Very Discouraged

[gdkcwhite 0]

I guess I get discouraged easily. The insurance specialist at my dotor's office has just notified me, that the procedure is not a covered benefit. I was so excited at the prospect of getting the lap band. I thought, in the beginning, I wouldn't have a huge problem with the insurance because I am morbidly O. and I have high blood pressure, cholesterol, and fight depression (with the help of medicine) Then I discovered, since my problems are controlled with medicine, they are not considered comorbidities. Then I expected to probably have to go through the physician supervised diet. Now, the insurance has said, it's not even a covered benefit. This may sound stupid, but I feel like I am on hold, as I wait to find out if I qualify and or to find out what the next step is. I wouldn't have a problem financing the procedure, but I don't want to get us more in debt, when we are trying to get out of debt. My husband is supportive about the procedure, but is also very concerned about spending money. :tongue:

[StLouisGal 1]

I guess I get discouraged easily. The insurance specialist at my dotor's office has just notified me, that the procedure is not a covered benefit. I was so excited at the prospect of getting the lap band. I thought, in the beginning, I wouldn't have a huge problem with the insurance because I am morbidly O. and I have high blood pressure, cholesterol, and fight depression (with the help of medicine) Then I discovered, since my problems are controlled with medicine, they are not considered comorbidities. Then I expected to probably have to go through the physician supervised diet. Now, the insurance has said, it's not even a covered benefit. This may sound stupid, but I feel like I am on hold, as I wait to find out if I qualify and or to find out what the next step is. I wouldn't have a problem financing the procedure, but I don't want to get us more in debt, when we are trying to get out of debt. My husband is supportive about the procedure, but is also very concerned about spending money.

Is your insurance through an employer? Are there other options? If you go the self pay route, your insurance probably won't pay for complications or fills either so that can run into a large amount of money. When your company's open season on insurance come around check the other available policies and see if you can change plans. Make sure you call them to make sure LAP Band is a covered procedure or you may find yourself in the same boat all over again.

You could also try appealing to your insurance company. Call them up and find out why it is not a covered benefit. Some companies just reject it the first time around to make patients go away. Other times it is because the employer has made that a specific exclusion for Bariatric surgery. Mine did for a long time but now it is covered. Keep working at it and it will work out. If your insurance will pay for the doctor supervised diet, start now. That way when the insurance is figured out, you will be ahead of the game, if they don't you will at least be a few pounds lighter.:tongue:

Hang in there. It is worth the fight.

[sara7venus 0]

I guess I get discouraged easily. The insurance specialist at my dotor's office has just notified me, that the procedure is not a covered benefit. I was so excited at the prospect of getting the lap band. I thought, in the beginning, I wouldn't have a huge problem with the insurance because I am morbidly O. and I have high blood pressure, cholesterol, and fight depression (with the help of medicine) Then I discovered, since my problems are controlled with medicine, they are not considered comorbidities. Then I expected to probably have to go through the physician supervised diet. Now, the insurance has said, it's not even a covered benefit. This may sound stupid, but I feel like I am on hold, as I wait to find out if I qualify and or to find out what the next step is. I wouldn't have a problem financing the procedure, but I don't want to get us more in debt, when we are trying to get out of debt. My husband is supportive about the procedure, but is also very concerned about spending money. :tongue:

