Are you kidding me?! Insurance won't cover it.

[voodoo 0]

My insurance company said "yes, it's covered."

Then another person said, "No, not covered."

Then a different person said, "Yes, that last person was wrong."

Then another person said, "No...absolutely NOT covered."

I finally got ahold of the huge book of coverage

and read through it. NOT covered.

I'm really sad.

It has to be out of pocket...

but they are having a "sale" right now.

ONLY $11,400.

[susan0978 0]

What insurance do you have?

[voodoo 0]

What insurance do you have?

Aetna...and in their documentation it says that

they see WLS as "medically neccessary,"

however, my husband's company has it as an exclusion.

It was just kinda painful to be given hope

then have it snatched away...twice.

We don't have $11 grand sitting around

so it might have to go on a credit card,

which is a scary thought.

I have PCOS so losing weight the "normal" way isn't working, no matter what I do.

Every year I'm just a little bit bigger...

[StarsZie 3]

Voodoo,

I'm sorry to hear this! I went through something similar, but in the end my doctors sent letters to the insurance company and I was able to get covered. I have Cigna and they are tough.

I wish you all the very best... good luck!

[Melinco 1]

Can you finance it rather than putting it on your credit card? You might be able to pay less in interest.

[Sluggo 0]

Who does it for $11,400? I am going to pay on my own. BCBS doesn't hesitate to take my money out of my pay every month for 30 years. I've had very few claims. Now I need help to get healthy and you know the rest of the story. I'll pay on my own but going over the border is not an option. Too many problems finding after care in my area with that but they will see you if you had a U.S. surgeon. I know...more BS. Talk about a minority group of second class citizens getting everything but respect and decent treatment.

[nazzy 1]

bcbs payed mine

[Sluggo 0]

BCBS of AL will also pay but with the hassles and everything, running around for this eval, psych, etc. it's not worth it to me. Just a matter of personal choice on my end and refusing to be treated like I'm stupid. My new doc knows what to do and can make absolutely certain I am medically cleared for this surgery. I have a medical history of years of obesity but have not seen a doctor in 5 years (okay maybe I am stupid on that part or just plain lucky). I have no 3 year history of documented obesity. I've been on strict diet & exercise for 4 months but get no credit. I have to jump through hoops like a trained circus dog for 6 months then if I fall below qualifying BMI - I don't qualify. I am old and crabby and will just pay for it myself instead of putting up with their attempts to take away my last shred of dignity that remains.

[thinin10 0]

Voodoo. I feel your pain. I looked at surgery 10 years ago when I 1st heard of the lapband and found out my husgands ins. had it excluded as well. After 10 years of losing/gaining, I finally followed up. I found out that the ins. plan thru my employer covered it- I called , verified all the info, and then Jan. of that next year, took out the ins. thru my co. and put my copay that would be due away pretax from my checks. Even with that I got denied 2x and had to file an appeal. It was SUCH a pain and brought me to tears more than once. Hopes up and down. Finally after almost exactly 9 months of red tape, I got my surgery. Voodoo do you have the option of taking out ins. thru your own employer/ covered thru your work?

Sluggo. I know it's easy to just say forget about it to the ins. co. but DON'T. It's a numbers game. I can assure you somewhere they've got a report that benchmarks how many people give up at each level of denial. If we as a group don't push,then they win... they will keep doing these unethical practices of denying on frivolous grounds since it's cost effective for them.

Chubbers are growing by the day in this country (no pun intended) and we need to make ourselves heard and push for fair insurance covg and rights. We all pay stout preimiums for coverage and deserve to have reasonable and nessisary medical procedures covered as our primary care physicians dictate- not a board of directors !

Ok.. that's my soapbox speech for the day! And I work for and ins. co. too! :thumbup:

[thebandedgirl 0]

My insurance wouldn't cover my surgery, so I financed. Making the monthly payments is hard. It's discouraging to think that I'm going to have payments for the next few years, but it was even more discouraging to think of being 300 pounds (or more, at the rate I was going) for the next few years.

I'm sorry you're feeling upset about the situation--I understand. I hope that you're able to reach the decision that is best for you quickly.

[Sluggo 0]

My insurance wouldn't cover my surgery, so I financed. Making the monthly payments is hard. It's discouraging to think that I'm going to have payments for the next few years, but it was even more discouraging to think of being 300 pounds (or more, at the rate I was going) for the next few years.

I'm sorry you're feeling upset about the situation--I understand. I hope that you're able to reach the decision that is best for you quickly.

thebandedgirl:

Good way to think. I am very pleased with my decision to self-pay. That says a lot because I am a cheapskate. For my own reasons and circumstances, I feel like I don't really have a choice - well maybe I do but doing the dance with BCBS and probably still getting denied 8 or 9 months from now will make me crazier. If I was 10 years younger maybe I'd wait it out with the BCBS vultures but my clock is ticking down these days. I am looking to get banded in San Antonio and make a little vacation of it. The only reason I don't do the across the border thing is the AH docs here in my area won't take me for aftercare but will with a US doc. Ironinc since this MD is a "ferner" (that is "foreigner" in Alabama speak). Congrats on your progress and strength.

[thebandedgirl 0]

thebandedgirl:

Good way to think. I am very pleased with my decision to self-pay. That says a lot because I am a cheapskate. For my own reasons and circumstances, I feel like I don't really have a choice - well maybe I do but doing the dance with BCBS and probably still getting denied 8 or 9 months from now will make me crazier. If I was 10 years younger maybe I'd wait it out with the BCBS vultures but my clock is ticking down these days. I am looking to get banded in San Antonio and make a little vacation of it. The only reason I don't do the across the border thing is the AH docs here in my area won't take me for aftercare but will with a US doc. Ironinc since this MD is a "ferner" (that is "foreigner" in Alabama speak). Congrats on your progress and strength.

I live in the Phoenix area--going to Mexico would only have involved a 6 hour drive and would have been a lot less expensive. I decided to go locally anyway, just because it felt safer to me (I have no real reason for that feeling; it is what it is). Thanks for the kudos :biggrin: