i have been crushed!!!!

[COLLECTOR 0]

I had the same problem, United Health care called and they told me excluded but as long as employer said ok to cover it and medically necessary and outpatient they would cover. THen started with surgeon to find out "excluded" and no way will they pay. One person at insurance company just said real rudely "we don't pay for obesity". THank you very much. Our company insurance agent told me even if I waited until September when my employer renews insurance it could not be added even if employer said ok because we have less than 3000 employees. Said that most companies will not add until company of that size. I am not sure if that correct or not. I own my house so I borrowed $17,000 to do self pay. Ouch. good luck to you. If self pay not a option really check your new jobs insurance plan out.

[Kat817 19]

My insurance covered it IF you made it through the hoops! I too have BCBS of TX. Which is a pain, because I do not live in TX!!! So many local Dr.s are out of network---a royal PITA!

Anyway, they did cover the banding with certain guidelines. I met the required BMI. I had the required co morbidities, I had the 5 years worth of medical records showing my weight in the obese range for the 5 years. What I didn't have, was 12 consecutive months of medically supervised weight loss, with a bi monthly meeting with a licensed nutritionist. I live in a rural area, there are no licensed nutritionists---not in network, nor even out of network. Once they argued that point for 3 months, they agreed to let my PCP counsel me in nutrition, which meant I was to see him every 2 weeks---once as a Dr, and once as a nutritional consult. I paid my co-pay each visit. I did this for 10 1/2 months. Then I was in a car accident (not my fault), and I was injured. I ended up having surgery to repair my knee following the accident. During the time I was in the hospital, I missed my Dr. appointment. I called and changed it. They knew---my DD is the nurse---but I rescheduled the appointment. Went to it, then to my next nutrition consult, and the office manager called me in, and told me I was going to have to get the nutrition consult approved again, that by missing the scheduled appointment, I was being found to be non compliant in the 12 months issue. It has to be 12 consecutive months, without a lapse. I appealled it, and was told I would be covered IF I complied. They denied it twice....I had no choice I thought except to start over. And then I was going to have to pay some of the other things (sleep test etc.) out of pocket, because they would not cover them again, and the results would be too old the following year!

When I ended up getting a cash settlement due to my injury----I ran to Mexico it felt like to do is self pay! In reality I researched non stop for 2 months, then scheduled it, and had it done within the month. All my tests were done---they did the required EKG, chest X ray and blood work---but the rest they accepted.

It was so worth going self pay! However you can work it---it not only saves your life in the long run, it gives you back your life in the process!!!

Kat

[Stevee 0]

i so wish i could do self pay i really do. i just can't.. my income barely pays my bills. adding another bill on top of that is just not wise. i can guarantee i wouldnt be able to make the payment ya know. ;(

[WASaBubbleButt 41]

i so wish i could do self pay i really do. i just can't.. my income barely pays my bills. adding another bill on top of that is just not wise. i can guarantee i wouldnt be able to make the payment ya know. ;(

This sounds harsh but it's true. When it comes to this surgery if you want it badly enough, you'll find a way if insurance doesn't approve you.

I've seen people get 2nd and 3rd jobs, borrow money, get financing, sell off belongings, and one lady sold her house for the equity. If someone wants the surgery badly enough, they find ways.

Besides, financing isn't as bad as it seems. Just the money saved in fast food and grocery bills often times pays the $150 monthly payment. It would have for me in fast food alone. I just used savings and paid for the surgery in Mexico but others have to really jump through hoops to get the financing.

[Stevee 0]

omg omg omg.. ok here is the latest.. i've talked to the benefits coordinator at my g/fs job and here is what Aetna told her...

"We are instructed to state the surgery is not covered BUT their doctors can certainly submit a pre-determination with all the medical information - clinical, history of tried procedures, current medical problems its causing and the reasons for medical necessity at this time. It can then be reviewed by our medical staff if it will be covered under the terms of their contract."

ok so.. what do ya'll think??? i'm definately thinking its worth a try. now i have to pray that they will allow me to be added to her insurance. at this time not all insurance companys allow same sex couples to share insurance!!!! cross ya'lls fingers! please!

i would say if i can get added to it.. and i go to a doctor the surgeon recommends that supports lap band.. and he submits a statement stating what i've tried and all my weight history and that my bmi is a 46 and that its medically necessary then it should work what do ya'll think!??! i'm so trying not to get my hopes up.

[lrw26 0]

I kind of agree with you, that is what I finally di, there is always a way if you want something bad enough so don't give up. It is worth it and oh yes the money I spend on food is so much less than before.. it is amazing.. .

I've seen people get 2nd and 3rd jobs, borrow money, get financing, sell off belongings, and one lady sold her house for the equity. If someone wants the surgery badly enough, they find ways.

Besides, financing isn't as bad as it seems. Just the money saved in fast food and grocery bills often times pays the $150 monthly payment. It would have for me in fast food alone. I just used savings and paid for the surgery in Mexico but others have to really jump through hoops to get the financing.

