Insurance does not cover...depressed :(

[deemarie 0]

:sad:I am 54 years old, 5'2", weigh 235++ lbs. and have a BMI of 42. I have been overweight for the past 21 years, trying to do it on my own but with no sucess. My husband and I moved to our current address fall of 2007 and I began seeing my current doctor for help with weight loss Spring of 2008. I mentioned to him I was interested in trying the LapBand. He wanted to try other methods before resorting to it. It's been a year. I've taken it upon myself to attend the seminar and get the details but the cost is too much for me ($18,000++) and my insurance UNITED HEALTHCARE EPO does not cover the procedure. I've seen other posts stating that others with UHC eventually got approved. Please tell me how I can get them to approve surgery.

[Brandy~ 2]

Hello and welcome. I had UHC and was denied. However, I didn't even bother to appeal. I just rolled over and gave up. Luckily 1 year later my work switched insurance to BCBS of Minnesota and they paid for it.

There's alot of doctors that will do it for alot less than 18k if you do end up being a self pay patient... There is a doctor here in Oregon that is 10k for everything he is in Coos Bay, Oregon Terisigni (I think thats spelled right) There's one in Colorado I have heard about.

Do you have any comorbities? Your BMI is over 40 so you're fine there. Does your insurance have a specific exclusion for WLS? I would get on the phone and find all this out.

[OnTheWay to Thin 0]

Hi I am so sorry you are having difficulty with insurance. The thing you need to do is call your insurance and ask if WLS is excluded. If it is you are kind of out of luck, if it is not excluded but covered if you meet certain criteria, then you need to ask them for a copy of their medical policy regarding WLS and take that to your doctor to see if you qualify with additional documentation. Good luck to you.

[RestlessMonkey 7]

I agree...if your insurance doesn't cover lap band, it doesn't. But if it does cover it but you don't meet the requirements, that's a different matter.

Please understand too you can have the surgery done in the USA for less than 18K...you just have to shop around and so on.

And 18k sounds like a lot but we spend that much on cars...you are worth more than a kia, don't you think? (not to diss kias lol)

[ParrotheadCathy 0]

Snickers is right. IF your policy has a written exclusion for weight loss surgery, you have no room for appeal. If, on the other hand, you have been denied for some other reason, they should be able to tell you WHY. Then you can work with your doctor to submit an appeal. Usually, if you are denied and your policy does not specifically exclude WLS, the problem is that information was missing. Just remember that just because someone with UHC got approved doesn't mean you will. EVERY POLICY IS DIFFERENT. Example, I have BCBS of Georgia and so does my girlfriend. Hers covers WLS but mine has a written exclusion.

[leahwebster 0]

This is where I was too. Trying to find financing then couldnt. Hun, Dont be depressed. It will work out. I found and great dr. in Mexico who is only charging me 5500. My mom is meeting me in San Diego and we are going down there together. with the costs of the lap band here in the states I had almost lost hope. I am so glad I didnt give up. If you would like and help let me know my email is leahwebster@msn.com. My kids are 9 and they seem to know mom has been trying so hard to be healthy. They are excited for me to be able to go bike riding with them. They even want me to jump on the trampoline! LOL :thumbdown: We have walk a way in the same path and I know banding together will make us all stronger.

Lapband surgery date 5/19/09- SOOOO EXCITED!