gdkcwhite, I totally understand your frustration. I knew a couple of years ago that the surgery was expensive, and that it would likely not be covered by insurance. One would *think* that insurance companies would want to cover the procedure to simply lessen the amount of Rx costs and future problems related to morbid obesity, but I'm at the point to where I really believe that insurance does NOT want to cover it. Period. There's no obvious reason, other than they don't want to fork over the large amount of money initially, but I'm sure they could work something out with the lap band centers who do the surgery routinely. It's getting to a point where I feel like I am viewed as a second-class citizen because of my weight. I even had one Dr. I was seeing for an *ear infection* tell me that he would put me on Phentermine, and that "the insurance companies won't pay for the prescription or the appointment, so the appointment will be $60 instead of $30". I have Blue Cross Blue Shield, and they'll pay for any Dr. in-network for a $30 co-pay. This scheister was going to charge me more money for being fat! Needless to say, I did not return to see him after that. I'm beginning to think that there is an entire industry around keeping people fat and unhealthy. The Lap-Band is a person's way to lose weight and become healthier, and if that happens, the drug companies and insurance companies won't get as much money in the long-term. I don't think that all drug companies are evil or anything, but I definitely believe that the weight loss industry stands to lose a great deal (no pun intended) if a large number of overweight people lose weight and keep it off... Sorry if that adds to the discouragement; I just know what I've seen, and how I feel. My husband and I are paying for my surgery ourselves, and borrowing money from our various investments, etc. Luckily, we don't have to put ourselves into a huge amount of debt to get it done ... Is there any way you could plan financially to have the surgery in a year or two and pay for it yourself? I know it's a lot of money, but it's attainable ... I started putting money into an interest-bearing checking account, and in a few months I earned about $100 toward the surgery ... I hope this helps ...

Edited June 17, 2008 by sara7venus
misspelled word

[anitamc 0]

Just think of all the money you will save in medicine and in food after the surgery. Think of as a long term saving plan. I have heard of several people who are having the surgery done in Mexico to save money. From what I hear its as safe there as anywhere. Try to think positive. I believe you can do it.:tongue:

[Northwest_Nance 0]

Weight loss surgery is specifically excluded from my health insurance coverage. This is a coverage your employer can elect to pay for, or not. My employer elected not to make it available to employees, to save money on premiums for itself and for the employees. In their defense, it is a small company and I didn't work here when they negotiated their coverage, and I'm pretty much the only employee who has ever been a candidate for weight loss surgery.

But I agree, you'd think insurance companies would either make the coverage more available or more cost effective or something.... I'm no expert on insurance so I can't speak with a lot of authority about this. It just seems it would be in their interest to include weight loss surgery as part of general coverage the way most other surgeries are. It is very short sighted because, as you said, they sure do pay out a lot of money every year for obesity related medical treatment and prescriptions.

I had to go self-pay. I took out a loan against my retirement plan, and it's like having a car payment (only a better investment than a new car, I think). And, with each monthly payment, I'm paying myself back. Of course, not everyone can afford to take on a monthly payment like that. I'm fortunate that didn't have a car payment already.

The fact that self-pay patients don't have insurance coverage for any complications from the surgery is a scary thing and I had to think about it long and hard. It's one of the reasons I elected to go with lap band instead of bypass surgery.... lower risk of complications (not to mention bypass is much more expensive in the first place).

[candiland12 0]

Do not lose hope. Am having the same problem and where there is a will there is a way.

[U_go_gurl68 0]

My employer recently added the Lap-band surgery, but has to be performed by our hospital's docs, which haven't been performing the procedure very long. They are great trauma surgeons but I didn't feel comfortable so I went out of network, which isn't covered on my insurance for this kind of procedure.

The first place I went to look into lap-band surgery was going to charge me $23,000. The place I am actually going to is charging me about $12,000 with 6month worth of aftercare and fills. The other was for a one year worth of aftercare. In any case, get on the net and research different offices in your area. Some do cost more than others.

As far as taking phentermine, I wouldn't recommend that route for weight loss. I have done that so many times and when you quit taking the meds, the weight piles back on and then some.

With all the news about obesity in this country, you would think the insurance companies, employers, and physicians would do something about it by including wls in the policies, but when you think about it, if you lost weight and had good health from here on out, they all have more to lose. When it comes down to it, the only one who cares is you, those who are going to go through this and have gone through this and those physicians that are trying to help those of us battling obesity. When we lose weight and stay healthy, the pharmaceutical companies lose out, so do the docs, so does insurance, so does the government, and so on and so on. The truth is they want us to stay fat, it puts more money in their pockets. Think about it. We spend more money in weight loss products, exercise equipment, gym memberships, plastic surgeons for Lipo procedures, etc...

Sorry to make this long, just my thought about that.

