ins. won't cover what now??

sandi1972 · April 22, 2008

Hello everyone! I was so excited about having this done. I have researched and researched, scheduled the information seminar, I was absolutely sure this was going to be the answer to all my prayers (and believe me I have prayed about it!) today I finally got a human at the insurance company and they tell me that this is a non covered surgerical proceedure. I'm devistated. I want to just go into debt and self pay. I want this that bad. I will never drive a new car, I will work summers (usually I am off) I will give up my mulch and spring flowers....But is it fair to ask that of my family? To put the entire family in debt because I'm tired of being fat and cannot solve the problem on my own?! I have a daughter turning 16 in June, and a 12 year old son. I didn't think twice about dropping 8k on braces for both of them only to still nag every night about brushing, but feel that if I do this for me I am being selfish. I'm in easter PA and don't know where to go next if I do decide on self pay does every dr. do it? Any information would be very helpful! Should I pay more and stay close to home or go to Mexico??? Help, wise ones, help

wildercrews · April 22, 2008

Appeal their decision. I was denied twice but appealed it with help from my primary physican and surgeon. Ask them to assist you. Doc's know how to talk that insurance language. Be encouraged.

Sanlortut · April 22, 2008

First of all, is the procedure something the insurance company never approves, or is there some reason they didn't approve it for you? If it's the latter, I've read on this site that the lapband company will fight insurance battles for you. I can't remember the name of the website you need to check, but perhaps someone else can supply the name for you.

Secondly, if insurance won't pay and you are able to borrow the money, I think you should give serious thought to doing it. As women, we tend to take care of everyone else first and seldom get around to taking care of ourselves. You're not being selfish by wanting this surgery. In fact, it will be better for the entire family if you're happier and healthier and able to live a longer life with them than you might have without the surgery.

Thirdly, I've read of many people who have gone to Mexico for the surgery and have been very happy with the experience. But I've also read about people who have had the surgery there, have had complications upon returning home, and have not been able to find a doctor who would treat them due to liability issues. If it were me, I'd have the surgery closer to home where I had easy access to my doctor.

I wish you all the best as you make the decisions that are ahead.

sandi1972 · April 22, 2008

there is an exclusion to our policy for any weight loss type surgeries regardless of reasons of diagnosis. I just didn't know it. It is anthem BCBS... you see those letters and you think good to go. Thank you for all your advice and help. I know what you mean about putting everyone first as a mother... I just bought my daughter a $23 bra for dance recital... I've never even bought $23 shoes lol!!

TxChelsey · April 22, 2008

That is such a hard decision. I would hate to be in your shoes. If my insurance had not covered it, it would not have been an option for me at all. I never would have been able to come up with that amount of money and my credit is less than fabulous. If you do have credit options, I would certainly consider it. I just got my hospital bill (pending insurance payment) and it was over $23,000. That doesn't include everything else I am expecting. Surgeon, asst surgeon, anesthesiologist, etc. I researched and switched insurance companies during open enrollment. Though I pay a higher rate per pay period, the coverage is great. Is changing companies an option for you? Good luck!!

Long2BFree · April 22, 2008

I know as a mother it is hard to put ourselves first but we need to learn how to balance our needs just as much as everyone elses. It's not like you are asking for a $30K car. I know that my surgeon charges less if you are self pay and also lets patients chose a surgery center over the hospital which makes it even cheaper.

Check your options for insurance. It might be cheaper in the long run to change policies or even get a private policy for yourself.

Enchanted · April 22, 2008

Stinky :tongue_smilie:

I have Anthem BC/BS and have been approved -- so they do have policies that cover the procedure. My husband's employer offers several plans from which employees can choose. Can your current policy be upgraded? It would be more expensive and you may have to wait until open enrollment (usually at the beginning of each year), but it would definitely be less expensive than self-pay. (Just make sure it's covered before you switch.)

As someone else mentioned, buying a separate policy may also be a viable option. Again, expensive and they may require a six month (or more) supervised diet before considering it.

All of those things aside, you seem to be asking, "Am I worth it?" I say we each are. But if you aren't at the point where you can tell yourself that, consider this: you have a family. They are counting on you to be around for a long long time. The healthier you are, the better able you will be to take care of them.

Best of luck to you.

there is an exclusion to our policy for any weight loss type surgeries regardless of reasons of diagnosis. I just didn't know it. It is anthem BCBS... you see those letters and you think good to go. Thank you for all your advice and help. I know what you mean about putting everyone first as a mother... I just bought my daughter a $23 bra for dance recital... I've never even bought $23 shoes lol!!

Southern Missy · April 22, 2008

Sandi,

If you notice underneath my screen name, it says "finally it's all about me". There's a reason for that. I am a mother of 4 and a wife. I give, give, give all I have and then I usually dig deep and give some more. This surgery is for me. However, isn't it for them too? Without it, I might not be around as long as we have "planned" and, in that case, can you afford not to do it? Ultimately, the choice is yours but I know this is the right choice for me... and for them. :tongue_smilie: Good luck to you!

rynodad · April 22, 2008

My insurance company told me that there was no way under any circumstances that they would pay for me to be banded. We (my wife and I) could not afford the $17,000 (each!) that everybody we could find wanted, and we ended up going to Mexico. We did a lot of research and came up with a great doctor, and for $8,000 it's done. We were worried about being able to afford it, but we really couldn't afford not to. We have small children, and we're not getting any younger. I figure that if the $8,000 bought me another 20 years with family, then it's the best money I've ever spent.

my

jam265 · April 23, 2008

well, if you don't want to go to Mexico, you could consider Dr. Kirshenbaum in Colorado. He is 9950, doesn't mess with insurance companies. I think there are a couple of threads on Dr. K.