Hopeless

Well.. yesterday I had a wahoo.. I went to Dr. Valin's office, had both evaluations, my phsyical, attended the meeting and was given a date for a pre-op type meeting all to be brought to a halt by having my insurance "exclude" any kind of weight loss program or surgery. I meet like 10/10 criteria for having the surgery.. and at most I thought I'd have to appeal. I guess that's pretty useless if the insurance company doesn't even consider it. I know other people have had it done that work at the same hospital the insurance is from.. so I don't understand. I used to think this insurance was great, b/c they paid for everything. Just not something I really needed. Anyhow.. it's been wonderful seeing all of your success stories, very inspirational. I wish you all the best. Take care, Michelle

How did you find out that they do not pay for it? Is it a self-funded insurance or a fully-insured one? Ask your employer if you don't know the answer to that question. If it is self-funded, then the employer can make the decision of whether they want to pay for it or not - so this could be something you can appeal. Hope this helps. Regards, Kathy Bilodeau

Kathy, I called this morning and asked about benefits. I asked if the procedure (code) was covered, after I gave them the diagnosis code that I got from the Drs. office and they said there was an exclusion in my policy. I think it should be a fully insured one, but I guess that's something I can find out. Thanks for the advice. I'll see what can be done about it. I just don't want to get my hopes up again. It's a huge let down. Take care, Michelle

Just keep plugging, no matter how difficult it may seem. If you fight hard enough you can often get what you need. Maybe you can effect a change in your company's policy. Did you talk to the other people at work & find out how they paid or whether insurance paid? Take care of yourself, Kathy F.

I battle with insurance companies all day and I have a few suggestions. First and foremost....don't give up! Go to your human resource department and find out who your provider relations representative is and have them advocate for you. If you work for a large company the insurance company won't want to lose your companies business. You should keep calling the insurance company and keep escalating your complaint up the chain of command. The one thing I have learned is that there are ALWAYS exceptions to the rules and insurance companies CAN flex the benefits. Good Luck!

I probably shouldn't get so panicky. When I heard "exclusion" I thought.. No hope. I guess when I called my insurance company it may have sounded like I was looking to have it done as an "elective", instead of coming from a Dr. as a necessity. I was reading on a FAQ that there are exclusions in a lot of plans and they do make considerations b/c of medical need.. and I'm in need. So through great advice, I'm going to let the Drs. office handle the work and possible appeals and I believe we can do this. I really hope so anyhow. Thanks for all the advice! Take care, Michelle

Michelle - Remember to keep us updated on your progress!