The sum of all fears

[Jerr_Bear 241]

After 6 months of preparation, over 60 lbs lost, a sleep study that I'm pretty sure gave me pneumonia, an upper endoscopy, and thousands incurred in medical expenses, it turns out that the clinic made an oversight and bariatric surgery is excluded from my insurance. So the thing that I had been planning my whole life around for the last 6 months will not be happening. Also gone is any hope I had attached to it. I usually carry myself as a confident person, and don't like to show any signs of vulnerability, but my life has just been shaken to its very core. And all the clinic could offer was a sincere apology.

They say to never attribute malice to what can be explained by incompetence. But how can I not? Maybe I'm burdened with having unreasonably high expectations of people. When they way is shown to you, and you are motivated by that hope, only to see it ripped away from you just at the moment it seems so real that you can touch it. How can one not be angry? Because a seemingly minor clerical error to them has far reaching impact on the lives of the patients and their families. How can I not take it personally? They've told me coldly that they can no longer help me.

I'm sure people have gone through this, and I have been told that I wasn't covered before. But that was before I went through the whole agonizing pre operation ordeal. One that is both physically and psychologically taxing. I've talked to everyone I can, and it appears that there is no recourse for me. And I have no fight left in me. Where do I go at this point?

[dhrguru 1,238]

I'm so, so sorry. It sickens me how often I read this happening to people!! It would be so much better if we could receive the details of our plan from insurance companies directly, and not have to rely on second hand information (that's often inaccurate!!).

I assume self pay/ Mexico aren't considerations? You've dinner great so far with pre op weight loss, maybe you can keep the momentum going?

[JustWatchMe 7,117]

I'm so sorry. I really hope you find a solution somehow.

[UalreadyKnow 843]

It's happened to me twice the first time I was a week away from operation day!! I went in to pre register at the hospital and they asked me for $7600 for anesthesia costs!!! I had even been on a pre-op diet for a week already!!! BUT I never gave up and 3 years later, I got my sleeve. I am now almost 3 weeks post op!! Keep working at it maybe something will give! I'm so sorry you're also going through this, I know how devastating it could be and self destructive,.. I gained 60lbs after that and only made myself more miserable, don't give up!!!

Edited September 15, 2015 by UalreadyKnow

[ShrinkingPeach 1,291]

So sorry to hear about your situation. Maybe you can save up toward a self-pay price or could Mexico be a valid option. Good luck and keep abreast of any changes to your insurance at annual enrollment with your employer to see if there is another insurance option that does cover the surgery.

[The Candidate 3,215]

I am so sorry for what has happened. I can only imagine your heartbreak. I went through a program that included six months of classes. In a situation similar to yours, one of my classmates didn't find out until two more months after classes had ended, that she wasn't eligible either. She had attended all the seminars, classes, weigh ins, food journals, completed the lab tests, etc. In fact she was only waiting on the surgical consult, and a surgery date. It's terrible that things like this can happen!

The last day of class this dear lady gave all of us in class a little angel with the tag line "courage" and every time I look at it I think of her. I'm happy to report though that she's still fighting towards getting her surgery. I hope you too will be able to find a way somehow.

Best of wishes!

[CowgirlJane 14,260]

Sorry this happened! I was lucky that my surgeon's office managed the insurance very well. In fact, my insurance handled it very well! I received a written "pre approval" so I knew roughly where i stood. We have a insurance coordinator who informed me in late 2011 that starting in 2012 my pre-approved sleeve would be "excluded" and bypass would have been my only option. I would have been caught by surprise so I am grateful they gave me that alert. This is why my sleeve surgery was mid Dec 2011, I needed to get in under the 2011 rules....

[Drew7651 23]

Maybe this sounds ridiculous but a close friend of mine was denied by her insurance not thinking of using her husband's. Maybe if you are married yiu can check out their insurance?

[India928 81]

This may be a far reach, but you never know unless you try and no harm for doing so.....what if you asked the surgeon to opt pro-bono. Given your BMI is high (so is mine) maybe they will be willing to help or even on at a discounted financed rate...? Also, if funds are not available what about trying a "go-fund me" account. There is much to say about social media these days!

Don't give up. You are not alone!

Hugs

Edited September 15, 2015 by India928

[Mountaingal 322]

So sorry you have had this devastating news. With all you have been through and how ready you are if you can manage it in any way I'd say go to Mexico. My friend and I both used BariatircPal and could not have been any more satisfied and their prices are fantastic compared to US prices. The pro bono idea India 928 mentioned is good one also if you could get special consideration from the anesthetist and hospital. Good luck in finding an answer to this dilemma.

[lisacaron 5,075]

I don't want to be the naysayer here, but when it comes to our health and our health care we need to be our own advocates. You can't listen to what Dr.'s offices or staff have to say. You need to call your insurance company and find out directly what is covered, what is not covered, ask them a million and one or more questions you are paying them for goodness sake and it is their job to provide you with the answers to ALL your questions about your health care coverage and plan.

it stinks to have gone through all those tests to find out that your coverage excludes this type of surgery but don't give up, and don't look at it as an all for nothing. You found out some very important things about your health that will help you in the long run to be healthier. In the mean time call your insurance company and ask them why the preclude this type of surgery, and if there is an option to have it included. Is it because of the employer not opting into a part of the plan? Are there any other options for Weight Management that they suggest under the plan? If it is an employer exclusion is it possible to speak with your HR staff about it and see if an exception might be made?

Don't give up on yourself no matter what. Keep the momentum going...!!

[James Marusek 5,244]

Generally most insurance plans have a plan book that spells out in detail what expenses they cover and which ones they don't. What does your insurance plan book say about bariatric surgery? Today many of these plan books are available on-line. If your plan book describes the conditions for coverage of this surgery, have you met those conditions. If you have then I would still butt heads with the insurance company and find out why they are refusing to cover these expenses.

[SaraSleeves 17]

Where do you live @Jerr_Berr? Some travel to Texas and use the clinic I am using (Nicholson clinic) as they check for hiatal hernia (most obese patients have at least a small one and they'll find it!) and will use your general surgery benefits for most of the cost with then add on a small cost for the sleeve separately that they allow you to pay out at $100/mo.

Sent from my iPhone using Tapatalk

Edited September 16, 2015 by SaraSleeves

[newmebithebypass 713]

im so sorry this happened this is why i called my insurance company directly and asked about my benifits directly and i made sure they sent it to me in writing. i am pre-aproved for surgery also because of my high bmi and co morbities so i really dont have any advice other than call your insurance directly. or if you make less then the poverty level maybe apply for medicaid they sometimes cover it depends on the state you live in mine does

[Djmohr 6,965]

I am so very sorry that this has happened! It just isn't fair but please please please don't give up. There has to be another way for you.

The other thing you might want to consider is buying a health plan that includes bariatric surgery for a few months. It will be less expensive than self pay, they will likely accept your 6 months of supervised diet. And of course they are not allowed to deny you because of preexisting conditions.

It might really be worth looking into.

I had to do something similiar just to make sure my spine surgery and specific surgeon was in network for me. He is actually in a whole other state. It was totally worth it for me to be able to have peace of mind and work with someone I trust.

It was a lot less expensive for me than paying out of pocket.

Hugs!