Discourged

[zoepoodle 64]

Today I went to my doc appt ready to get my surgery date. I've done all the required prerequisits, etc. Only to be told my insurance company denied benefits. The clinic said the insurance originally told them I had coverage, and now they are saying I never did have coverage for bariatric. I cried. Not sure what the next step is. Checking to see if the hubs insurance will cover. What have y'all done in this situation?

[Ginger Snaps 1,323]

I'd try appealing. You can ask your surgeon's office how to do that -- I hear they have to do it a lot and also that many times appeals are succesfful.

[zoepoodle 64]

<p>I'd try appealing. You can ask your surgeon's office how to do that -- I hear they have to do it a lot and also that many times appeals are succesfful. </p>

I am. In fact the Doctor office is. But they said their insurance girl is out for 6 weeks, so it will be after that. :-/

[dlf23 9]

Sorry, that's not acceptable. Their "insurance girl" is on vacation!! What? The surgeon needs to make a phone call first and follow up in writing. If you have your insurance through work, your HR department should be able to help. However, if the policy specifically says "weight loss surgery is excluded" then you are probably out of luck.

I get the point. This is an expensive procedure, which over time make you healthier. The problem is, in the US we change insurance so often, that the company will probably expect you to move on before they realize the benefit of your improved health.

By the way, Medicare (and all Medicare Advantage programs) will cover it. Obamacare (except for a few states) will not.

From what I hear, the large clinics in Mexico are priced so reasonably, it is probably worth looking into. And they do LOTS of surgeries. And if experience is the teacher, they know what they're doing. Good luck.

[pinkhiker 18]

My insurance never covered the surgery. I went to the information session knowing it was an exclusion. I am self paying for the surgery. I have been working withe the billing depts. at the hospital. They are wonderful and have allowed me to set up payment plans. I still had to have a down payment and pay for all the appts leading up to my surgery next week. There are different charges too (surgeon, anesthesia md, nurse anesthetist, and hospital stay. They are working on making it more streamlined.

Not all hope is lost check out self pay. I've been getting some discounts for self pay too.

,

[brannstuff 9]

I had insurance hell too!!! We switched to one during our open enrollment that covered it, only to be told later that it wasn't covered. Fought to get to a new insurance, only to be out oh hold. It took HOURS and hours of phone calls, emails, letters, and crying. I'm now six days post op. Please don't give up!!!