Insurance declined. Must self pay - who else has?

[rlm34 42]

Im disappointed. Just got phonecall from insurance company to say I've been declined. My comorbidites are not serious enough.

So...my only option is self pay. My surgery will be 22k. It's serious money. My bank has pre approved a personal loan to pay for the surgery which is great...but I'll be paying this back for years.

Has anyone else self-paid a large amount and had no regrets?

[bb00024 21]

I was denied and then denied again with my appeal and then the surgeon scheduled something called a "peer-to-peer" review. That seemed to do the trick.

Apparently, this peer-to-peer review is my doctor scheduling a phone call with an actual doctor from the insurance company and my doctor explaining all the problems using medical terminology, I was having with my lap-band and that I now have a hernia, which could cause bigger issues. It worked and I was approved.

It wasn't a quick process by any means, but it worked. Between each of the appeals and the doctor review the insurance has 30-days to respond.(Response time could be different based on ins. company rules.) My whole process was 8-mths long, but I started with one doctors office and changed due to his horrendous staff and poor bed-side manner, so the process started over.

Good luck!!! I had surgery 09/16th and I am soooooo excited.

[Kcarr1120 15]

I was self pay to the tune of 22k also. I am now almost 5 weeks out. I do not have regrets per se, but I am putting a lot of pressure on myself because we did pay so much. I am terrified I won't lose it, and will be out such a huge chunk of money! Good luck with your decision!

[rlm34 42]

That sounds interesting and promising. But im not sure that sort of process exists here. I will certainly run it past my surgeon thou and see what he says. Right now im so over waiting. Might just suck it up and self-pay. That level is debt is truely daunting and a little terrifying but so is living a miserable life for any longer.

[rlm34 42]

I was self pay to the tune of 22k also. I am now almost 5 weeks out. I do not have regrets per se' date=' but I am putting a lot of pressure on myself because we did pay so much. I am terrified I won't lose it, and will be out such a huge chunk of money! Good luck with your decision![/quote']

This is my fear too. What if I dont lose much? Or it doesn't work well? I'm sure I would lose weight though. Those fears seem common and unfounded from what I've read. How much have you lost so far?

[SarahBeth 11]

I too was self pay, and I don't regret it for a minute. It does put a little added pressure to lose weight, but I think it is a great motivation to not give up! It is truly a life-changing operation and it's worth every penny!

[rlm34 42]

I too was self pay' date=' and I don't regret it for a minute. It does put a little added pressure to lose weight, but I think it is a great motivation to not give up! It is truly a life-changing operation and it's worth every penny![/quote']

Its so great to hear you have no regrets. I hope your enjoying watching and feeling yourself getting smaller and healthier. It must be exciting!

[Nel 189]

I paid $12,000 and my insurance paid $4000. I have no regrets....even though I'll be paying it off for a while.

[Kcarr1120 15]

This is my fear too. What if I dont lose much? Or it doesn't work well? I'm sure I would lose weight though. Those fears seem common and unfounded from what I've read. How much have you lost so far?

I have lost 21 so far....a little slower than I was hoping, but it is going in the right direction!

[rlm34 42]

I have lost 21 so far....a little slower than I was hoping' date=' but it is going in the right direction![/quote']

Great attitude and 21lb loss sounds great to me. Congrats! Must be an awesome feeling watching number on scales creep downwards.

[Mid West 99]

In the UK, we don't have health insurance per se. We have the NHS and some regions fund WLS but most don't and with those that do, it seems they make people jump through many hoops and wait a long time until they're approved - it's rare here. So, I'm self pay. Yes, it'll take a while to pay off but it's an investment in my next 40+ years (God willing). Good luck to you all.

[J-La 4]

I was a self-pay also. Mine was $19,000. I had 3 Doctors write letters to the insurance company BCBS and they still wouldn't pay a dime. Even though I met all the criteria BCBS said that there was a stipulation in my policy that stated that they would not pay for ANY weight loss related treatment.

[TinyMamiOf3kids 1,280]

Try fighting it 1st before you pay a large amount & be stuck paying it forever

[jules75 12]

I too will be doing self pay. I am from Canada where it would actually be covered by my provincial health coverage, unfortunately it is a minimum 5 year wait. And I am borderline 39-40 bmi. So there is strong chance I would not get accepted anyway. I made the choice to do self pay. I will be doing it in Costa Rica. It cost $8,500. And I am confident in the doctor, he does more procedures in a week than most North American doctors do in six months. I have been to their hospitals and can say they are extremely clean and put our North American hospitals to shame. It is something to consider. And with the money saved you will be able to do skin removal in the future if needed. I haven't selected my date yet, but will likely be before Christmas.

[jules75 12]

I too will be doing self pay. I am from Canada where it would actually be covered by my provincial health coverage, unfortunately it is a minimum 5 year wait. And I am borderline 39-40 bmi. So there is strong chance I would not get accepted anyway. I made the choice to do self pay. I will be doing it in Costa Rica. It cost $8,500. And I am confident in the doctor, he does more procedures in a week than most North American doctors do in six months. I have been to their hospitals and can say they are extremely clean and put our North American hospitals to shame. It is something to consider. And with the money saved you will be able to do skin removal in the future if needed. I haven't selected my date yet, but will likely be before Christmas.