Watching and never posted......Here I am

NurseTeresa · January 27, 2006

Hello everyone and congratulations on your successess! I have been reading posts for a few days now and was so glad when I found this site. I am in the starting process of this whole thing. However, I have realized that more insurances then not, mine included are not covering any sort of weightloss surgeries medications etc. Where do you start when trying to fight them to get this covered? Where do you find financing for the surgery if they continue to deny it? I am a nurse and work on a surgery trauma unit and we are rolling out our barriatric section of our unit in feb. I have been to several seminars offerred by the companies that do the teaching to the Drs. regarding all of the surgeries. I was so excited when we found out that the banding was going to be offerred at our hospital. As I want to take the less invasive procedure so that if complications occur it can be reversed. Please help me on where to start.........it is all so frustrating. Anyone else feel the frustration?

Alexandra · January 27, 2006

Hi NurseTeresa! Welcome to LBT!!

Where you begin depends on your insurance carrier's reason for denial, and of course with your medical testing. On the one hand you will have to be screened and tested no matter what, so get started on that process. Choose your surgeon and find out what preoperative steps you have to take before submitting a request for pre-cert.

Once you have your denial from the carrier, you should be given appeal instructions. Depending on where you live you may have the right of third-party appeal, or you may be able to appeal to your employer. Dig out your insurance contract and see what they say about who makes the decisions. Take it step by step and don't be intimidated!

Tess L · January 27, 2006

Welcome, before I began, I called my insurance company and asked them to send me every thing in their weight loss & healthy living section of the policy my employer had. This included not only weight loss but discounts they gave to gyms or weight watches. I reviewed this and went from there. Good luck

NurseTeresa · January 27, 2006

Thanks for all the wonderful advice. Lapband vol #1 would be a great thing however they are not doing anything like that as I already asked for that position. They said that since the practice is an established one and just changing hospitals that is not any option. As for the insurance...I started by calling and asking about what sort of weightloss procedures they will help pay for and they said NONE!! I then had to wonder why would a hospital have insurance through a carrier that will not cover any weightloss procedures at all or discount a gym memebership let along drs appts for any sort of prescription weightloss. Just makes no sense. However, I will take your wonderful advice and check with HR and see about petitioning for a change in the policy and to see if they will approve it. Again thanks for the help and appreciate anymore anyone has to offer!

ReneBean · January 27, 2006

Your doc has to specify MORBID OBESITY and MEDICAL NECESSITY. If you don't specify MO - nobody covers anything.

Call the insurance again - ask if they cover WLS for MORBID obesity if the procedure is deemed medically necessary. You might (hopefully) get a different answer!

Also - if you work at the hospital - don't they have some kind of employee discount and/or financing plan? Maybe they can take some payment amount out of your paycheck for the next 5 yrs...

Also - Capital One offers financing for "cosmetic" surgery and they include WLS under that category.

good luck!!!

NurseTeresa · January 29, 2006

Thanks ReneBean for the insite on what to tell the insurance co. My family doctor would very well state that with out a problems since I am undergoing several health issues most from my weight. Lord knows I have tried ever other "diet" under the sun and have ran out of options. Working third shift makes it hard to eat the way one needs. Sure would be easier to take a bite and run and take a bite and run. Will also have to check out with the hospital if they will do a payment plan. I do know for co pays to other surgeries they will do the $100.00 over two pay periods but that is about it. However, I do know that there are other hospitals in the area that will do payment plans. A good friend of mine who had WLS is about to have a Tummy Tuck and the girls lifted and her hospital is going to do it on payroll deduction over three years. Again thanks for the help! It is all greatly appreciated. I will share this with a co worker who is also wanting to have the Banding done. I am trying to get her on this site to check things out for herself.