i have been crushed!!!!

[Wheetsin 714]

i just dont get it. why would an employer say hey dont cover anyone that wants weight loss surgery.

When it's an employer exclusion, it's because they don't want to pay the extra in premiums that WLS tacks on. When it's a provider exclusion, it's because insurance companies need to see a return on their investment, even if it's just breaking even. It takes a lot of time and saved prescriptions, etc. to see that. Now consider that they aren't just looking at it from the individual perspective, e.g. "we saw a return on John", they're looking at it from the group persective, and maybe even regional. The bottom line is that most insurance companies aren't seeing a return for their outlay.

I second the submission. That way you can know for sure why it was exlcuded. If it's a provider exclusion you'll have more room to dance for an appeal. If it's an employer exclusion, there's virtually nothing you can do, short of begging your HR department to add it to the policy... which probably isn't going to happen.

But don't give up. Is there any creative financing that would work for you? Can your mom or other family loan you the money? Can you afford an installment loan for it? It really is soo worth it...

Hang in there. This too shall pass.

[Stevee 0]

i recently got divorced and was stuck with all the bills that he and i had together. therefore all of my income and my now g/f's income is going to bills and bills only. there is no extra. the reason my mother is so upset is because they can't help me. my mom was fired, for no reason, from her job in february and has yet to find a new job. i have a very low income family there is no wealth in my family at all. i know there is somone out there that would finance me to get this done however i dont thing that getting a loan that i know i can not afford is wise. ya know?

[becca4uf 0]

I am presurgery preconsult and my employer also doesnt include gastric procedures of any kind. There were no mixed messages, the first phone call I made they said "No, but thanks for calling today." I feel your pain because now I am going to have to try and finance the whole thing and don't know how I am supposed to do that.

[Stevee 0]

i just cannot finance it. i wont be able to make the payments.. i just can't do it

[ReneBean 3]

Capital One offers financing.

You can also take a loan against your 401k - assuming you have enough balance to do it.

I know exactly how you guys feel. I am so sorry!

[WASaBubbleButt 41]

A lot of people think they can't afford it but in reality, they can. The change in your grocery bill alone will often times pay the $150 monthly payment if it is financed.

[Stevee 0]

ok i have a question for you all... since my employer exludes weight loss surgery i'm checking on getting added to my partners insurance. she has Aetna. I was looking online today at the covered benefits and exclusions and limitations and this is what i found under exclusions and limitations...

"Surgical operations, procedures, or treatment of obesity, except when specifically approved by HMO."

what does this mean?!?!? i'm hoping this is a good thing! crossing my fingers!

[Mrs Husker 3]

The best bet would be to call them. We had to switch insurances back in November here at work. I was on my last appeal with my then current insurance (which I could have stayed with), so I called the new provider and they we very helpful in answering all my questions. I was approved 15 days after I switched. That was almost a month before it took effect.

[Stevee 0]

thank you! i have a call into them right now just waiting for them to call back. i have decided i WILL find away to make this happen!

[Machele 0]

There is usually a procedure code that the dr.'s office uses to get approval/denial from your insurance compamy. I called the dr.'s office and asked what the procedure code was for the band. Once I had the number, I called my insurance company and my husband's company to see if either of them covered the procedure. Once you have the procedural code, it is much easier to get information from the insurance company. Good luck!

[Machele 0]

There is usually a procedure code that the dr.'s office uses to get approval/denial from your insurance company. I called the dr.'s office and asked what the procedure code was for the band. Once I had the number, I called mine and my husband's insurance company to see if either of them covered the procedure. Once you have the procedural code, it is much easier to get information from the insurance company. Good luck!

[Daisalana 33]

I was told originally my provider (BCBS of AL) covered gastric bypass only. Then I was told they cover both, if you have the records of 5 years overweight and 6 months of medically supervised dieting. Then, when I went to the doctor, she pulled up my invididual plan and said, the company I work for does not cover it "You must be at a small company with less than 50 employees".. I said no, we actually have about 100.. but... she led me to believe it has to do with the size of the company you work for. I wasn't put out, because I was already going in there as a self-pay. I was told my insurance didn't cover lap-banding regardless.

When I went to our consultation there were about 8 of us. Several of us using BCBS, and they got us all indivial information for our plan. Most of us would have to jump through hoops to get gastric bypass covered, but no lap banding.. which is another reason why a lot of the women in there were going with gastric bypass. One woman had Federal Mogul(sp??) and their list of requirements were minimal. You had to have a comorbity, and so she was able to get signed right up. I always thought BCBS was the best insurance.. but hum..

[lrw26 0]

I am sure someone made a mistake at the doctors office and that is such a shame. I also thought mine was covered and talked to insurance several times. Turns out our plan also had an exclusion so no chance of getting coverage. Some people told me they were sure there would be a way around it but after alot of frustration I realized there was not. I was also crushed for a while and let the whole thing go. A month or so later I decided I had to find a way and was able to finance it. I figured this was the most important thing in my life right now as I am sure you do. I know how you felt when you got that news but maybe you can work something out somehow.

so my doctor called me yesterday and said i am covered my insurance i just have to provide 6 month diet history and 5 yr weight history. so i have all of that i've been calling the doctors office for 2 days now they FINALLY called me back a lil bit ago and said "i've called the insurance 3 times and they say its not covered i dont know who called the first time and found out it was covered and put this in your file but you were mis informed you aren't covered." then got off the phone me... to leave me balling my eyes out uncontrollably. how can they do this to a person and have no remorse! they had me so excited and now have crushed me!!! my mother is pissed off! so she called the doctor and they said they can't help what the insurance company says and my mom said you can help what you say. and they said well we'll send her paperwork on how she can pay for it herself. my mom said don't bother she can not afford it!

i am so hurt.. i dont know what to do. i feel like my heart has been ripped out of my chest!!!! please someone talk to me.:help:

[lrw26 0]

yes that is a good thing!! means it is covered if approved by them, you may have to jumpt through hoops but it will be worth it...

ok i have a question for you all... since my employer exludes weight loss surgery i'm checking on getting added to my partners insurance. she has Aetna. I was looking online today at the covered benefits and exclusions and limitations and this is what i found under exclusions and limitations...

"Surgical operations, procedures, or treatment of obesity, except when specifically approved by HMO."

what does this mean?!?!? i'm hoping this is a good thing! crossing my fingers!

[Stevee 0]

i called member services at UHC originally and they told me it was excluded by my employer. but i went ahead and went to the seminar and had the surgeons office try it. so when she originally said i was approved i was leary but still very excited. so when she then called and said oops i wasn't shocked but still crushed. so now i'm working on gettin on at my g/fs insurance. with the exclusion saying except when specifically approved by HMO i see hope. so i called Aetna member services and was told i have to speak with ACCORD HR which is who handles my g/f's benefits, so i called them. she said "no i dont think its covered" i said well i kinda need to know for sure. i said it states blah blah blah which to me sounds like in certain instances it is covered. she said "well let me check and i'll call you back"

why are people so quick to tell you no instead of finding out for sure! isn't that in their job description of CUSTOMER SERVICE! grrrrrrrrrrr