I need to have surgery, but my insurance has an exclusion
I have BCBS but they have an exclusion to gastric surgery, what other options are available. I cannot work right now because of my health, my Cardiologist recommends gastric surgery. Someone told me I should apply for medicaid, but I don't know any surgeons who would accept it. Help me find a solution!!!!
Dear Terri
This is such a catch 22 for you, and I can offer little help, but in a nutshell, medicaid has a nasty habit of pre-approving you and then refusing to pay the Doctor or the hospital after the fact. So, of course, now no Doctor in Colorado will take medicaid because they don't get paid. And even if a Doctor is willing to do the surgery for nothing (Dr. Snyder in Denver was willing to do this for me) no hospital will admit you for gastric bypass surgery with medicaid as your insurance because they haven't been paid in the past. I did hear recently that there was one surgeon up in Greeley who would accept medicaid but he would only work with medicaid patients in his county because he could not afford to take on everyone in the state of Colorado so he was working primarily with patients in his area only. Now this information is several years old and he may have since decided not to take on medicaid patients no matter where they live. (At one point I was seriously considering relocating to his county just so that I could have the surgery, even though I knew no one up that direction and would have been all alone in a strange city for at least 6 months. But the cost of moving up there and then re-locating back down here after the surgery was too much.) ANyway, for more information, please read my profile. Right now I am trying again to get the surgery, this time my son has put me on his insurance, and hopefully, this time I will be able to see this all the way through. Good luck, Terri.....
Janet Wyckoff
Terri,
I just had my surgery on September 21, and yes I have Medicaid. I went to Dr. Schoen at University Hospital. He was awesome. The whole process took about 8 weeks, from consult to surgery date. It was not as long as some other doctors I have read about. I hope this helps. If you can get on medicaid it is possible to have the surgery.
April, Thanks for the info. I called Dr. Schoen's office and I am now is the process of getting medicaid, ( I already have $20,000 in hospital bills for heart problem.) they say medicaid may go retroactive 60 days. Dr. Schoen's office said they would see me after I get my medicaid number. I hope I'm on the right road. Health wise I have to get going soon. Thanks for help. How did your surgery go? Was it really scarry.? Are you glad your on a right road as well. Good Luck, Thanks again for your HELP!!!!!
Terri, although your insurance has an exclusion, I wonder if you can appeal that based upon what your cardiologist has recommended. I would start with your HR department (assuming you have your coverage via your job) and go from there. See if your company has a patient advocate who could assist.
In the long run it would likely be less expensive for the insurance company to pay for your surgery than to pay for the complications you already have and will have in the future. Of course, that's logical and insurance companies are not always logical.
If your company has open enrollment in the next couple weeks or so check to see if any other insurance companies are available and what they will cover.
Liz
Liz, Thanks for the idea. I do have open enrollment soon. The other insurance option I have is Kaiser. I am trying to get more info on them. I have been hearing its not my insurance that puts the exclusions on the policies, its my employer. This is kind of sad and frustrating. You think it would be a benefit to help you employee get healthy. I am now on a medical leave of absence, with some serious issues, and my Cardiologist reccommends I have surgery. She said she would write me a letter, but this doens't make any difference to them. I won't give up, I have three kids I need to raise. One way or another I will begin to change my health. Thanks again for the info. Terri
That is great. I am happy for you. The whole Medicaid process didn't take that long either. I heard that they will go retroactive too. I wish I had known that though when I applied. I had bills from 4 months before we got on medicaid. But, anyway the surgery went great. It wasn't scarry at all. I am just having a hard time adjusting to my new way of eating. Sometimes your new pouch and brain do not agree about when you are full. That has been the hardest thing for me. I hope it gets easier. Keep me posted. I hope you get to have the surgery too.
I am also needing surgery. I was approved 6 years ago for surgery with Aetna but 2 days before surgery my husband freaked out and wouldn't let me go through with it. We are now seperated and his plan with Aetna exclused wls. I also have medicaid as secondary insurance and i'm not sure where to start or what I need to do. But i'm even heavier now then I was 6 years ago and really kick myself for not doing it then. I am now single mom with 4 kids and not feeling so good. Help! Lisa