Do they make more if insurance pays?

[Aliciafl2014 57]

I'm going through a center that does WLS with local Drs who also have their own practices. My insurance company recently denied my claim as I don't have co morbilities. I'm ready to self pay but center wants to keep pushing for coverage. I am getting really frustrated at this point. I'm wondering If there is a benefit to them if insurance pays rather than me paying? There must because I don't get it. I'm ready to go somewhere else.

[2muchfun 8,927]

Look at it this way. If insurance pays, your follow-up visits may also be paid and your compliance won't be an issue over money issues? And, some offices truly believe in patient advocacy which is good for you. Compliance is a huge issue with the band and removing monetary issues is very important.

Let them go through the motions unless it takes more than 3 months? I'd cut it off at 3 months and self pay if you have the money. And I doubt the monetary difference between self pay and insured pay would be all that much.

[Aliciafl2014 57]

Thanks. They couldn't find any co morbilities so I'm going with self pay. If I waited much longer I would have additional health problems, but I got a date now! I'm happy! I wouldn't think twice about spending the money on my kids. This is for me

[B-52 7,113]

They are doing their best to do YOU and everyone else who needs bariatric Surgery a favor....my office would be THRILLED if we did not have to deal with insurance co.'s , all the red tape, for the type of services we provide.........

But no one, who is ethical, wants to see anybody have to spend their own money when they are paying premiums to the insurance co.

Would not be able to sleep at night knowing they did not, or should not have to pay out of pocket for something the insurance co. would have.

Plus is sets a presidence....Insurance companies will look for any excuse and reason NOT to pay for something.....and it is up to the providers to fight and force the Insurance co.'s to recognize that a particular procedure should be recognized, accepted and the cost covered.....

I attended a conference once where the speaker was very adamant and insisted people stop writing costs off, stop giving freebies.....it only lets the insurance co.'s off the hook, whereas the insurance companies have to learn, have to forced to cover the cost....and that only takes a lot of unhappy people, not getting the medical care they need, complaining to all the politicians, etc,...demanding change....

I know it's tough, but insurance co.'s, and the lawmakers, have to realize that people are going to die, or go broke unless they accept the Dx and pay for the cure - treatment.

This all sounds silly for one individual who wants to pay $$, but it is what is happening today in the healthcare industry....and Obama care....don't get me started......what advocates fought for for as long as 30 years, and slowly got recognition for, has or will be erased and they will have to start over from scratch with a new healthcare system....

Edited June 12, 2014 by B-52

[Aliciafl2014 57]

Thanks B52. I agree. There is nothing more tragic than not getting the coverage you need to support your health. Aetna has a section on my site when I log in. In the site they list me as obese and in danger of diabetes. I thought this would help persuade them if they themselves have me in these categories. And I pay for greater coverage which does include bariatric surgery.

My frustration came as it has been a six month journey and after going through pre testing I do not show any co-morbilities (yet). At a 35 BMI I needed at least one. The centers own patient advocate told me to move forward with self pay if I didn't come up with co-morbilities as it will take months to fight. I did agree however to submit the claim, but after the denial did not see any purpose in fighting. Believe me if I thought there was something we could point to I would have been with them pushing on insurance. I do have RA but not in criteria.

The center did agree yesterday that there wasn't anything we could use as a co-morbidity. I don't want to wait any longer as my body is in pain with the extra weight my sugar levels are rising and I'm not engaging in as many social activities because I feel uncomfortable with my weight.

I am thrilled that I have a date just six weeks out and that I can move forward in this area. Paying stinks but I've wasted money on dumb stuff or run around to do things to help my kids out without thinking twice. This is a new journey for me and I feel so blessed. I'm so thankful for the education I get from this site, and I am so glad you are out there as an advocate in this area. Some people who need this so much either can't get the needed coverage for it and can't afford to pay. I'm so grateful.

[LowRainRats 11]

My insurance flat out denied my request saying that my company has an exclusion written right into the plan. That decision took them 5 months to make. The next day I called the surgeons office to go self pay and 3 weeks later I was banded.

I had to prepay $11,000 to the surgeons office, $6000 on Care Credit and $5000 of my savings. The new roof will have to wait until next year!

At my first follow up today, I asked if I had to pay on the way out and she said, no, you're all covered for your monthly visits.