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I was denied coverage by the insurance company due to the employers clause



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I know! I am so excited for them both. They have seen how well I am doing and seeing my weight drop off and it has spurred them both to get on board!!! When we reach our goal weight we are headed to Paris for a 'chic celebration' and no hubbies allowed! We are starting a savings plan today. I can't wait.

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My work insurance is the same way, fought them for fifteen years trying to get employer to Change there ways". Then I found out that the VA hospital does WLS, took a year and a half finally got it done 2 1/2 months ago. If you are a Veteran look into it.

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I don't understand insurance companies. From everything I've read, obesity in every form and fashion leads to more and more health problems or co-morbidities, as the clinic prefers to call them. Heart disease is a biggee and probably one of the most common, other than diabetes. How many insurance companies are paying for knee and hip replacements for people who are obese and their joints can't handle their weight anymore? Those are high dollar surgeries too. Pacemakers, a lifetime of diabetes testing and treatments (dialysis can't be cheap either).

Insurance companies need to look at their practices and come out of the dark ages. Approving weight loss surgery is a way for them to SAVE money!

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I don't understand insurance companies. From everything I've read, obesity in every form and fashion leads to more and more health problems or co-morbidities, as the clinic prefers to call them. Heart disease is a biggee and probably one of the most common, other than diabetes. How many insurance companies are paying for knee and hip replacements for people who are obese and their joints can't handle their weight anymore? Those are high dollar surgeries too. Pacemakers, a lifetime of diabetes testing and treatments (dialysis can't be cheap either).

Insurance companies need to look at their practices and come out of the dark ages. Approving weight loss surgery is a way for them to SAVE money!

I could not agree with you more! Insurance companies also need to get out of the relationship between drs and their patients. It amazes me that a non medical person can decide against what our dr believes is for our best health.

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Can you appeal? If you get your doctor's together and they think it is medically necessary you may get them to do it. My husband plan just started covering it this year

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I don't understand insurance companies. From everything I've read, obesity in every form and fashion leads to more and more health problems or co-morbidities, as the clinic prefers to call them. Heart disease is a biggee and probably one of the most common, other than diabetes. How many insurance companies are paying for knee and hip replacements for people who are obese and their joints can't handle their weight anymore? Those are high dollar surgeries too. Pacemakers, a lifetime of diabetes testing and treatments (dialysis can't be cheap either).

Insurance companies need to look at their practices and come out of the dark ages. Approving weight loss surgery is a way for them to SAVE money!

When I was crying and complaining about this with my husband after we found out about our exclusion, he said that it's because the insurance companies know that there is a good chance they won't still be your insurer when the complications set in. They'd rather not pay today for what *might* ail you tomorrow, because tomorrow you'll be somebody else's problem.

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When I was crying and complaining about this with my husband after we found out about our exclusion, he said that it's because the insurance companies know that there is a good chance they won't still be your insurer when the complications set in. They'd rather not pay today for what *might* ail you tomorrow, because tomorrow you'll be somebody else's problem.

Yeah, this is the problem with getting health insurance through your employer. By the time your obesity leads to other serious health issues, chances are you won't be working anymore and will need to rely on Disability and Medicare/Medicaid. They are banking on the fact that your failing health will force you to quit/lose your job, then they won't have to cover your costs anymore.

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What is the average cost to go to Mexico for surgery? Are there usually packages - airfare and hotel, etc? Is it safe? I'm waiting to hear from my insurance for a reversal from band to RNY - trying to be hopeful ...I will fight any denial. Just want to know if I have options. Thank you!

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I would say the prices range from about $400--$6500 and most do not include airfare, but they do include hospital and hotel. I suppose it depends on where you go whether or not it is safe. I suggest carefully researching the surgeons. I had my sleeve at Obesity Control Center in Tijuana with Dr. Ariel Ortiz and I felt 100% safe the entire time. I stayed one night in the clinic and three nights in the Tijuana Marriott (one pre-op and two post-op). I walked the streets in the are of the hotel to go to a nearby convenience store and felt perfectly safe there. The hotel staff was AMAZING.

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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
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    • BeanitoDiego

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    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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