disappointed and hurt

[thickinphilly 1]

Change you change your insurance for 2011 to one that will cover it?

humpty dumpty

i wish it was just that simply.my employer only offers insurance from aetna and i have ppo which is the top and aetna still only covers 80% the other 20% of it is all on me. the surgury is $26,000 and 20% of that is $5200.00 and then i have a $1650.00 deductable that i knew i had but $7000.00 i don't have and won't have. i will keep trying staying hopeful in philly

thickinphilly

[MINI-Me 196]

humpty dumpty

i wish it was just that simply.my employer only offers insurance from aetna and i have ppo which is the top and aetna still only covers 80% the other 20% of it is all on me. the surgury is $26,000 and 20% of that is $5200.00 and then i have a $1650.00 deductable that i knew i had but $7000.00 i don't have and won't have. i will keep trying staying hopeful in philly

thickinphilly

Just a thought here ... and maybe this was already investigated ... But how much does Aetna allow for the surgery? If it's lower, then you 20% would be for the allowed amount, not the billed amount. For instance:

• 
  
  
• Billed: $26,000
  
• Allowed: $15,000
  
• Deductible: 1,650.00
  
• Aetna 80% Pay: $10,680
  
• Your 20% Pay: $2,670
  
• Your Total Out of Pocket - $4,320
  

I know it's still a lot, but it's less than the $5,200 + $1,650 deductible you estimated.

[weightnomore 8]

There are doctors in the United States that do it for a lot less than $26,000. Was it that recent news show on the sleeve where the doctor said the surgery is now $13,000 at his hospital? Maybe you could travel within the USA. I would also call Aetna and ask them to tell you what your cost will be. Like someone above stated, perhaps the way they figure it is different than you were figuring. They have a name for an estimate like that. They call it a "Plan of Care" or something.

Lastly, maybe next year your employer will offer more options and you can take a lower deductible, lower co-insurance plan for one year, since the higher premiums would probably pay off.

In any case, there is always hope and God can always make a way. I will pray that he does.

[rain 2]

I would try tthree things here:

(1) CLINICAL TRIAL. There are a lot of them going on now, often at some of the top hospitals. It is a lot of work, you have to look on the main government clinical trials web site. Go here and type in several different phrases, like try "bariatric surgery" or "surgical weight loss" or VSG... keep trying to see what is out there. http://clinicaltrials.gov/ct2/search

Often, they pay YOU to be in these trials. I was in one for a year and a half for weight loss drugs, but they do have surgery ones. Look on the web sites of local hospitals, as well, some of them post their ongoing clinical trials on their web site. Weight loss is a HOT HOT HOT topic right now, and they might have something.

(2) Try a different hospital. Any hospital that is a Center for Excellence will be approved by Aetna, if they are in their network. All you have to do is have that doctor switch the insurer.

(3) APPEAL your case to Aetna... you say it is "elective surgery," but not if it is a medical necessity, which is what you have to prove through your BMI and/or co-moridities. Then, I think they might pay 90%... check your policy... and APPEAL.

Don't give you your dream, fight for it!

And, if worse comes to worse, get a part-time job on the side and start saving money. If you haven't lost weight in the next year or so, you can still have that surgery, and by then, who knows.. the cost may even be less!! Look at how the price of lap bands fell over the years.

Good luck to you....

[Becca 108]

I will pray for you! I know how your feel. I had an exclusion and paid $8,000 for a lapband that didn't work. Even though I have coverage now, I still have a $2,800 co-pay for my revision. Are you sure the hospital won't allow a payment plan? I would think they would rather have a payment plan than to not cover the surgery at all- since they will still get plenty of money from the insurance. I would call and speak to someone at the hospital and explain your situation. Don't give up!

[thickinphilly 1]

I will pray for you! I know how your feel. I had an exclusion and paid $8,000 for a lapband that didn't work. Even though I have coverage now, I still have a $2,800 co-pay for my revision. Are you sure the hospital won't allow a payment plan? I would think they would rather have a payment plan than to not cover the surgery at all- since they will still get plenty of money from the insurance. I would call and speak to someone at the hospital and explain your situation. Don't give up!

Becca

i spoke to directly to the bariatric coordinator and she is the one that gave me the info about all money being paid up front because it is considered "elective surgury" i will not give up someone on the site said they are going through a program right in NY which is no where from me the function within the Aetna network so i may look into that. i also signed up to be notified about grants for 2011 so i will keep all my options open and see what happens. thank for your support.

[pumpkin07 32]

When God closes a door, he opens a window.

You'll find a way, or its not meant to be...either way goodness will be in your future.

DON'T give up on your dreams. Be resourceful, save money like a fool.

Do a fundraiser for you. I know this guy that does fundraisers for my school. He said he has individuals that do their own fund raisers like selling magazines or chocolates or gifts (I know, kinda counterproductive). They earn 40-50% He even has a guy that works his way through college just selling magazine subscriptions.

There is a way.......fight for it. Do something outlandish. You'll get there.

[determined1 3]

I'm so sorry to hear - must be devastating. I will pray that you get your surgery. Good luck girl- dont give up!

[Josey 0]

hello everyone

i feel back from the site because i received some disappointing news about two weeks ago. i will not be able to get my sleeve. finally i thought i would have a chance of being a normal size not. I found out that there would be a $7000.00 out of pocket expense that i just simply can't afford and this is with insurance. I don't have the option of a loan no one in my family has this kind of money to loan ( i wouldn't any way no way to pay back) there is just no way i live check to check and $7000.00 is a lot of money. i knew there was a $1650.00 deductable which i was fully aware of and ready to pay but i was forgetting about the 20% that Aetna will not cover it just completely slipped my mind. I was told because this is elective surgery all moneys had to be paid up front. it took me this couple of weeks to finally except the fact that i would not be able to have the surgery. i know some of you would suggest mexico still a cost of $7000 to $8000 same difference i can't afford it. this is worst than being denied by the insurance company at least you can appeal that. i don't have and won't have the money that i would need to pay for the surgery. i was so encouraged i thought i would finally have a some what of a healthy body. yes i can go on a diet and i can lose 50 or 60 pounds ( not a lot when you need to lose 140) but i will gain it all back plus some just as i always have over the last 20 years. i am 330lbs with a bmi of 53 and looks as if this what i will always be. sad in philly

thickinphilly

[Josey 0]

I am sorry to hear of your money problems but just to let you know I had to go to Mexico ( because my insurance did't cover it) to have my sleeve and I wish I had never gone. You always hear of how wonderful it is and I would just like to say it's not alway a great experance. 6 wks. in and 30 lbs. lighter and having difflculty keeping anything down. I regret having the surgery.

Joesy