Help! My insurance said any obesity coverage is out
I am desperate for this surgery because I have been up and down the diet roller coaster several times. I always end up heavier than I started. I am depressed and occationally have simply given up. If I weren't such a wimp, I might have taken my life by now. Actually I just know it's not even a solution, but when your depressed, you can't help but think that maybe you would be better off dead. My wife and son would do well on the insurance. Don't worry, I'm not planning to off myself. I have a family history of type II diabeties, heart desease, obesity. I have mild angina, sleep apnea and stress from it all. I don't have good enough credit to get financed and can't come up with $17.000 plus. Does anyone have any advice for me? Just to let you know, I am sending an appeal letter to my insurance that said this coverage was never written into our policy. Any help would be great.
P.S. My surgery of choice is the lap band.
Hi Chad,
First off, don't give up! There is hope. First, I would talk with your HR department. They're the ones who have to buy the rider for the surgery, and they might do it just for your policy so that you can get the surgery. I've heard of it happening before. It all depends on your company. Second, just an FYI, but a lot of time insurance doesn't cover lap band. They say it's experimental (bunch of bull, I know). I was going for lap band at first too, but my insurance company won't cover it so I'm going to get RNY. Also, if you don't already have one, get a PCP so that he/she can write a letter recommending the surgery. Plus, you'll need one to follow up with after the surgery anyway. But really, the best advice I can give it to talk to HR! Ask them to help you. MAKE them help you.
As for as financing surgery, if it comes down to that, do you own a home? Could you get a second loan on it? Even with bad credit, if you own a home you can usually get a loan. I know it would suck, but if you really really want this surgery it might be worth it.
Other than that, I'm not sure what other advice I can give ya. But I can give you tons of support and wish you the very best of luck in getting this surgery. Please keep us updated on how you're doing and how the process is coming along for you. Have a good day 
Chad, I'm kinda in the same boat however, I just sent in an appeal to my insurance.
Shelley gave excellent advice and I'll just mention that you may want to have additional tests taken such as a sleep study (this is done at the old St. Francis hsp. in the Springs) because if sleep apnea is detected, this is a dangerous co-morbidity of obesity and may help sway your insurance to cover the cost of surgery.
I'm not giving up even though my insurance has an exclusion as of 1/03 regarding coverage. However, I'm going to start calling insurance this week and 'bugging' them relentlessly until I am approved.
If a second appeal (phone conference with Board of Trustees) is also turned down, I am going to go to atty. Gary Vascia in New York and have him file a case. Others in Colorado have used his services and he has an astounding record for having insurance companies not only perform the surgery for their patients, but having them pay 100% for the surgery. He evidently uses his expertise regarding state/federal laws.
Good luck, Chad, and please keep us posted with your story.
We're all here to help one another!
Leslie D.
(hoping for surgery soon)
Oh Dear Leslie D..
I know the Hattie's that you are dealing with with Sloan's Lake !! I know that I had this very insurance company when I finally received my surgery !! We fought and argued and sent notices back and forth for 3 years !! They would send me approvals and the next day would call my doctor office and say that my file was sent back to be re viewed !! I had infact recieved 3 approvals by snail mail !! befor I had gotten my surgery done !! And still I had to pay huge amounts out of pocket !! my advice to you .. Get another insurance carrier !! you can buy them on line !! Via paper ads.. Huggles -A-
Dear Chad,
Please don't give up or give in. This is sooooooooooooooo frustrating, but eventually you will find a way. I'm in the same boat...trying to get Medicaid to cover a Lap Band for me. It's like beating your head against a brick wall, but my surgeon says eventually they will give in and pay for it. He has gotten approval before successfully. In the mean time it is so hard waiting. My son got a Lap Band three weeks ago (he's 14) and is doing fantastic. We too have all the medical problems you listed......stay strong, pray, and there will come a way.
I'm here for you too.
Sharon
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