After getting a letter over the weekend from insurance looking for more evidence of "medical necessity," I got another letter yesterday informing me that I was denied. Reason: "The service you requested is not covered." "We found the service requested is not a covered benefit in your case." "Exclusions, Expenses Not Covered and General Limitations."

It's not a complete shock. I had called Cigna before I even had my first consult and was told the same thing. I went through with the consult and I as assured up and down from the insurance coordinator, whose job it is to verify coverage, that I was, in fact covered. Wanted to believe her, and that I had just caught an idiot on the phone at Cigna, I pressed on.

I'm a disappointed, but not devastated. I'm probably as much angry as disappointed; I'm out of pocket somewhere in the neighborhood of $1000 for all the pre-op stuff (EGD, etc.). I want recourse on that, but I'm sure it will amount to nothing.

Going fully out of pocket isn't much of an option. I don't know.

I guess I just keep on with this diet I've had myself on. I've been generally successful, but it's starting to get harder now, three months in.

Don't give up dude, There are ways to get this done. Peer to peer, letter writing, even OOC (more affordable). Just keep at it, it will happen!

What is OOC?

Good luck!

I drive a 12 year old Jeep, instead of replacing it soon, we invested in me. I'll be the sportscar!

Unfortunately for me, we bought two new cars last year, and paying around $1k/mo between them.

I wish I could put my wife back to work! lol

Yep...it is worth asking doc about making "an arrangement" with you. I had to wait and switch insurance at open enrollment time, but surgeons office said, at the first appt, that if I ended up with no coverage to make sure to talk to them and not just disappear.

Good luck... Truly wish you the best. Hang in there...you never know what is just around the corner.

Hopefully this doesn't cause you problems with HR at work.

I'm not sure what basis the coordinator is using to try and get an excluded procedure on appeal.

I know the last go round cost you 1,000.00 dollars...

They should have verified before starting.

They should have verified before starting.

Supposedly, they did. She told me she had the name of the person who verified coverage too.

Arcus, see the link below, this may assist you:

http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/what-to-do-when-youre-denied-bariatric-weight-loss-surgery

Good luck!

What is OOC?

Out Of Country - Mexico!

Most doctors here in the States have a "cash" price for people with no insurance. Some are a better deal than others. Many have partnerships with organizations that specialize in financing surgeries.....if you don't want to go to Mexico, this could be your option.

Most doctors here in the States have a "cash" price for people with no insurance. Some are a better deal than others. Many have partnerships with organizations that specialize in financing surgeries.....if you don't want to go to Mexico, this could be your option.

My eyes read, "cash" PRIZE. LOL.

I guess cash/finance could be an option, but I think it would be a while...

Arcus, until I read all the way through the thread I was going to say that your company is prob at least partially self-funded and thats why gastric surgery is excluded-- they can pick and choose to exclude alot of high dollar surgeries to keep their costs for the corporation's insurance as low as they can.

I too have Cigna through an employer. Although the employer claims that the surgery is 'cosmetic regardless of medical necessity' instead of just 'too risky'. I'd rather go forward at this point and discuss payment options should it come down to it. At this point I can't get insurance elsewhere because of the weight and my comorbities and even if I did it would end up costing more to get another insurance plan.

Think of the money and time you put into it thus far as something less to do later. Your surgeon's office seems to be ready to fight for you! And from what I have seen on this forum they generally win *knock on wood*!

I'm pretty lucky because I work for a HCA hospital and have Cigna. Everyone I know here who had had either sleeve or bypass have all been approved. Maybe they figure it's cheaper for them in the long run.

Your surgeon's office seems to be ready to fight for you! And from what I have seen on this forum they generally win *knock on wood*!

Yeah, she said she wins about 50% of appeals. Not hanging my hat on that one, but I'll be patient.

My eyes read, "cash" PRIZE. LOL.

I guess cash/finance could be an option, but I think it would be a while...

Mine was $10,400, cash in Las Vegas (baby!). Stayed at the Golden Nugget ($45/night), rented a car ($150) and enjoyed a little time in the desert. It was great.