I Need Advice

[PhoenixRising8 3]

Hi! This is my first post and it's been a VERY bad day for me. My insurance company told me today that they do not cover ANY bariatric surgery. I was mortified. My doctor has been talking to me for the last six months about needing to do the sleeve procedure. I cannot do lap band for health reasons nor regular gastric bypass [although for health reasons]. I'm on disability and my husband is a teacher. We are on a VERY limited income. Has anyone had ANY success with an insurance appeal? I have to write a letter the insurance company this weekend but don't know what details I should put into it. Any advice would be greatly appreciated.

Thank you in advance.

Blessings~

[GoldyGirl 186]

Have your DR write a letter also, listing any and all health problems you have. Good Luck!

[Newme48 104]

I would talk to your doctor and their office staff to find out how to approach the insurance company. Maybe they will cover if you list comorbidities? You probably already did that. I think your MD or his assistant could be a good help. I also would keep contacting the insurance company. You pay for your insurance so they need to help you. Don't accept no. Keep pressing on. I am new to this, my surgery was on feb 5. I am sure there are a lot of people here that will have more advice or better advice than me. Good luck to you!

[PhoenixRising8 3]

Thank you all! I've just been very depressed today. I don't understand how insurance can opt-out of this type of coverage. It's not as if I'm looking to get a boob job or face lift, i.e. cosmetic/elective surgery. This is NECESSARY! I'm SO tired of having to fight for everything! I've got my seminar lined up for February 27th, which I was told is the first step before the surgeon will see me. My husband told me to keep the appointment. We'll figure something out. It's just so frustrating! He's a teacher and I'm on disability so $15000-$20000 bucks is like a million to us! Tired and weary today.....thanks so much for letting me vent.

Blessings~

[Mastiff_mama 171]

Thank you all! I've just been very depressed today. I don't understand how insurance can opt-out of this type of coverage. It's not as if I'm looking to get a boob job or face lift' date=' i.e. cosmetic/elective surgery. This is NECESSARY! I'm SO tired of having to fight for everything! I've got my seminar lined up for February 27th, which I was told is the first step before the surgeon will see me. My husband told me to keep the appointment. We'll figure something out. It's just so frustrating! He's a teacher and I'm on disability so 15000-20000 bucks is like a million to us! Tired and weary today.....thanks so much for letting me vent.

Blessings~[/quote']

As a teacher our insurance excluded ALL obesity treatment! I too am on disability now and have Medicare. It covers sleeve. .do you not have Medicare with your disability? I too could only have sleeve due to health issues.

[VSGJean 68]

Have you looked into having your surgery in Mexico? That's where I went, because our insurance wouldn't pay for it. I had my surgery on September 21 and I'm down 60 lbs. If you have any questions, just let me know.

[lucky8mb1 167]

My insurance excluded all bariatric surgery as well. There was no appealing - the policy I had simply would not cover it. It seems the options are to either self pay (which is what I did) or appeal to your employer to add bariatric surgery coverage (or see if they can switch policies during the next open enrollment period).

You can always try to appeal, but in my experience - I would prepare yourself for the worst if your policy specifically excludes it.

[PhoenixRising8 3]

Hi, Mastiff_Mama, Yes. Medicare is my supplemental and they told me that they only covered lap band [can't have] gastric bypass [can't have] and the more extreme gastric bypass. So, I felt a little deflated. If you could give me ANY more information so that I could call them back on Tuesday, I'd appreciate it. Is there a specific name other than Gastric Sleeve that I should reference? I've been on Medicare as supplemental to my husband's insurance for seven years. This is all so new to me and I'm just overwhelmed. Thank you for ANY direction or further information you can give re: Medicare. Thanks to all who have responded to me. My husband's insurance co. HR department told me today to write a letter of appeal so I'm going to do that. I don't expect anything from it, but I'm willing to exhaust ALL avenues.

Blessings~

[SomersetCottage 2]

I called my insurance company and explained why my MD & surgeon thought the sleeve was best for me, after giving them the CPT code they reviewed my case and are going to cover my surgery. I'm just waiting on a certificate of coverage from our previous insurance company.

Best of luck!

[Mastiff_mama 171]

Hi' date=' Mastiff_Mama, Yes. Medicare is my supplemental and they told me that they only covered lap band [can't have'] gastric bypass [can't have] and the more extreme gastric bypass. So, I felt a little deflated. If you could give me ANY more information so that I could call them back on Tuesday, I'd appreciate it. Is there a specific name other than Gastric Sleeve that I should reference? I've been on Medicare as supplemental to my husband's insurance for seven years. This is all so new to me and I'm just overwhelmed. Thank you for ANY direction or further information you can give re: Medicare. Thanks to all who have responded to me. My husband's insurance co. HR department told me today to write a letter of appeal so I'm going to do that. I don't expect anything from it, but I'm willing to exhaust ALL avenues.

Blessings~

When did they tell you that? Medicare approved VSG in July 2012. Arkansas, which is in a larger region didn't approve it until Jan, but mine was ready to go as soon as it was approved and I get sleeved Monday! Check again. I can't have the others either....its an nsaid thing....its very common for many to only be able to have this surgery. But Medicare DOES cover this surgery.

[PhoenixRising8 3]

Thank you, Somerset!

[PhoenixRising8 3]

They told me yesterday, Mastiff_Mama. I started to cry when she said they only covered three types of weight loss surgery and she didn't list the sleeve. I will call again on Tuesday and specifically mention VSG. I appreciate your assistance and will certainly keep you updated.

Blessings~

[Mastiff_mama 171]

Billing code is 43775

[Mastiff_mama 171]

They told me yesterday' date=' Mastiff_Mama. I started to cry when she said they only covered three types of weight loss surgery and she didn't list the sleeve. I will call again on Tuesday and specifically mention VSG. I appreciate your assistance and will certainly keep you updated.

Blessings~[/quote']

Are you in AZ?

[Mastiff_mama 171]

They told me yesterday' date=' Mastiff_Mama. I started to cry when she said they only covered three types of weight loss surgery and she didn't list the sleeve. I will call again on Tuesday and specifically mention VSG. I appreciate your assistance and will certainly keep you updated.

Blessings~[/quote']

They are flat wrong!!!! Fight 'em!