disappointed

Hi, I'm new to OH, and I have a problem I'd like to get some input on.  My doctor has recommended sending me to Little Rock for a consultation for gastric bypass surgery.  He sent a letter to my insurance company, and they have said that there's a written exclusion in our policy for the surgery, and absolutely WILL NOT cover it, even if it's deemed medically necessary.  I have Aetna POS Choice II through Advance Auto Parts.  I even called the benefits office at Advance Auto Parts to see if there was anything they could do, and they told me the same thing Aetna said.  I have a BMI of 55, high blood pressure, incontinence, back and joint pain, and skin problems due to my weight.  I have been overweight since I was in kindergarten, and have tried every plan under the sun.  I do lose some, and then gain it back, blah blah blah.  Anyone who's struggled with obesity knows what I've been through, and that's not why I'm messaging.  My question is "has anyone else dealt with these written exclusions with their insurance companies, and how do I get past them if it's even possible?" Thanks.

short answer:  it's probably not possible.  i know a lot of doctors are keeping up with data to prove to these insurance companies that is in their best interest to pay for surgeries rather than deny then, but it will be time before any changes are made. this happened to me.  my insurance (BCBS) has all exclusions fro obesity.  and i work at a freaking hospital!  AUGH!!!  i finally had to decide i was worth it and took out a loan.  it was overwhelming at first and i wouldn't even consider it, but the more you look into it, the more you find out that it is very very feasible.  i am paying for my lapband rather than buying a new car.  so it works for me! best of luck to you, and don't give up.

Thanks so much for your reply.  I looked into financing today, as a matter of fact.  My car is almost paid for, and i would be more than happy to drive it for a while, and finance my surgery.  The hospital gave me a "ballpark" figure on the surgery, and when I called to find out about what my payment would be, I was told it'll be more than TWICE my car payment......ugh.  I just don't think I can afford it.  I don't know what to do.  I think I'll make an appointment for a consultation anyway, and let the surgeons office fight with my insurance company for a while.  Any suggestions? Thanks, Kerrie

HI there Kerrie, I'd go ahead with the seminar and then have the people at the doctor's office help you. I know Carrie at Dr Gibbs is a very strong patient advocate and really strives to help their patients get what they need to have happen done. We've found that we are saving about $400 a month on going out to eat and groceries since my surgery last September. Even when we do go out, which is so seldom anymore, I usually order off the appetizer menu. Our tab usually ends up way under $20 for both of us. Where there's a will there's a way. Don't give up. Even with an exclusion in the policy you can sometimes win on appeal. It's worth the effort, believe me. I just bought two pairs of capri's...size 6! Good luck

Thank you so much for the encouraging words.  I think I'll try to get an appointment with Dr. Gibbs and see what happens.  I really don't think I've gone far enough to give up just yet, but I was so disappointed to hear about the exclusion that I figured it wasn't even worth the effort.  It sure won't happen without any effort at all, though, so I think I'll try. Thanks!!

I wish I could offer you good news, but from what I know if your plan has a written exclusion you can forget about it. I've also heard that AETNA is one of the worst to deal with. Our plan also has a written exclusion, so we're taking some from savings and financing the rest. Other people have car notes, we'll have a surgery note. For us, the health benefits are worth it.  It's a shame that insurance companies don't realize the benefits of bariatric surgery . Best wishes to you :) Missy

Thanks for your input.   I sure am getting more and more discouraged....