insurance not paying

[sleeveme4152 16]

My insurance denied me because there is a clause from my husbands employer stating no coverage for weight loss and bariactric surgery. I will finally see my PCP on Tuesday the 19th. then maybe we can start the appeal process. my BMI is 45 and no co morbitities, I do have a haital hernia, and depression, that's it. so we will see, if not I will be self pay, even at $25,500, it is just so much to pay, and my husband doesn't want me to fly somewhere to get it done.

[chelseahall91 1]

My dad's (I am 23, 5'4, 230 lbs, bmi 38.7) insurance just doesn't want to pay. I have three doctors telling them I'm losing my vision. And they apparently didn't care. So I am appealing. I need this because my weight is causing excess Fluid on my spine, which is pushing into my brain, onto my eyes. I hope they allow this surgery soon & okay it. I've tried so many diets and exercises!!!!

[woo woo 872]

My insurance denied me because there is a clause from my husbands employer stating no coverage for weight loss and bariactric surgery. I will finally see my PCP on Tuesday the 19th. then maybe we can start the appeal process. my BMI is 45 and no co morbitities, I do have a haital hernia, and depression, that's it. so we will see, if not I will be self pay, even at $25,500, it is just so much to pay, and my husband doesn't want me to fly somewhere to get it done.

If his employer has purchased a policy that does not cover bariatric surgery at all, then doing an appeal won't do any good and will just waste time.

At the very least I would call your insurance company yourself and ask the question before you waste any more time and potentially money (co-pays) on trying to get insurance coverage, and if so then you can focus on getting scheduled as a self-pay.

Good luck to you.

[bikrchk 1,313]

Appeal their decision. Some insurance companies deny first if they can to avoid paying and hope you'll get discouraged and give up or go elsewhere. Appeal, and if that fails, I'd look at a cheaper US option. It's not that I have a problem with surgery in Mexico. They do A LOT of them and there are good docs there. The issue is that if you have a problem when you come home, (complications can and do happen whether you have the work performed abroad or in the US), you may find that no Doc at home wants to touch you. Wouldn't be worth the risk IMHO.

Edited August 14, 2014 by bikrchk

[Jersrose43 837]

My insurance denied me because there is a clause from my husbands employer stating no coverage for weight loss and bariactric surgery. I will finally see my PCP on Tuesday the 19th. then maybe we can start the appeal process. my BMI is 45 and no co morbitities, I do have a haital hernia, and depression, that's it. so we will see, if not I will be self pay, even at $25,500, it is just so much to pay, and my husband doesn't want me to fly somewhere to get it done.

I will PM you suggestions

But this is not appeal able if it is in fact a contractual exclusions.

[moonlitestarbrite 902]

if they have a specific exclusion, an appeal wont help. PPOs are renegotiated each year. you can talk to your H's employer and see if they are willing to ask that the surgery be included in coverage next year.

you can also negotiate the price of the surgery. insurance companies only pay a portion of what they are billed, you arent required to pay more than insurance companies do. my surgery was about 18K, the insurance paid about 12k. you can also assign flex spending benefits to pay for this... its pre-tax, so in the end, ends up costing you less.