I went to a center that does Lap Bands and did a free consultation. They said I was one of the best candidates they'd ever seen (given my weight, enthusiam, preparedness, etc.) but then when they called my insurance they denied it. They said there was an exclusion and there was no way they'd cover it.

Am I just screwed? I can't afford to hire an attourney (which is why I was depending on insurance so much; I can't afford this!).

This was the one light for me in turning my life around. I can't do this alone. I know it isn't a cure; it's a tool. A tool I need. I can't build a house without a hammer, y'know?

I have a BMI of 45 so that isn't the issue. It's just that the insurance company (Mercy Healthcare.... not very merciful...) SUCKS. They're a company for small business partially funded by the state of Arizona and they're tanking. They are refusing to take on any new people, and they tripled our rates at the beginning of the year.

I'm so frustrated. I cried my eyes out at the clinic and felt like a total moron. I'm sure the insurance lady had seen tears before, but I bawled. I felt like such a doof!

Do I have any options when there's an exclusion? The insurance lady told me there was no other plan that covered it that I could buy, either, they simply refused to pay for it. Am I as stuck as I feel?

You know what REALLY sucks? Since I'm so fat, I don't qualify for any other insurance without:

a) quitting my job and drawing State Insurance

:teeth_smile: paying $600/mo premiums

WHAT THE HELL?! What is someone supposed to do? I feel so very very lost... I don't know what to do... I just need someone to talk to, I suppose. Anyone been there? Anyone gotten through Mercy Healthcare's bullcrap? :-(

Hi, look on your insurance website and make sure it is an exclusion, sometimes insurance companies do not want to pay for the procedure. I do believe Mercy hospital/insurance is under the Catholic health initiative, and the organization does not believe in surgeries of this kind. I used to work for them in the corporate offices for Centura health.

((((HUGS)))) I'm sorry and feel so bad for you. I know that I would feel the same devistation that you are feeling if I can't have my surgery for one reason or another. I'm on pins and needles right now with waiting to hear back from the surgeon as to whether or not he's going to accept me.

There are a lot of us who have insurance exclusions....and many, many insurance companies that do.....I knew up front mine did, so went a self pay route.

Hoping you're able to find a way to do it for yourself.....

Good thoughts.......

Don't give up!! I,too, have been denied. But what I am doing, is getting the documentation ready and an appeal letter done. Most of the time, you will need several medically documented weight loss attempts. These can range from 6 mon-1 yr. I have had both my primary care and gyn wrtie letters stating it is MEDICALLY NECESSARY for me to have this procedure done. My surgeon will also write a letter and then I am writing an appeal letter. We will see what happens. You, too, can do this. Yes it is alot of work, but you are worth it! If all attempts fail, I have been saving money to put towards a self pay. If my insurance will approve, I have a start for a down payment for a crusie! Good Luck

Thanks, you guys. I feel so down. My insurance company told me basically that with the exclusion there's no way they'll pay for it and they have no riders and essentially it sucks to be me.

And I don't qualify for any other insurance companies because I'm too fat! I mean, I could get coverage if I paid, oh, 90% of my salary each month!:thumbup:

I don't have the money to self-pay. I live paycheck to paycheck, which you'd think would mean I could lose weight but nooooooooooo somehow I just stay within the same, oh, 8 lbs or so. I am the only one who supports my family of 3.

I know deep down that this would be the key to helping me change my life, but this really sucks.

Oh, hey! Has anyone got any experience with having any other surgery and having the ins. cover it then paying for just the band itself?? Because I believe my ins. would cover a hiatal hernia repair (which I think I have, will look into it more soon) but if I can pay the difference in installments, I could sure afford that more than the whole surgery! Anyone? Please? :confused2:

Same thing happened to me. I know that does not help much.:-) Some Drs. in Mexico have financing if thats an option for you. Don't give up your dream.

I financed part and paid cash for the balance. Also I heard that it can be a taxable deduction. Sorry that I can not be of any more help.

That's a very unfortunate situation. When your insurance companies denies you and self pay isn't an option it leads you with very little outs. Since they felt you were such a great candidate you may try and see if your surgeon can do it pro bono publico. That would dramatically reduce the costs.

It's worth a shot.