so my doctor called me yesterday and said i am covered my insurance i just have to provide 6 month diet history and 5 yr weight history. so i have all of that i've been calling the doctors office for 2 days now they FINALLY called me back a lil bit ago and said "i've called the insurance 3 times and they say its not covered i dont know who called the first time and found out it was covered and put this in your file but you were mis informed you aren't covered." then got off the phone me... to leave me balling my eyes out uncontrollably. how can they do this to a person and have no remorse! they had me so excited and now have crushed me!!! my mother is pissed off! so she called the doctor and they said they can't help what the insurance company says and my mom said you can help what you say. and they said well we'll send her paperwork on how she can pay for it herself. my mom said don't bother she can not afford it!

i am so hurt.. i dont know what to do. i feel like my heart has been ripped out of my chest!!!! please someone talk to me.:help:

Did the doc send the package in? Or did he just call somebody?

If he sent the package in - then you should get a denial letter.

Make him send the package. If they deny you, they have to tell why.

Is it a COMPANY exclusion of the employer? Or does your insurance company not cover the procedure for ANYONE?!?

I know that every time anybody called my insurance company, they got a different answer about whether or not it is covered. It seems like the folks answering the phones at the insurance company are not always the sharpest crayons in the box.

Also - if you don't specify bariatric surgery for Morbid Obesity - sometimes they just flat out give you the "we dont cover treatment for weightloss" answer.

Who is your insurer?

it looks as if its an exclusion by the employer!

United Healthcare

I'm sorry That really sux!!! I do know there are MANY people on here that have gone to Mexico and had it done for under $10k, including airfare and accommodations. I know $10k still seems like a lot but if you're able to get a loan, it is money well invested. Just a thought. I wish I could help more.

I'm sorry this happened to you. Best wishes.

thank you. i appreciate it. i just dont get it. why would an employer say hey dont cover anyone that wants weight loss surgery. hello my bmi is a 46!!!! its medically necessary. thats just wrong in my eyes!

baybee, it really stinks! Sadly, many many employers have that exclusion in their policies. It makes it cheaper for the employer's insurance costs. Which makes no sense to me that insurance would want to pay for cholesterol meds, CPAP, heart attack, insulin, etc..., when WLS is much much more cost effective. But, alas...for an employer to pay for the rider for weight loss surgery is like adding leather seats to a new car, it's an extra expense. Companies don't like to spend money. But it seems to me that heavier people are going to have more sick days and cost more in the long run, it would make sense to buy the rider...

Never ever believe what anyone says about your insurance coverage unless it is the insurance company saying it, and then get it mailed to you so you have it in writing.

Good luck, and I hope you can find another way.

thank you. i will keep everyone informed. things aren't looking very positive.

This is making me nervous now too. I am presurgery, preconsult at this point but have talked to the insurance company a couple of times, they even sent me a packet of info that I need to get done for preapproval. How do I find out for sure that this surgery is an 'exclusion' in my policy? I have Univera insurance

Have you considered changing jobs? Some employers still cover WLS.

This is making me nervous now too. I am presurgery, preconsult at this point but have talked to the insurance company a couple of times, they even sent me a packet of info that I need to get done for preapproval. How do I find out for sure that this surgery is an 'exclusion' in my policy? I have Univera insurance

You need to call and ask then to look you and your specific policy number up and make sure yours is covered. Most insurance companies have case managers that deal with things like bariatric surgery, ask the customer service person who answers at your company if they do. If so, ask to be connected to one of them. They are the true experts at this. That is all they do is complex cases. I have been working with my case manager for almost a year now and she's been a HUGE help. She sent me a copy of the requirements and has talked to me several times and given me tips on what to do. She calls and checks in on me to see where I am at in my process, too. I urge you to see if your insurance has a person like this and then always talk to that person. I read lots of stories where every time you call the insurance company, you get a different story. That's got to be sooo frustrating!

im actually looking for a new job. i've got apps out there.. when she called and told me it was covered yesterday i prepared myself to stay here. i hate this place but was willing to do it just to get this surgery. but now the hunt is on..but still. say i get a new job... and their insurance doesn't cover. i can't keep changing jobs ya know??

That sucks!! I am so sorry for you. I agree with Carlene, any way you could switch jobs? Or is there any chance your employer will change the exclusion?

i talk to HR and she said its exluded in our policy and there is nothing we can do to change it. period.

i said THANKS!

i just dont get it. why would an employer say hey dont cover anyone that wants weight loss surgery.

When it's an employer exclusion, it's because they don't want to pay the extra in premiums that WLS tacks on. When it's a provider exclusion, it's because insurance companies need to see a return on their investment, even if it's just breaking even. It takes a lot of time and saved prescriptions, etc. to see that. Now consider that they aren't just looking at it from the individual perspective, e.g. "we saw a return on John", they're looking at it from the group persective, and maybe even regional. The bottom line is that most insurance companies aren't seeing a return for their outlay.

I second the submission. That way you can know for sure why it was exlcuded. If it's a provider exclusion you'll have more room to dance for an appeal. If it's an employer exclusion, there's virtually nothing you can do, short of begging your HR department to add it to the policy... which probably isn't going to happen.

But don't give up. Is there any creative financing that would work for you? Can your mom or other family loan you the money? Can you afford an installment loan for it? It really is soo worth it...

Hang in there. This too shall pass.