[lrw26 0]

Hi again, I have worked in health care for a long time and am familiar with HMO rules etc. They often say that somethign is approved you can do it and that is correct, You just have to do whatever they want you to do to get it approved and that can vary, however in the long run it is worth it. Hoep you can switch..

"We are instructed to state the surgery is not covered BUT their doctors can certainly submit a pre-determination with all the medical information - clinical, history of tried procedures, current medical problems its causing and the reasons for medical necessity at this time. It can then be reviewed by our medical staff if it will be covered under the terms of their contract."

ok so.. what do ya'll think??? i'm definately thinking its worth a try. now i have to pray that they will allow me to be added to her insurance. at this time not all insurance companys allow same sex couples to share insurance!!!! cross ya'lls fingers! please!

i would say if i can get added to it.. and i go to a doctor the surgeon recommends that supports lap band.. and he submits a statement stating what i've tried and all my weight history and that my bmi is a 46 and that its medically necessary then it should work what do ya'll think!??! i'm so trying not to get my hopes up.

[Daisalana 33]

Good luck. I wouldn't get too excited yet, like you and many of us have said, insurance say yes, then they say no, then they say maybe..etc.

I have to lose weight because of my back problems, I've been having to do cortizone shots for years now and it's getting worse, and shots are no longer working. To me, it's worth everything I own to get this done. I am 23 and having a hard time walking, it's very disturbing Not to mention the cost of the shots, which insurance pays for and I would think they'd be happy to have me stop running that tab up on them!!

I am lucky enough to have someone paying for me to have it done, but if they weren't I would certainly have sold my car to pay the majority of it.

[lrw26 0]

lauraj23.. Just had to say that in your picture I see a gorgeous girl.. too heavy yes but I hope you do well and shed the pounds, you will be stunning. Well you are pretty as it is but without the extra lbs even more so. And when you are just 23 you have your whole life ahead of you.

Good luck. I wouldn't get too excited yet, like you and many of us have said, insurance say yes, then they say no, then they say maybe..etc.

I have to lose weight because of my back problems, I've been having to do cortizone shots for years now and it's getting worse, and shots are no longer working. To me, it's worth everything I own to get this done. I am 23 and having a hard time walking, it's very disturbing Not to mention the cost of the shots, which insurance pays for and I would think they'd be happy to have me stop running that tab up on them!!

I am lucky enough to have someone paying for me to have it done, but if they weren't I would certainly have sold my car to pay the majority of it.

[Stevee 0]

just an update.. my g/f's insurance policy does not allow same sex partners to be covered! so again i've been crushed. because her insurance will cover it. grrrrrrrrrrrrrrrrrrrrr

[WASaBubbleButt 41]

just an update.. my g/f's insurance policy does not allow same sex partners to be covered! so again i've been crushed. because her insurance will cover it. grrrrrrrrrrrrrrrrrrrrr

I'm so sorry, hopefully someday people will grow a brain and recognize same sex relationships.

Will you be paying cash now?

[Stevee 0]

at this point no.... i budgeted last night and there is just no room to budge right now. i'm needing to refiance my house because i found out my mortgage is on an adjustable rate is about to adjust on july 1st so i have to get out of it. when i refinance.. i hope to take some extra money out because i am in desperate need of a new heat and air unit since mine is a 1970's model and my roof needs replaced, my dad doesn't think it will last thru another oklahoma storm season..which just started in march!

[WASaBubbleButt 41]

at this point no.... i budgeted last night and there is just no room to budge right now. i'm needing to refiance my house because i found out my mortgage is on an adjustable rate is about to adjust on july 1st so i have to get out of it. when i refinance.. i hope to take some extra money out because i am in desperate need of a new heat and air unit since mine is a 1970's model and my roof needs replaced, my dad doesn't think it will last thru another oklahoma storm season..which just started in march!

Well, keep in mind that after you are banded your food bill will go down drastically. Fast food is out, home cooked will be a fraction of what it was.

I didn't used to cook, the reason I am fat is because I survived at fast food joints. In my individual case, my band will pay for itself in 1.5 years just from not going to Mickey D's and Jack In The Box. I'll save $1500 a year just in Diet Coke alone. If I would have had to do financing my payment would be around $150/month for an $8K loan. I save that easily in just fast food.

Just something to consider.

[Daisalana 33]

Baybee.. I was wondering about your g/f's insurance covering you. I thought that was the big problem right now about getting same sex marriages, so spouses can rightfully insure each other as a heterosexual couple could. I thought maybe you had a very liberal insurance policy or something! My sister is a lesbian and I know her and her fiance have been fighting a lot due to financial reasons that would be helped if they could claim each other.. Does any insurance cover same sex 'spouses'??

Edit to add, not to sound inconsiderate. I sympathize with your situation and hope you can find a way to afford it.

[Stevee 0]

yeah as a matter of fact a lot of policies are starting to do so. when she worked at petsmart it was allowed and my aunt works for sonics corporate headquarters and they just added it to their policy so more and more are allowing it.