Dreams STOMPED by my insurance company

[mami2two 1]

Thank you all for your advice.... unfortunately with the rules of obamacare I can not drop my group insurance for obamacare because group insurance is offered to me and I am a salary employee. I even attempted to try and change my pay scale from being a salary employee to a contract employee so that I could then get obamacare, but it would highly put my job at risk, a risk I'm not willing to take. I will be going to my doctor and talking to him about it to see if he can submit it to the insurance company and see if that will make a difference even though they say no. Wish me luck, I will update everyone as I figure it all out.

[Beach Lover 1,084]

My insurance company did not offer bariatric surgery either. It it's not part of the insurance package unfortunately it won'thappen. I was self pay with a fantastic surgeon in Boca Roton that charges $10,500. If you can finance it I would highly recommend him. I know of several people who flew in and had surgery with him. It was the best thing I ever did for myself. If not, I just spoke with a woman the other day who researched and found an insurance plan that covered it. Maybe you could pick up an insurance plan like this and once the surgery is done and your cleared after surgery you can drop the insurance. Just a thought............Best of luck to you!

[Kindle 8,667]

Thank you all for your advice.... unfortunately with the rules of obamacare I can not drop my group insurance for obamacare because group insurance is offered to me and I am a salary employee. I even attempted to try and change my pay scale from being a salary employee to a contract employee so that I could then get obamacare, but it would highly put my job at risk, a risk I'm not willing to take. I will be going to my doctor and talking to him about it to see if he can submit it to the insurance company and see if that will make a difference even though they say no. Wish me luck, I will update everyone as I figure it all out.

Even an individual Obamacare policy may not cover it. Depends on what state you live in. I am self employed....own my own business, so an individual policy is my only option. My state opted out of covering any WLS, so despite paying over $3600 in insurance premiums, I still had to pay for my own surgery. Used my entire savings plus a couple grand on a credit card and went to Mexico. Best money ever spent.

[VGB 130]

Well, my insurance does not cover WLS so that was out......but it does cover hiatal hernia repair surgery! So, my doctor is getting me in for a hiatal hernia and while he is in there, he will sleeve me! I have to pay $3500 for the sleeve! You may want to check into that as an option! My surgeon is in Dallas!

[wannaBthinsoon 1,634]

@@VGB That is awesome! (not that you have a hernia, but that, you found yourself one savvy Doctor)!!

[Croaker 26]

It will likely take several lawsuits in order to get insurance policies changed regarding WLS.

There's new ammunition, however, with an article published just last week in JAMA (the Journal of the American Medical Association - one of the most prestigious and reputable medical journals in the country, if not the world).

It involved a study of patients at the VA Hospitals who averaged a BMI of 47. One group underwent WLS, and were matched with controls who didn't. They then followed them for a decade and the results were stunning. The surgical group had an approximate 60% reduction in mortality at 10 years. It's a stunningly convincing finding, one that basically says that WLS is not a lifestyle surgery, but a life saving surgery. It will be nearly impossible to refute in a court of law and will be a big wallop of ammunition in disputes against insurance company denials.

Good luck.