Got denied not sure what to do next HELP!

[ELLYMAY 0]

Hello all you out there in band land future and present bandsters. I need some advice I feel lost and hopeless , I guess hurt more than anything because I had my heart set on getting banded. I just called my insurance company after attending a seminar and found out that my policy excludes all obesity related surgeries and treatments. Talk about feeling like I had been slapped in the face, I felt the sting before I hung up the phone. I was crushed, I was suprised because most BCBS of Texas policies cover the lap band procedure. They informed me thay my husbands employer choose not to cover anything obesity related. I feel that this is really dumb considering what they will spend covering all the other health problems due to obesity high blood pressure, diabetes, knee replacements etc..... Sorry had to vent thank Goodnes for this site. What my question is should I try to appeal something like this since it clearly states that it is excluded from the policy? Should I hire an attorney $ limited? Could this be considered a form of discrimination? Should I forget all of this and just try to find a way to finance the surgery as a self pay? As you can see I am very confused and frustrated any help or input would be great.

[3loves 0]

I really do feel bad for you and feel your frustration. :cry I am still trying to work with insurance, but after today, I'm thinking I may be facing a battle. I really don't know how to guide you since our insurance covers the band if they decide to give approval. :phanvan I'm sure there are others on here that can offer advice after being down similar roads. I just wanted you to know I feel your pain. Hang in there and keep your chin up b/c your worth it!! :clap2:

[Morsaille 4]

I am sure it is discriminatory, but I went self-pay after they added the written exclusion to my policy. Check out Obesity law if you are looking to make the world a better place to get help. I didn't have the fight in me. http://www.obesitylaw.com/

[Wheetsin 714]

What my question is should I try to appeal something like this since it clearly states that it is excluded from the policy? Should I hire an attorney $ limited? Could this be considered a form of discrimination?

This is my limited understanding as it applied to the general insurance world.

If the employer has specifically excluded the coverage, then there is nothing to appeal unless you wanted to write a letter of appeal to the employer asking them to consider changing their coverage for you, which they won't, because it's something they do to reduce premiums. Appealing to the insurance company does nothing because it's not something the employer has purchased. That would be like if you bought a base model car from a dealer, then complained to the manufacturer that your car didn't have a sunroof.

IMO there's nothing to hire an attorney for. It's 100% up to an employer what coverages they want to purchase and what they don't. There's also no discrimination in it - what coverages an employer opts to purchase is 100% that employer's business. Not choosing to buy WLS coverage isn't discrimination against the overweight anymore than a $50 copay is discrimination against people who don't have $50. They aren't doing it specifically to treat you any differently... there's no discriminatory intent there. Some employers have incurance policies that exclude x-rays, but they aren't discriminating against people with bones.

Not good news, I know - but when the denial comes b/c it's an employer exclusion, there's not a lot of room to play with. If the insurance company denies you, you have a lot more room and substance for appeal.

[Morsaille 4]

This actually makes ME feel better because I can let it go. I have been feeling weak and stupid for going self-pay. Knowing that a month or year of fighting would not better my chances lets me know I did not waste time, effort, and money NOT losing weight. Thanks Wheetsin, and sorry ELLYMAY. I would recommend my doc in Mexico, Dr. Kuri http://beliteweight.com they are friendly, cheap, and cover after-care.

[ELLYMAY 0]

Wheetsin,

Thank you for your post. This helps clear up a lot of questions I needed answers to. I didn't understand the whole appeal thing, figured it was as you stated, but wanted to make sure. I have been so upset with all of this denial that I knew that I had to check out all avenues before taking out a loan as a self pay. Congratulations on all of your progress, can't wait to see where it goes from here!

To all of the other people who posted thank you for taking the time to post. It really means alot to see that you are not the only one in this this situation or that people just care enought to encourage you. Thanks to you all!

[picardy3 0]

Ellymay,

I am so sorry to read that your employer does not cover wls. That sucks big time! :angry PM me if you need to blow off steam. I'm hear to listen.

Audra