What Would You Do?

[Leederz 49]

I have wellmark bcbs and was denied twice and it took me about 8 months to get approved it was through the external appeals process they finally said yes.

[Shelly-NO-Belly 15]

I wound up paying cash...kind of. I got a loan. I didn't have insurance at all. I stayed in the US, but it cost $17,000. I went to Michigan and I live in Indiana. The first hospital I considered charged $60,000 JUST FOR TWO NIGHTS in the hospital...so I saw $17,000 for everything a bargain...plus they have the highest excellency in the area...the first hospital was still pending. It is a big loan, but so worth it. It's got low interest on it because my bank is amazing- and nothing was going to stop me from getting the surgery LOL No regrets at all!

[lisahg 9]

My first denial was at the end of August and I was finally approved in Mid November. So the process of filing 1 internal appeals and 1 external appeal took just over 2 months. That's not a terrible timeframe compared to some appeals stories I have heard. I would lie, it is hard to wait and for things to be in limbo, with something you want to happen, like yesterday lol. Highmark totally irks me in respect to other things with my health care so i love when I hear they are made to cover services people deserve.

[Wheetsin 714]

You know my thoughts on the band

Given the options you're presenting, I would go to Mexico. UNLESS I truly believed that once I lost weight, I'd be able to keep it off on my own. Then I might consider the band. But I would assume it was a temporary implant, not a permanent fixture.

I'm kind of like you. I had set a timeframe for this. If I'd been denied, I was going to appeal once. If that appeal was denied, I was going to self pay. I did not want to spend 8 - 10+ months appealing only to never be approved and essentially be out 10+ months of time. Yes, that's "giving up" in a sense. But to me, it was more a matter of how much is my time worth? If I could pay $12K (my selected surgeon's self-pay cost), and know I would get the surgery, or wait 10+ months and know I still might have to pay $12K anyway... it was worth it to me.

(Actually if denied it would have been for fightable causes, so I was going to self-pay, and then go through appeals, and if approved fight them for reasonable & customary reimbursement)

[aldmb2 24]

I'm not sure my family will support me going to Mexico. So, I will be looking into self-pay options, if the call from my surgeon does nothing.