Back to what I was going to say, I am having to self pay too and my credit is bad due to an ex husband that ruined my credit. I took a loan out against my 401k and my payments are lower than those companies financing medical procedures. If you have it available, this may be an option for you. It doesn't take anything away, so their are no withdrawal penalties and your money keeps growing. Also the wls procedure is tax deductible because you are having it to treat obesity which is a disease. Under the IRS rules, it doesn't pay for weight loss programs, but will pay for surgery to treat obesity.

Good luck!!!!!

Stephanie Marquez

Edited June 17, 2008 by smarquezrn

[gdkcwhite 0]

THANKS GUYS!! You are awesome and I don't feel so alone. It's amazing there's people out there in the same situation. I am not giving up hope. The insurance specialist is sending a letter to the insurance. It just seems so slow... I wanted this DONE months ago, I haven't hardley even begun. I feel I am going to figure something out. I am a professional dieter. (Wish I got paid by how many pounds I have lost in my lifetime.) I have a feeling no matter how long it takes to get to the surgery, I will still need it.

You may have thought your words weren't encouraging, but they were, because I don't feel like I'm the only one in the boat in the middle of the ocean.

Oh, the cost for me to have it done with this doctor is $16,000. My mom knows how much I want this, she has offered to pay for it when she hits a jackpot at the casino. Maybe there's hope there.

[mem123 0]

I have BCBS. I was denied the surgery too back in February/March. My surgeon appealed the decision, so did I (through the web-site). They changed their minds and are now allowing the surgery. I have all the same medical conditions you stated. I started this journey last August, did 6 months with my pcp weighing in each month. I was devastated when they turned me down, but the center I am dealing with really helped with the insurance. I suggest you file an appeal. I don't know what kind of BC you have, I have Anthem of Ca., although it it processed in TN where I live. However, the appeals go direct to the California office and it is them who reversed the decision. I also visited the BCBS website, filled out the "personal heath" forms, which of course told me all about my mortality rate (weight, BP, Cholest.,etc.); that in turn lead me to THEIR weight loss suggestions including surgery. I specified this in my letter of appeal. BCBS told me the procedure was acceptable for 40BMI or 35BMI and two other conditions related to the weight. I stated That THEY say I'm in need of weight loss and bariatric surgery is an accepted method according to their website/webMD. Anyway, the point is, appeal a couple of times at least before you go in to debt. Good luck.

[anitamc 0]

mem123 Where did you have your surgery done? I am see doctors at Vanderbilt. I have BCBS of Tennessee. Ihope I don't have alot of trouble getting approved. My first hoop to jump thru is I have to lose 10% of my wieght before they will process the insurance. I hope to lose this befor my July 21st visit. I go this Friday for a phych evaluation and nutritional consuling.

Anita

[mem123 0]

My surgery date is July 14th - it'll be almost a year since I first contacted the dr's office! Dr. Virginia McGrath-Weaver?Memphis is my surgeon. I have Anthem BCBS of California although I am in Tn. All of my insurance goes through the Tn office and I have had to call California several times to resubmit something that Tn denied. BCBS have many plans though. I know it was hard for me to even find exactly what was in their policy regarding bariatric surgery. I actually followed a link through a previous message in the insurance section of this site to see what BCBS required. I could never seem to get out of them what they required to allow the surgery. Have you actually looked at policy documentation regarding this surgery? I guess some people have insurance that may stipulate no bariatric surgery. Seems immoral to me - over-ruling a physician. Still, if I was you I'd try to appeal the decision, find your insurance's appeal process and see if you can get your Dr.'s office involved. Look up on this site if any other BCBS/TN people have been approved for the surgery and what they had to do. My pcp told me she had several other patients with BCBS who have had the surgery. I am a very cynical person when it comes to insurance, I believe some of them turn down anything to see what they can get away with and for how long! And remember, I haven't had mine yet - they may refuse to pay after the fact! God forbid! I truly wish you the best of luck.

[candiland12 0]

Good Luck to all of you ladies. Do not let the insurance hold you back fight. I am in the same boat fighting with the insuranc company to have the surgery done. I went to a Dr. close by but they did not want to help me so yesterday I went to different office. The ladies in the office are looking for insurance companies that they know will pay for the surgey. So if I have to pay for personal insurance I will. I have BCBS Healthselect and they will not pay one cent. Once again good luck ladies and keep fighting.