I'm giving up ...

[Candle 11]

I hate to say it but I'm giving up the insurance battle ... really before it began. Thanks for all the advice and info from everyone here. I probably won't be visiting this site any more ... I think it's depressing me even more and I'm getting very jealous (and dare I say bitter) when seeing people complain about having to do the 6 month diet or pay a co-pay or or or ...

Anthem BC/BS won't cover the band since it's an exclusion w/ the small business plan. I contacted a few lawyers and other than send me paperwork to fill out and a BILL, can't really get them to talk to me and give me any REAL information and/or odds on beating the insurance co. I big fat BOOOOOOOOOOO to all those lawyers who advertise they want to help you and have the band themselves .... if they really wanted to help, why I have I not gotten ONE call back in two weeks?!

My employer said if I wanted to purchase an individual health plan they would pay $400 per month of it (that's what they pay for my BC/BS plan) and I'd pay the difference. I've only found one plan for less than $750 per month here in NY. It was with GHI and only $415 and they cover the band but ........ they don't cover doctor visits .... no co-pay or deductable ... they pay $0. What the hell is that? If I just get sick, have any complications, etc they pay nothing?!

I called 2 doctors today and s/w the insurance person in their offices and both recommended NOT even trying to start the process with the intention of trying to fight my insurance co through appeals. (since it's an exclusion on my plan.) I guess they are right. Why pay for all the up-front doctor visits, 6 months with a nutritionist, seeing a shrink, etc to only be denied anyway?

If I buy one of the expensive plans there's no guarantee I will get approved for the band. I doubt it would be a problem: I have a BMI of 48 and a number of other health issues. I'd have to jump threw hoopes and between co-pays plus the extra money every month for the policy - I could get the band in Mexico or CO for close to a year or two of those fees with no hassle.

If I purchase the cheap policy w/ GHI or try and fight BC/BS, it will be pretty much the same thing since doctor visits aren't covered.

Self pay is not an option right now since we wiped out our saving buying a house (that still needs some work) last year and I already have credit card bills that keep me up at night.

I've done about 6 months of research on the band and really had to talk myself into accepting that I need some help getting my weight under control - under permanent control. Kinda surprising since I've been overweight my entire freakin' life - lol. It never even occured to me that my insurance company wouldn't cover this. I feel like going to the doctor for every little sniffle now to rack up the bills they have to pay for what IS covered -lol.

Back to WW on Monday I guess ...

Thanks for listening.

[BabyGotBack 0]

Sorry to hear about it. The only way I got my band was as a self pay and I refinanced my house to do it. That may be an option somewhere down the road!!

[in_denial 0]

My employer said if I wanted to purchase an individual health plan they would pay $400 per month of it (that's what they pay for my BC/BS plan) and I'd pay the difference. I've only found one plan for less than $750 per month here in NY. It was with GHI and only $415 and they cover the band but ........ they don't cover doctor visits .... no co-pay or deductable ... they pay $0. What the hell is that? If I just get sick, have any complications, etc they pay nothing?!

You should do some more research into this plan. I bet this is a catastrophic policy with a high deductible. It could cover the majority of the procedure.

[TracyinKS 7]

Candle! I am so sorry to hear this, but I can so very much relate.. my mom has anthem and they too have the exclusion.....

Good luck with what ever journey you go on.

[piercedqt78 658]

my insurance also excluded the band. It was listed as experimental and I was told by the ins rep that a snow ball had a better chance in hell then I did for coverage. I fought it, it took 3 appeals, and I was getting ready to go to a state appeal (an outside review board looks over the appeal) and I was approved. Several people have since been approved with the same company. I called Walter Lindstrom (www.obesitylaw.com) and they didn't even want to touch my case, I as told that my ins company was very difficult and I would probably not win. When I got approved I called them back and they were amazed. If it's possible try to submit for preapproval and see what happens, a good surgeon will have an insurance person to help you appeal. It doesn't cost anything to submit and appeal. It just might be worth the effort, I know my battle was worth every tear, sleepless night that I spent trying to get approved. ~Mandy

[Candle 11]

I'm back ... I think my tantrum/break down is over - lol - *blush*

Thanks for the kind words.

You should do some more research into this plan. I bet this is a catastrophic policy with a high deductible. It could cover the majority of the procedure.

I am looking into it a little further. The office for the doctor I am interested in using, is going to have their insurance biller call me back on Monday to give me a better idea of what my out of pocket expenses would be.

I also need to check with BC/BS to see if I re-join my current plan in a year (after the surgery) and have any complications, they will still cover me.

[Elisabethsew 50]

I had my surgery done by the MD you're with and the office does everything they can to get you help with the insurance. I found that I too had to be proactive and called the insurance company and began asking questions. I was originally denied but then got letters from my MDs and asked to speak with my case worker who was VERY helpful. I won the appeal and had the surgery. Keep exploring insurance options, even if you need to carry double insurance for a few months.

[2bthinagn 3]

Don't completely give up. More insurance plans are going to have to start covering this. It is being proven, by all the results that is NOT experimental. You may also get a tip on here that helps things work out somehow for you. I was stopped in my tracks a year ago (different situation that caused it than yours)

I know how depressing and frustrated it can be. Good luck and take care.

[Alexandra 55]

Candle, what state are you in?

[beachgirl 2]

Don't give up just yet, maybe everyone on here can put our heads together and can come up with something that could help. I too had bc/bs and so I had to self pay and they don't even pay for any fills, fluro, nothing and I've been out about 15k so far. I wiped our savings account out and we're in the middle of building a house so it will take longer now to finish it. What about 2nd mortgage or capital one health loan, it was at 2 percent. My surgery in Mexico was just 8500.00 with free fills for life and it's 7500.00 all this month. Pm me if I can help you any and good luck.