Denied. Service Not Covered.

[ArcusX 216]

Mexico baby... $4500 covers all surgery expenses, ground transportation, two nights in the hospital, and three nights in the hotel. The doctors are super experienced and all is arranged through American companies.

The thought of Mexico scares me, to be honest.

[ArcusX 216]

Don't give up dude, There are ways to get this done. Peer to peer, letter writing, even OOC (more affordable). Just keep at it, it will happen!

What is OOC?

[JennyBeth 127]

Good luck!

[ArcusX 216]

I drive a 12 year old Jeep, instead of replacing it soon, we invested in me. I'll be the sportscar!

Unfortunately for me, we bought two new cars last year, and paying around $1k/mo between them.

I wish I could put my wife back to work! lol

[moregoodtimes 331]

Yep...it is worth asking doc about making "an arrangement" with you. I had to wait and switch insurance at open enrollment time, but surgeons office said, at the first appt, that if I ended up with no coverage to make sure to talk to them and not just disappear.

Good luck... Truly wish you the best. Hang in there...you never know what is just around the corner.

[lessofmeismore 1,405]

Hopefully this doesn't cause you problems with HR at work.

I'm not sure what basis the coordinator is using to try and get an excluded procedure on appeal.

I know the last go round cost you 1,000.00 dollars...

They should have verified before starting.

[ArcusX 216]

They should have verified before starting.

Supposedly, they did. She told me she had the name of the person who verified coverage too.

[Geminidrive 389]

Arcus, see the link below, this may assist you:

http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/what-to-do-when-youre-denied-bariatric-weight-loss-surgery

Good luck!

[johnlatte 1,232]

What is OOC?

Out Of Country - Mexico!

[Butterthebean 8,146]

Most doctors here in the States have a "cash" price for people with no insurance. Some are a better deal than others. Many have partnerships with organizations that specialize in financing surgeries.....if you don't want to go to Mexico, this could be your option.

[ArcusX 216]

Most doctors here in the States have a "cash" price for people with no insurance. Some are a better deal than others. Many have partnerships with organizations that specialize in financing surgeries.....if you don't want to go to Mexico, this could be your option.

My eyes read, "cash" PRIZE. LOL.

I guess cash/finance could be an option, but I think it would be a while...

[jac1970 39]

Arcus, until I read all the way through the thread I was going to say that your company is prob at least partially self-funded and thats why gastric surgery is excluded-- they can pick and choose to exclude alot of high dollar surgeries to keep their costs for the corporation's insurance as low as they can.

[Tvorceskiy 6]

I too have Cigna through an employer. Although the employer claims that the surgery is 'cosmetic regardless of medical necessity' instead of just 'too risky'. I'd rather go forward at this point and discuss payment options should it come down to it. At this point I can't get insurance elsewhere because of the weight and my comorbities and even if I did it would end up costing more to get another insurance plan.

Think of the money and time you put into it thus far as something less to do later. Your surgeon's office seems to be ready to fight for you! And from what I have seen on this forum they generally win *knock on wood*!

[jac1970 39]

I'm pretty lucky because I work for a HCA hospital and have Cigna. Everyone I know here who had had either sleeve or bypass have all been approved. Maybe they figure it's cheaper for them in the long run.

[ArcusX 216]

Your surgeon's office seems to be ready to fight for you! And from what I have seen on this forum they generally win *knock on wood*!

Yeah, she said she wins about 50% of appeals. Not hanging my hat on that one, but I'll be patient.