New to this forum and looking for so many answers.
Hi everyone,
My name is Veronica (age 37) and I'm just now beginning to look into WLS. My family is on the heavy side and at 5 feet 1in. I tend to look quite heavy myself (185 -190). I have type II diabetes, have pcos and hypertension. I was diagnosed with diabetes back in 2003 as I was undergoing IVF to have my children. My hypertensioon came after the birth of my fist son in 9/2004.
I've had to friends see Dr. Aranow in middlesex hospital and they look fabulous.
I did call my insurance company (united healthcare choice plus throught at&t) and was told my policy excluded weight loss surgery. Dr. Aranow does show up as in network so I'm wondering if there is something that can be done to have this kind of surgery covered.
I wondered also if I should just make an appointment first to see if I even qualify before starting the whole appeal proceedure.
Any guidance is greatly appreciated.
My name is Veronica (age 37) and I'm just now beginning to look into WLS. My family is on the heavy side and at 5 feet 1in. I tend to look quite heavy myself (185 -190). I have type II diabetes, have pcos and hypertension. I was diagnosed with diabetes back in 2003 as I was undergoing IVF to have my children. My hypertensioon came after the birth of my fist son in 9/2004.
I've had to friends see Dr. Aranow in middlesex hospital and they look fabulous.
I did call my insurance company (united healthcare choice plus throught at&t) and was told my policy excluded weight loss surgery. Dr. Aranow does show up as in network so I'm wondering if there is something that can be done to have this kind of surgery covered.
I wondered also if I should just make an appointment first to see if I even qualify before starting the whole appeal proceedure.
Any guidance is greatly appreciated.
~ Veronica ~
Hi Veronica -
Right now your BMI is 35 or 35.9 depending on if you're 185 or 190 - that does put you in the obese category and you do have comorbidities (diabetes, pcos, hypertension) so if your healthcare coverage did include weight loss surgery you would be eligible for coverage.
Trying to get an insurance company to include a coverage that is mandated excluded by your company is an extremely difficult path to travel. I am not an expert but from what I've heard it doesn't get overturned very often... but you would need to investigate that first. Or perhaps talk to someone in HR at at&t and see if they will be putting the rider for coverage on for 2010 (things change all the time!).
Some people self-pay for the surgery if their insurance doesn't cover it (some even travel to Mexico because it is so much less expensive there).
If you poke around this site, there are tons of people who will be able to give you advice. There is a forum called Insurance, Cash pay and financing under weight loss related forums - I've not been there but there might be some good ideas there!
Best of luck to you on your journey!
Right now your BMI is 35 or 35.9 depending on if you're 185 or 190 - that does put you in the obese category and you do have comorbidities (diabetes, pcos, hypertension) so if your healthcare coverage did include weight loss surgery you would be eligible for coverage.
Trying to get an insurance company to include a coverage that is mandated excluded by your company is an extremely difficult path to travel. I am not an expert but from what I've heard it doesn't get overturned very often... but you would need to investigate that first. Or perhaps talk to someone in HR at at&t and see if they will be putting the rider for coverage on for 2010 (things change all the time!).
Some people self-pay for the surgery if their insurance doesn't cover it (some even travel to Mexico because it is so much less expensive there).
If you poke around this site, there are tons of people who will be able to give you advice. There is a forum called Insurance, Cash pay and financing under weight loss related forums - I've not been there but there might be some good ideas there!
Best of luck to you on your journey!
Warm Regards - Tammy - 
hi Veronica,
I attended a 3 hour seminar 1st . In this seminar they discuss all types of WLS. They also went over the cost, with, or without insurance (self pay). One of the topics of that discussion was about insurance. They directed us to call our insurance and ask if they cover WLS or if they have an exclusion policy? If they don't cover weight loss surgery it won't matter (I don't believe) if he is in or out of network.
If you use this OH network on the homepage there is a section that has insurance responses, you may be able to look to those for some kind of tool. Some of those people appealled there cases and were finally covered.
Here in Knoxville, TN the doctors 1st consultation visit without insurance runs around $300 (approx).
Good luck and if I can help in any way I will
Denise
I attended a 3 hour seminar 1st . In this seminar they discuss all types of WLS. They also went over the cost, with, or without insurance (self pay). One of the topics of that discussion was about insurance. They directed us to call our insurance and ask if they cover WLS or if they have an exclusion policy? If they don't cover weight loss surgery it won't matter (I don't believe) if he is in or out of network.
If you use this OH network on the homepage there is a section that has insurance responses, you may be able to look to those for some kind of tool. Some of those people appealled there cases and were finally covered.
Here in Knoxville, TN the doctors 1st consultation visit without insurance runs around $300 (approx).
Good luck and if I can help in any way I will
Denise
7-09
Hi Veronica,
You really need to make the decision as to how much you want this, If your insurances doesn't pay are you willing to self-pay. Did you go out to your insurer's website and see if they had any specifics on weight loss surgery. You may want to do that.
Wish you luck in your endeavor.
Nancy
You really need to make the decision as to how much you want this, If your insurances doesn't pay are you willing to self-pay. Did you go out to your insurer's website and see if they had any specifics on weight loss surgery. You may want to do that.
Wish you luck in your endeavor.
Nancy
71 lb lost pre-op Abdominoplasty & Panniculectomy Dec 4th, 2009Most Active
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