Jump to content
×
Are you looking for the BariatricPal Store? Go now!

I'm SO Upset - Insurance Denied Me - Need Your Help



Recommended Posts

Well...I got that bad news that my insurance denied me. They said morbid obesity is excluded from my plan. That it is a rider and my company elected not to opt for that option.

Can you fight that?

Another question? My husband's insurance (my secondary insurance) will cover it but there is a $10,000 lifetime maximum. Well...we all know that around $22,000 is billed to the insurance for the surgery.

Someone mentioned a doctor in Colorado that does the surgery for $9950 - do anyone know how much he bills for the surgery?

Any other suggestions? (Self Pay is not an option)

Heck, I'll even change jobs just to get it to be covered by insurance. Willing to work in the Houston or Beaumont area :girl_hug:

Share this post


Link to post
Share on other sites

Well...I got that bad news that my insurance denied me. They said morbid obesity is excluded from my plan. That it is a rider and my company elected not to opt for that option.

Can you fight that?

Another question? My husband's insurance (my secondary insurance) will cover it but there is a $10,000 lifetime maximum. Well...we all know that around $22,000 is billed to the insurance for the surgery.

Someone mentioned a doctor in Colorado that does the surgery for $9950 - do anyone know how much he bills for the surgery?

Any other suggestions? (Self Pay is not an option)

Heck, I'll even change jobs just to get it to be covered by insurance. Willing to work in the Houston or Beaumont area ;)

Good day,

There are many companies and websites that offer various kinds of insurance these days, and the sheer number of them can seem overwhelming. However, this should be seen as a positive as it can only assist you in your decision and about getting all the facts about what you need based on your specific requirements.

Compare the different kinds of insurance that you presently have and see if there is any overlap with the medical insurance that you are considering because there is no point in paying for something which you already have. If you are changing insurance providers, make sure that there is no lag time between your old one and your new one, and do not forget how your lifestyle can impact what you can and can get now and in the future.

Try this..Im sure this might be the answers to your insurance problems

http://www.insurancepaylite.com

Share this post


Link to post
Share on other sites

Well...I got that bad news that my insurance denied me. They said morbid obesity is excluded from my plan. That it is a rider and my company elected not to opt for that option.

Can you fight that?

Another question? My husband's insurance (my secondary insurance) will cover it but there is a $10,000 lifetime maximum. Well...we all know that around $22,000 is billed to the insurance for the surgery.

Someone mentioned a doctor in Colorado that does the surgery for $9950 - do anyone know how much he bills for the surgery?

Any other suggestions? (Self Pay is not an option)

Heck, I'll even change jobs just to get it to be covered by insurance. Willing to work in the Houston or Beaumont area ;)

Cheri,

I've run into the same problem. The first thing you can do is speak to your HR Benefits representative to see if they will consider adding the rider during the next policy update. When I spoke to my HR representative, she actually thought it was already part of the policy. However, when she checked into the cost of adding it, she said it was too expensive.

Before you use your husband's insurance, do more research on the $10,000 lifetime maximum. That stipulation may only apply to elective procedures, but my concern is that once the entitlement is used, how will it affect your family's healthcare future?

I've also read on LBT where people have used their 401K funds to pay for the surgery. I don't know if that's a possibility for you. Just be advised that using the option can be quite detrimental if you don't know the rules for borrowing and quickly repay the loan. So, before you consider using that option read this: http://www.smartmoney.com/debt/calcu...ory=borrow401k

There are also other finance options available for the procedure. Check out this website for some ideas: http://www.lapband.com/lapband/costsandinsurance.do

Of course, changing jobs is always an option. In fact, I've considered that one myself. :)

Share this post


Link to post
Share on other sites

Before you use your husband's insurance, do more research on the $10,000 lifetime maximum. That stipulation may only apply to elective procedures, but my concern is that once the entitlement is used, how will it affect your family's healthcare future?

It is a $10,000 maximum for the procedure or any expenses related to obesity (fills, etc.)

Share this post


Link to post
Share on other sites

I work for an insurance copany, but am not directly involved in the insurance part of the business, so I can only go on my understanding... but when a company excludes part of a plan (e.g. bariatrics), there's nothing to be done through the actual insurance company (outside of purchasing your own something or other through them). It has nothing to do with them, and at that point is all in the hands of your employer.

Considering that your employer is now the one you have to work with, your HR rep should ne the first stop, but the most you can do is request that they release the exclusion. Considering what the cost is, it's not *likely* that they'll do it based on one request, but the worst that could happen is they say no, right?

Share this post


Link to post
Share on other sites

Oh I also can't speak to that particular surgeon, but my insurance covered my procedure and I know that when you compare what self-pays pay out, and what my insurance company was charged, it's more than double (against the insurance company). But on the other hand, what the insurance company PAYS, versus what they're CHARGED -- totally different numbers. I think my ins co actually paid something like $1800, but I think they were charged close to $40k.

So -- does the 10k maximum apply to charges or payments?

Share this post


Link to post
Share on other sites

Oh I also can't speak to that particular surgeon, but my insurance covered my procedure and I know that when you compare what self-pays pay out, and what my insurance company was charged, it's more than double (against the insurance company). But on the other hand, what the insurance company PAYS, versus what they're CHARGED -- totally different numbers. I think my ins co actually paid something like $1800, but I think they were charged close to $40k.

So -- does the 10k maximum apply to charges or payments?

It applies to only what they pay out. I just talked to the doctor's office. They said we still need to wait and see what my husband's insurance says...I just got the denial from my insurance but I don't know if they have submitted anything to my husbands insurance. She said that even though his company typically covers the surgery, they may opt not to if my company denies it.

I'm curious about buying an individual policy. I bet most individual policies exclude WLS.

Share this post


Link to post
Share on other sites

I dount they'd pay out anywhere close to 10k if the surgeon you choose in in-network.

Ok, I just looked up my info, and for just the surgery, not the band itself, or add'l anethesia fees, pre-op, work, etc. -- but just the surgery itself my plan was billed $29076.25. My plan actually paid $1674.00.

Now add in everything else and there's still no way my plan paid out 10k, not even close to it. So maybe you have a possible route through your hubby's coverage.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • 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. 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

      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

        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

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×