Defeated & sad :(

[Meglvn100 2]

So when I began this process one of my first questions was, how much out of pocket? My lapband financial coordinator contacted my INS co & they told her that I'm 80% covered w a $500 deductible. She also told me that w their team they waive the excess 20% so naturally I was like ok let's do this! Well today the financial coordinator called me & said that whomever they spoke w from my INS gave them the wrong benefit information! So for a whole month I've been moving forward w the process ie: sleep study, endoscopy, psych evaluation, nutrition consult, travel expenses etc... Also come to find out that my Dr is not even in network for my INS! My only options now are to pay out of pocket, change to a different Dr who is in network, & even then I don't have as much coverage as I thought, or cross my fingers to get financed for everything. I am at a loss. I know I don't have enough to pay out of pocket. I really loved my Dr & team, & I'm not sure I could get financed. I feel soooo utterly defeated & sad today I'm beside myself. It was such a huge life changing decision in the first place & now to have it all taken away by someones mistake. Please if anyone has any knowledge of how to work this out I would greatly appreciate ANY information or ideas.

[Phranp 46]

So when I began this process one of my first questions was, how much out of pocket? My lapband financial coordinator contacted my INS co & they told her that I'm 80% covered w a $500 deductible. She also told me that w their team they waive the excess 20% so naturally I was like ok let's do this! Well today the financial coordinator called me & said that whomever they spoke w from my INS gave them the wrong benefit information! So for a whole month I've been moving forward w the process ie: sleep study, endoscopy, psych evaluation, nutrition consult, travel expenses etc... Also come to find out that my Dr is not even in network for my INS! My only options now are to pay out of pocket, change to a different Dr who is in network, & even then I don't have as much coverage as I thought, or cross my fingers to get financed for everything. I am at a loss. I know I don't have enough to pay out of pocket. I really loved my Dr & team, & I'm not sure I could get financed. I feel soooo utterly defeated & sad today I'm beside myself. It was such a huge life changing decision in the first place & now to have it all taken away by someones mistake. Please if anyone has any knowledge of how to work this out I would greatly appreciate ANY information or ideas.

First, what kind of insurance do you have? I had the same thing happen to me TWICE. My PCP sent me t a wonderful doc and his team was really great ... only to find out they were out of network. So I checked the website for my insurance and found another doc (I have BCBS). Once the new doc started the paperwork they found out that he was no longer on my insurance! So I found yet another doc ... I was careful and made sure he was on my insurance ... jumped through every hoop. The date was set and about a week before surgery I got a call from his office, they told me that my surgery had been cancelled because the surgery center that the doc uses (whichalso had a contract with my insurance) refused to accept my insurance because they said BCBS does not pay them enough. They just flat out refused! I couldn't believe it. Finally I searched and searched and found a general surgeon who in turn found a hospital that accepted what my insurance and was willing to pay. I had my surgery 2 weeks after the original date that had been set.

When all this happened I was disappointed just like you, at first. But I kept plugging through because I was determined to have this surgery. I am so glad I did. Check with your insurance directly and ask them where on their website you can find their policies for this surgery, then get to work making it happen.

Keep your head up, all is not lost. It may take a little footwork on your part, but you can make this happen.

All the best to you!

~Fran

[Erika78 1]

You have made one of the biggest decisions of your life, to get banded!!! Don't let these bumps in the road, make you lose your sight at your goal. I can completely understand how you are feeling. I just found out my surgeon's group is "out-of-network", but him personally is "in-network". What it boils down to is, if insurance co. pull this crap, many people will just give up and the ins. co saves ALOT of money. Keep pushing and Good Luck!!!!!

[Meglvn100 2]

Fran & Erika

Thank you for your kind encouraging words. I really needed them. My family & friends are really supportive, but to hear it from those of you that have expeirenced the emotional rollercoaster of the decision is very helpful.

Fran,

My INS is BCBS also. My biggest hurdle that I face is that my INS only covers $7500 (I know I say only like that's nothing I do realize it is better than nothing) but I am then faced w how to pay for the rest of it. I plan to contact my INS co. My financial coordinator filed a formal complaint against them & she recommended that I do as well. My only thought on that is what good is it going to do me. I think that the reason why she wants me to is to help them get paid for all the tests I've done already. My plan is to call them to find a Dr in network for me, contact the Dr & figure my options of excess payment. My other concern is if all the tests I've had done are transferable, were yours?

[NewStart95987 35]

Meg,

I'm so sorry to hear about it. I too had many hoops. Long story short (or even longer), I had my husbands insurance and spoke to the benefits coordinator on SEVERAL occasions who assured me all was well and told me to keep proceeding. I did the phsyc consult, nutritional visit, pre-op lab work and scans, surgeon appointments and all. I later found out that WLS was NOT covered through my husbands insurance and that everything I had done, I would have to pay out of pocket.

The coordinator called and apologized which I appreciated but that didn't help me and the bills I had not accrued. My husband pays hundreds each month for insurance that won't cover ANYTHING related to my WLS. SUCKS!

I cried for a couple minutes and decided I would wait (this was in October) and sign up for benefits through my work starting January 1st when I could enroll. I did this and had to start some of the process over.

It's so frustrating and I could never get a straight answer as to what EXACTLY to do and how the process worked, I was going in blind and couldn't take another denial.

I finally had paperwork submitted back to my new insurance and called 2 weeks later since I hadn't heard anything. I found out I was approved. My insurance- Anthem Blue Cross- will cover 80%, I'm still paying $6000 out of pocket. Luckily I recently pulled out a loan to pay of Credit Cards and such and asked for an extra $3,000 to cover part of surgery. The other $3,000 I owed, I paid with Care Credit Accounts. Money doesn't flow in my house. My husband works full time and goes to an expensive tech school full time. I work full time, have pay cuts from my company filing bankruptcy, doing 2 jobs for not even minimum wage. BUT knew I had to spend the money.

While I may be in debt the rest of my life, this is what I had to do.

Where there's a will, there's a way. You'll make it work. Look over all your options and speak to every person at your insurance if you have to. GET ANYTHING YOU CAN IN WRITING! I had a problem because of this!

Sadly, you have encountered hoops like I did but don't get discouraged! It just may take a little time. I know easier said then done, you make a life altering discision and want action fast, I had to wait over a year from the PCP referral to my surgery date. You can do it and you have tons of support right here at your finger tips on the forums.

LOTS of love and the BEST to you!

[Diva01 1]

Please don't give up! I have wanted this surgery for 4 years. I started out on my mother's insurance trying to get approved only to find out they did not cover any wls. Recently my employer switched insurance companies and they cover wls. I feel like God has given me this chance and I will not go down without a fight. Currently, my max out of pocket expense is $2500. However, the insurance new year starts Sept 1st, any wls will have a $5,000 CO PAY on top of my deductible of $750 plus my out of pocket max of $ 2000. So right now, I'm fighting to make sure everything happens before Sept 1st.

I would try to find a surgeon that is in network with your insurance company. Try checking out on the board if anyone has been banded by any of the doctors in network with your insurance company. Just make sure you feel comfortable with your dr and staff.