Disappointed Again - exclusion question

I finally found what I consider the perfect group of Bariatric surgeons, a great group who will handle my Type I diabetes with my insulin pump. I was initially told that WLS is covered if medically necessary. Well I called the insurance company again today and asked the questions that the Bariatric group had written out for us and found out that all Obesity surgery, treatment including Morbid Obesity is excluded. Has anyone ever encountered this and done anything about it? I am so sad and disappointed. I have been researching and going to doctors for over a year. Thanks, Nancy K

Hey Nancy What about riders from your company? Did you check into that? I am praying for you and keep my finger crossed for rider can pay for your surgery HUGS Kathy k

Kathy, Thanks for your idea. I am going to call my husband's HR department and see if there is anything they can do for me. Nancy

hey how are you doing im antionette lewis and im a single mother of three boys,i had surgery in september 2002,i lost 98 pounds, adn im trying to move back to ct.i use to live in greenwich,ct. and went to st.mary's high school,i have two kids that will living with me when imove ,could you please let me know if you know someone who trying torent out a apartment.guests house or even a roommate.please keep intoch im moving july 1,2005dont give up okay!!!!!!!!!!! e-mail me [email protected] or go to the obesity website i hate that picture

Hi Nancy, I looked at your profile and saw that you have the dreaded United Healthcare. UHC covers gastric bypass, however when there is an exclusion like that, it is because of the employers doing. In my case, I had the same insurance, the same exclusion and come to find out that my employer added this exclusion (and others - a whole page worth) so that their premiums are lower. I work for a fairly big company and went to HR to ask for help and although she tried - she wasn't able to help, because it would have cost a ton of money to have the exclusion taken off and they weren't willing to do that. So, I opted to hire an attorney and am in the process of fighting the insurance company - in the meantime, I was able to have my surgery on a self pay basis. I know it sounds like alot, but to me it was worth it. Hopefully someday soon, I will get my money back. I'm sorry I couldn't be any further assistance, but wanted to give you a head's up. Please let me know if you have anymore questions or want the name of my attorney - he answered alot of questions for me before I hired him. Have a good day! Phyllis

Hi Phyllis, I would love the name of your attorney. Could you email me privately ([email protected]). My husband works for a very small company so I don't know that they would even entertain the idea of looking into adding it but it is worth the phone call. Thanks for the heads up - it is a lot of money, not sure where I will get it but I will have to look into something. Thanks, Nancy

Nancy, I highly recommend my attorney - I was denied lapband surgery initially, and hired Steven Kalman, whom I had met online - He has the band himself! He charges very little, in my opinion, for the work. He had my appeal ready in less than a week! And I won! He won't take your case if he thinks he won't win - he is an honest lawyer, if there is such a thing! (LOL) He responds quickly to emails - you can also check out his website at bandedlawyer.com My insurance was CT Anthem Blue Cross/Shield - Email me privately for $$ amounts if you are interested - Good luck! Amy

hey dont be sad just pray,i had surgery 2002 and lost 98 pounds i live in north carolina now but moving back to ct.do you know of any apartments,guest houses for rent or room mates i have to move back for myacting/ modeling career i have a pictur of me on the obesity website,my name is antionette lewis dont give up keep appealing,you get it done so fast.please keep in touch ,because i will be moving to ct. injuly 2005