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Insurance Won't Pay!

egrazz

By egrazz, in Insurance & Financing

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Cocoabean    430

Cocoabean
Posted

I am in middle Ga and was just denied by my ins for the 3rd time. This means I can't appeal again. :( My Dr.'s office says they don't have a hernia repair/lap combo that would lower the costs. Does anyone out there know of anything else that could help? I was denied because my BMI went to 33 in 2009. So, according to BCBS, I haven't been consistantly fat enough. I can't handle it!!!!!

A couple of links are below. The first is for grievances against insurance denials in Georgia. However, if BCBS requires a 5 year history of morbid obesity (or a BMI over 35) you might not have a case. You might also go over to www.obesitylaw.com they are an advocacy group that help to fight insurance companies. See what they have to say.

http://www.online-health-insurance.com/coverage-by-region/GA/resources/page-25.php

http://guides.wsj.com/health/health-costs/how-to-appeal-a-health-insurance-denial/

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yelorz    9

yelorz
Posted

Not sure I can. The girl at True Results said there is an exclusion by the employer for no Lap Band Surgery.

I think I'm probably in the same boat. My company has an exclusion policy for weight loss surgery too. I'm going to True Results in Richardson and I have a consultation tomorrow morning. Amanda from True Results called me yesterday and said that my insurance wouldn't pay HOWEVER if they find an underlying problem, blah, blah, blah. So maybe if they find I have a hernia or something, we can get around that. Will know more tomorrow. I'm so determined to do this though. If I have to take the money out of my 401k, I will. I'm 61 and have been dieting since I was 12, so this is it.

Do you have a surgery date yet? Good luck to you!

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yelorz    9

yelorz
Posted

Had my consultation this morning. When the PA examined me, he said he thought from the looks of my stomach that I probably have a hernia. I hope so - in which case I'll only have to pay $5500. My insurance has an exclusion against weight loss surgery. I'm trying to get my endoscopy scheduled for 4/30 and that will tell for sure.

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
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