All my hopes and dreams down the drain

[lovestoned 0]

I don't even know where to begin :cry 4 months ago when I started this whole process of having surgery I was told by the "insurance specialist" at my hospital that all was good with my insurance...that I would be covered. Stupid ME never called the insurance company to verify this, after all, HE IS the "Insurance Specialist". After getting a surgery date of August 17, and after many tests and appts. and getting paperwork for these people I get a call on Aug. 7th from the hospital letting me know that weightloss surgery is EXCLUDED from my plan through my employer and that it was MY responsibility to have double checked that :think So of course I've been devastated for the past 3 days BUT this morning I get a call from the hospital AGAIN and get told "Congratulations, you've been approved" WTF??? So I'm all like "are you sure?? but what about this and that..." She reassures me that I've been approved and that she even has an authorizaton # :whoo:But something told me to call my insurance company and verify this. I called them and they said that the claim was presented and DENIED on Aug. 7th :faint:. YOU GUYS, I'M GOING CRAZY OVER HERE!!! :wacko:I know I need this band to help me lose weight...without it I know I can't succeed at losing the 140 lbs I need to lose. What do I do? I feel desperate, depressed, impotent :help: along with many other emotions!!

[gwhite 0]

So sorry for the rollercoaster ride you're being put on. I was told by my insurance company that my surgery was approved and the docs office said it was approved but then I called my insurance company back to double check and they said it wasn't. I sometimes think they like messing with people!

My suggestion is to call your doctor's office and ask for the approval number and ask the coordinator at the doc's office who at the insurance company they talked to to get the approval and then call the insurance company back and tell them what you find out.

I'm keeping my fingers crossed that this was just a minor clerical mistake.

Good luck

[WASaBubbleButt 41]

Get a copy of the authorization from the hospital. The insurance company will fax them a paper that authorizes payment for the procedure.

Look at your policy, what does it say about Weight Loss Surgery? That is the first place you should look. It will spell it out for you right on the policy.

[lovestoned 0]

The bad news just keeps coming :-( Turns out that the supposed authorization number was just something not unlike a case number. I was in fact DENIED :-(( I just contacted my employer to see if there's anything I can do and their response was "ABSOLUTELY NOT" they told me that it was removed due to high costs. I'm NEVER gonna know what it's like to be thin again without this surgery. I'm completely devastated.

[Mal 0]

love~I am so sorry to heart about everything you have gone through only to find out that your ins co denied! If the band means that much to you maybe you could look other places...a loan, credit card,??? I have heard some use a second from their mortgage??? I wish you well and hope that something will come through for you!

[jsrico 1]

Lovestoned,

I went throught the same situation last year....I was suppost to get banded in July 2006. I check w/ my insurance...did the list of criteria...I had to do......pyschologist, cardiologist, pcp, nutritionist!!! Then I was denied because it was written out of my policy!!!!! UUUGGG, I cried, I yelled, I cursed!!! Then I said....I will get my bills in order and I wll finance the rest of my life/health/wellbeing!!! So I finaned $13000 in May and had my surgery May 22!!! I pay 418 for 3 yrs!!!! I know thats alot....but considering I was paying 150 for presciptions a month and that my 600 a month car payment would be paid off in 4 months....I said what the hell and did it!! Well 11 weeks later, 36 pounds lost forever!!! My doc even said 20 more pounds an no more prescriptions!! If you want it bad enough you will find a way!!! Keep your head up!!!

Sandra

255h/242s/206c/165g

[SchexyMomma 0]

Have you looked into self-pay? If you are determined, then there is a way!!! If you could get a loan, it should be a heck of a lot cheaper than a little car note! I was covered by insurance, but I was really thinking that it would not be covered, so I looked into a personal loan for $15,000 and the terms were reasonable. I was also considering going to Mexico (less than half the cost here) because in all my readings, I have never seen one post negative about Mexican surgeons/surgery itself/after care, etc.

Don't give up!!!!!!

[WASaBubbleButt 41]

The bad news just keeps coming :-( Turns out that the supposed authorization number was just something not unlike a case number. I was in fact DENIED :-(( I just contacted my employer to see if there's anything I can do and their response was "ABSOLUTELY NOT" they told me that it was removed due to high costs. I'm NEVER gonna know what it's like to be thin again without this surgery. I'm completely devastated.

