Should I wait for my doctor to submit request to my insurance?

[Barbara278 9]

I'm new to this site but have been a member of several other WL boards.

I have an apt on January 6th with my surgeon. We just got a new insurance policy at my employers that went into effect today. Prior to picking this new insurance company, I requested that my agent make sure they cover WLS. She informed me months ago that they did so we went ahead and selected them. I even started seeing my Family doctor to establish the six months consults prior to applying for the surgery. Dec 23rd will be sixth visit.

My insurance agent informed me that she called the new insurance company today to find out what kinds of WLS they cover since she knew I wanted the sleeve and the customer agent told her they don't cover WLS unless a specific rider is written into the policy. She informed him that riders are not done in state of Colorado.

I'm so confused now. I don't know if I should call the insurance company to inquire or just let the doctors office do it when I go in January. I don't want to sabotage my chances in any way.

I think I'm just stressing because I want this so bad and I'm afraid I'll get turned down or they will refuse to cover it.

Any suggestions?

:001_tongue:

[Tiffykins 671]

I would call and find out the specific exclusions of the policy. Your policy will outline the exclusions. If you do wait for your appointment, and get a denial, you may have an option to appeal the decision. It will depend on the reason they decline the surgery for you.

Best wishes, and keep us posted.

[Oregon Rose 2]

Hi Barbara-

It doesn't hurt to call your insurance and ask what they cover and what they exclude. I called and was told VSG was excluded. I asked for a hard copy of the section of my policy that dealt with weight loss surgery and read the VSG exclusion myself. (The insurance representative told me where to find a copy on their web site.) My surgeon's office also told me that a patient with my same exact insurance was turned down for VSG, appealed twice and was turned down for both appeals.

This is how I knew that I would have to pay for VSG myself. I'm glad that I didn't waste any more time trying to qualify (6 month waiting period) for the non-existent insurance benefits.

Even though I had to pay myself, I'm glad I had VSG. VSG is so much better than Band (better weight loss) or Bypass (no malnutrition issues.) Why wait and torture yourself.

Best wishes,

Edited December 2, 2009 by Oregon Rose
typos

[Malaika 50]

Barbara - welcome to VST. I agree with the others - contact your insurance representative and ask them what WLS is covered and/or excluded - I wouldn't wait until January - you will drive yourself crazy with worry and doubt by then -- find out now and the you can determine a plan to work with whatever answers they give you.

[Barbara278 9]

Thank you all for your kind words and advice. I am going to contact them and ask what is covered. I do think it would be torture just waiting it out until January as I'm already stressing about it now.

I really feel the sleeve is the best choice. I've spent many months researching and trying to decide what is best for me.

If they exclude the sleeve but cover other options, I'm not sure what I'll do. I do know that I do not want the band. I orginally started out with intentions of doing the band, but have definitely decided I will not go that route.

Again, thanks for all your suggestions and I'll let you know what happens.

*keeping my fingers crossed*

[Barbara278 9]

Well, I found out that it is written in the policy that it is not covered. Looks like my insurance agent made a huge mistake. I'm so upset I barely slept last night. I did leave a message for my agent to call me and explained to her that the policy she sold us is not what she said it was and asked her how we can get it fixed. I'm not sure anything can be done at this point.

Can anyone tell me if they were able to get approval from UHC when WLS is excluded from the policy?

Seems like everything that could go wrong with this transaction has, but I'm still trying very had to keep a good attitude.

:tongue_smilie:

[Barbara278 9]

I'm going to be a self pay. I'm looking into Mexico.

[Tiffykins 671]

I'm going to be a self pay. I'm looking into Mexico.

Good luck with your research on Mexico surgeons.

[Barbara278 9]

Thanks Tiffykins! I'm actually getting excited about it now that I know where I stand and what my options are.

[Malaika 50]

Barbara - sorry that your insurance won't pay - it still amazes me that they find the sleeve so "experimental" or that employers (mine included) would opt to exempt WLS surgery. Maybe that trend will change one day (soon).

If you are looking to have your surgery in Mexico, I would highly recommend Dr. Aceves - he has performed surgery on several of us here on VST and my first hand, personal experience was absolutely awesome. He also performed my fiance's surgery 1 month later and the experience was just as excellent.

There are others on here who have also had surgery in Mexico with other surgeons and am sure they could offer you their experiences.

Regardless of who says what the most important thing is that you do your own research and then research even more and that you are comfortable with your decision.

If you have any questions about Dr. Aceves, feel free to PM me and I will answer them for you.

[cajun 46]

Thank you all for your kind words and advice. I am going to contact them and ask what is covered. I do think it would be torture just waiting it out until January as I'm already stressing about it now.

I really feel the sleeve is the best choice. I've spent many months researching and trying to decide what is best for me.

If they exclude the sleeve but cover other options, I'm not sure what I'll do. I do know that I do not want the band. I orginally started out with intentions of doing the band, but have definitely decided I will not go that route.

Again, thanks for all your suggestions and I'll let you know what happens.

*keeping my fingers crossed*

I hate it when people lie to you just to get your money. GRRRRR.

I hope you find a way to get the sleeve if that is what you want. I'm delighted with mine, and highly recommend Dr Aceves in Mexicali. "Summer" rate was 8700 all inclusive except for my airfare. He is president of mexican bariatric assoc., is a Fellow in American College of surgeons, has done over 700 sleeves and has an outstanding reputation. I'm a nurse myself, with 30 years experience, did extensive research on multiple surgeons before deciding, and I'd send my first born child to him...can't do better in my opinion.

[Barbara278 9]

Thanks for your replies. I've been researching this surgery for a while and have read so many posts. I had pretty much made up my mind that Dr. Aceves ranked way up on my list. In fact I have been in contact with his office several times and have been totally impressed with their professionalism. Looks like he will be the one and that I'll have surgery sometime the latter part of January.

I'm so excited and scared at the same time, which I know is a normal response.

Thanks so much for your information and for posting on this board so that us newbies can get an idea of what to expect.