Dissapointed and Discouraged!!

[Tigerlily1020 0]

<p>I just got off the phone with my insurance Company (Anthem BC/BS of NH) and they told me that WLS is excluded accross the board. I can appeal, but she warned me that because of the totaleclusion I was probably wasting my time with an appeal. </p> <p> </p> <p>I am extremely disappointed. I have been reading these boards, I bought books on WLS/Lap band. I have been preparing myself both mentally and physically for this journey and now I am afraid it will never happen!!!</p> <p> </p> <p>If anyone has any suggestions I would greatly appreciate them. </p> <p> </p> <p>Thanks for "listening"</p> <p> </p> <p>Rae</p>

[Tigerlily1020 0]

Whoa...I tried to edit and I think I messed it up...I just wanted to correct the spelling on exclusion..lol

[musicalmomma 1]

I also have Anthem BC/BS (of WI). When I first called the insurance phone #, they also told me WLS was excluded. When I talked to the HR benefits dept, they said it WAS covered because they paid for the WLS rider.

I'd advise contacting your benefits dept in HR before going any further. You may be covered, but the person answering the phone is spouting off generalities. If it's not covered, there are other ways...loan, 2nd job, Mexico (combination of all three).

Best of luck to you.

[ihv2bz 0]

Have you been tested for sleep apnea ?? This was my ticket for insurance approval.........if the weight causes you other health problems sometimes it is approved. Talk to your family DR and ask what medical issues could be solved with the weight loss. Good Luck.

[LoserWannaB 0]

don't give up! where there's a will, there's a way and you just need to find it. that's all. minor setback.

[Tigerlily1020 0]

Thank you both for your replies.

I have not been tested for sleep apnea yet, however, I have a congenital heart defect (Transposition of the Great Vessels) and have had open heart surgeries as well as a pacemaker implant, so I am hoping/praying that because of the strain the extra weight is putting on my heart, the insurance company will see that this WLS is necessary

[cin 0]

tiger please don't get discouraged my journey of approvals and fighting with the insur co. took me 2 yrs!!!!!!!!!! i finally took matters into my own hands with cigna which we are now changing to Athem B/C B/S as of Jan 08. I spent hours on end on the phone everyone told me a different story i would'nt give up until i got what i wanted which was my banding and proud to say 6 days post-op! I wrote several letters brought them to my PCP had my Doc put it on thier letter head i also have sleep apena borderline diabetes etc. all that sure did play a roll in my approval along with joining a gym over a yr ago and after 30 yrs i stopped smoking that's how serious i was on getting this weight off and with all the hard work and dermination i finally got approved not sure what is going to happen with my fill once our Athem insur kicks in come Jan but i'll handle that that will be the easy part.

Hang in the i was in the same boat as you and almost gave up when i got 3 denials months after months i was in tears and said the hec with it i'll stay huge and let the insurance co pay for my rehab after i stroke out I once again pulled my thoughts together and said who are they to say i can't have surgery they don't know me from here to adam i got extremely angry went to war and won my battle!!!!!!! now i'm on the road to success so pleaseeeeeeeeeeeeee don't give up fight until the bitter end you sound more than ready for this surgery and a life style change you can do it you can you can!

Sending postive thoughts, you started the war now win your battle!

best of luck

cindy from Ma.

[PeggyBluebird 0]

The same thing happened to me 2 years ago. I did my research and am scheduled to be banded on Sept. 18th at Detroit Medical Center. It is going to be self-pay but after discussing it over with my husband, we decided that my health was worth the cost of a used car. So I took a loan out for the amount of money that I needed. The lapband in Detroit costs $11,700.00. That is the least expensive one I could find in the states. If you are willing to fly to Mexico, you can get a lapband done for about 8,000 with airfare,etc.

If you live driving distance to MI, it may be worth checking into. Good Luck with your search. Believe me, I know the disappointment you are feeling right now but don't give up.

[Tigerlily1020 0]

Thank you all for sharing your experiences, it sure has given me hope. I was very upset yesterday and I too said "fine they can pay for all the problems that will arise with me being overweight" lol I am happy to hear that your struggles with the insurance company paid off. I will continue to battle until I win!!!!!

Rae

[WinterWish 0]

Insurance coverage is possible here in Canada but the wait is several years, so we opted to self-pay as well. Extremely happy to have done it - I find the weight loss to be effortless, and I haven't even had my first fill yet. It's $16,000 here, including 5 years post-op support. We decided that I might spend that much in another 20 years of diet clinics anyway, and I'd be fat and sick and miserable the entire time, so why not bite the bullet and get it over with in one shot? Now, the future is rosy, and now that the money is gone, we don't even think about it anymore. Every day DH comes home and remarks on my new cheekbones. Life is good.

[mary jane 0]

They have a web site called credit care that may be able to help you with the cost of the surgery....It's like a low intrest credit card...don't give up keep searching for the answer ...try taking out different insurance...had the surgery the end of July already lost 30 lbs....best thing I every did for myself!

[puglvr4life 0]

Tigerlily, do selfpay. Many of us are doing that. You will save $$$$$ over time with less spending on food and such. They have easy financing through capitalone!!!!!

[Gumper81 0]

Tigr....dont give up...insurance companies stink by nature...I fought for 3 months which seemed like an eternity....hundreds of phone calls...NJ Dept of insurance complaint etc...they finally denied me...I got on the phone and screamed like a lunatic and cursed like a longshoresman...2 hours later I had my approval....tomorrow morning, I get banded..hang in there...it will happen for you..

[lily 1955 0]

Hi Tigerlily, How about getting a line of credit from your bank, they are usually less interest than loans. Have you looked into a medical loan? Some clinics work with medical loan companies. Goodluck Lily.

[lily 1955 0]

<p>I just got off the phone with my insurance Company (Anthem BC/BS of NH) and they told me that WLS is excluded accross the board. I can appeal, but she warned me that because of the totaleclusion I was probably wasting my time with an appeal. </p> <p> </p> <p>I am extremely disappointed. I have been reading these boards, I bought books on WLS/Lap band. I have been preparing myself both mentally and physically for this journey and now I am afraid it will never happen!!!</p> <p> </p> <p>If anyone has any suggestions I would greatly appreciate them. </p> <p> </p> <p>Thanks for "listening"</p> <p> </p> <p>Rae</p>

Hi Tigerlily, How about getting a line of credit from your bank, they are usually less interest than loans. Have you looked into a medical loan? Some clinics work with medical loan companies. Goodluck Lily.