lynmar

Hi all! I have a question about insurance policies purchased through your employer (UHC in particular). For the last 3 years I have been trying to get a policy that will cover surgery. I have researched, talked to people both at work and the insurance company, and made phone calls until I'm blue in the face. I even offered to get an additional policy and pay more for it so it would not cost my employer any more money.The policy that my agency has says that bariatric surgery is not covered even if medically necessary. I have a team of doctors who are behind me 100% and 2 even wrote great letters for me on why I would greatly benefit from this and what has been successful and unsuccessful for me in the past years. The question I have is because surgery is excluded from my plan, would an appeal even be worth it? Has anyone ever done an appeal in this type of situation and had it change the outcome? Just want to know if there is anything I can do because I can not afford private pay up front which is what the hospital would require. Any help or suggestions?

Thank you both for the quick reply! I will look into some of the different financing options you mentioned to see what is available to me. My insurance company has told me that they will not pay for any WLS even if it is medically necessary and/or recommended by a physician, which to me makes absolutely no sense at all. As far as having the surgery in Mexico...now that's something that never crossed my mind. I would really have to look carefully in to that option as I would be a little fearful of going so far away from home to have the surgery...but I will definitely not completely throw out the idea. Thanks again for your suggestions. They give me some more options to look at for myself.

I am new to this forum but glad that I found it. I have been lurking for a little bit and decided this might just be the support I need. I have not had any surgery yet but I was finally convinced that going to a general meeting on WLS at the hospital might be a good start to decide what I really wanted to do. After that meeting and many discussions with my Endocrinologist (who is on the weight loss team at the hospital) and several other doctors, I decided that this is the way I wanted and needed to go. The next step was to make a call to my insurance...and when I did I found out that my policy did not cover bariatric surgery (or weight loss meds for that matter which I have been paying out of pocket for years). I was devastated after I had put so much thought and time into this decision to be shot down like that in a matter of minutes. For 3 new insurance years I went through the same ritual of trying to convince my insurance that this was needed, trying to get different policies offered to my workplace or for them to offer plans that include WLS, trying to find supplements, looking into self pay, and the list goes on and on. So here I am to see if anyone else has had this same experience and what if anything can be done to get WLS approved.I am sure that I am not the only person to face these obstacles. I am looking into trying to appeal this decision next, but not sure how to go about it since it is plainly stated that the surgery is not covered. I already have a good team of docs and an approved hospital. I have already lost some weight on medications, but have reached a plateau for years and it doesn't seem to be going anywhere. I am desperate to get help as I have quite a few medical issues that are related to weight. Any suggestions? I'm open to hear them all!