She said I have been reading your correspondence and I have to tell you NOTHING with morbid obesity is covered and we have made errors. I have 5 emails stating my benefits and clarifying them and numerous calls as well as my surgeons office verifying insurance. I just finished testing and my surgeon has not submitted the surgery for approval, that was to happen today. Because of this forum I know I have to be pro-active so I was watching my insurance claims as they came in and caught the eval denial. I am not sure I can appeal the denial since it was never covered and a mistake ? I am waiting to hear back from the surgeon office, they are less than all together and don't inspire a ton of confidence. It is a bariatric center for excellence but from their office staff I don't get that feeling and the person who normally deals with insurance is out on maternity leave. Reeling from the shock and really appreciate the posts. Regrouping and will challenge it anyway I can and if not mentally packing for a trip to Mexico. I will never give up this fight with obesity !

Hey yet to be sleeved, just ya know casually obsessing and not very patiently waiting for insurance. But think that's a great idea. When the crane can free me from my lair, I am totally in. Totally kidding, my humor goes dark when I am feeling a bit stressed and this waiting has been maddening.

I did mine really quickly so he did not have time to check to see if my insurance would go through. He told me it would be $356. I have to imagine their are cheaper ways to go but I was rushing and I was pretty sure my insurance would cover it.