A lot of people think they can't afford to self pay for surgery and I think you might be shocked at how much cheaper it is to be a thinner person. My grocery bill has been cut drastically but most of all, my fast food bill. Just my fast food and soda alone ... by not paying for this stuff anymore it will pay for my band in 1.6 years.

There is always financing. Lots of people pay their $160 a month (depending on how many years financed, interest, etc.) with savings from their food bill.

Once you are over the shock of realizing insurance isn't going to pay for it, consider financing. I paid for my from savings so I don't know a lot of details but I would seriously check into that. People do anything to get this surgery. I've seen them get 2nd and 3rd jobs, borrow from friends and relatives, go dumpster diving and sell the treasures on ebay, refinance homes, one lady even sold her home to use the equity for her surgery. I was reading this morning about one lady that saved for it dollar by dollar. Some months she could only save $5.00, other months it was more. It took years but she did it and just had surgery last week.

Some of the Mexican docs would let you pay a portion and then they would finance the rest of the fees. They quit doing that after getting burned so many times. I don't believe anyone does it anymore but maybe others have different information.

Never say never, when it comes to this surgery I have learned a huge lesson. When you want it badly enough, you will find a way to get it.

[marjon9 6]

Never say never, when it comes to this surgery I have learned a huge lesson. When you want it badly enough, you will find a way to get it.

lovestoned: What you went through really sucked. You had a right to be devastated and upset and feel angry at the world for a good long time.

But ... now you've been there and done that. Continuing to focus on this bad experience is not going to help change things. The fact is, it's time to start focusing on finding a different way to get the band, without insurance. The band can be had for about $10,000. Many of the Mexican doctors are very good and they do the work for around $8500. My surgeon (you can find him in my signature) is also very good, he's in Denver and he charges $9950.

You will make back the $10,000 many times over in reduced food cost, reduced medical bills, greatly improved quality of life, and very likely extended longevity overall. There is no better way to spend $10,000.

As WasaBubble said, when you want it badly enough, you will find a way to get it.

So, let's gitterdone!:bounce::whoo::clap2: If you are like 95% of the people here, you won't regret it.

[WASaBubbleButt 41]

You will make back the $10,000 many times over in reduced food cost, reduced medical bills, greatly improved quality of life, and very likely extended longevity overall. There is no better way to spend $10,000.

Isn't that the truth! The surgery pays for itself with cost savings and then again with quality of life.

My doc charges $8200 and has specials every now and again for $7800. But don't shop by price alone, shop by experience and skill.

[TracyinKS 7]

Don't forget taking a loan out on your 401K as an option.

[lovestoned 0]

Thanks all of you guys!! Your words really do help. I really am feeling better already. Self pay MIGHT be an option for me. I would have to talk to some people and figure some things out first. Does anyone know if it would make a difference if the surgeon wrote the insurance company letting them know that my surgery is medically necessary? I mean does that even make a difference when weightloss surgery is completely written off?

[WASaBubbleButt 41]

Thanks all of you guys!! Your words really do help. I really am feeling better already. Self pay MIGHT be an option for me. I would have to talk to some people and figure some things out first. Does anyone know if it would make a difference if the surgeon wrote the insurance company letting them know that my surgery is medically necessary? I mean does that even make a difference when weightloss surgery is completely written off?

Nope, it won't make a difference. Your employer didn't buy that part of the policy. It would be like your house flooding and you didn't have flood insurance, nobody would pay the claim. You don't have WLS coverage so nobody is going to pay that claim.

Honestly, if you have to finance your surgery you will also see a way to pay the payments in money saved after surgery. Your food bill will change drastically. Rx copays, the works.

[lizziee 0]

I'm sure you've already worked things out but for future users. I went through it all trying to get approved via Cigna. I finished my required 6 month diet in February and just got the OK in August. Still waiting on Surgery date (had pre-op nutriontist visit 9/4) so I'm hoping any day now I will get my date.

I did not know this but many companies have an Advocacy program that will help work with you and the insurance companies if you are having any problems.

I found this out in June and with the help of the Adovcacy Rep from my company I was approved in August after being denied three times! She actually called to inform me before the doctor's even knew.

Check with your HR Department or Employee Assistance to see if you have access to this additional support.

Anyone needs help getting approved through Cigna let me know. I sent them a binder with 208 pages of any and all documentation that my doctors office wouldn't do!

[WASaBubbleButt 41]

Lizzee...

May I asked why you were denied? I know Cigna and they are amazingly difficult to work with. I can't stand Cigna myself but YMMV.