Insurance Hassles

Well, my insurance sucks... actually, more like my employer for opting out of WLS coverage..... Anyways, I wanted to see what insurances were easy(ier) to work with recently. I looked at obesityhelp.com insurance page.. but all of those are mostly pre-2003. Since I won't be able to get coverage under my employer, I was wondering if anyone else had any ideas or luck with insurance they bought themselves or government programs. Thanks for your help. I just made the phone call today to "interview" my first surgeon and have an appt. Friday to talk with my PCP about it. Kinda nervous! What if they think I don't need it? I feel I do.. with diabetes and hypertension at 24 (5'6" 225lbs).... I think I'm in need of a radical change. Shannon

Shannon, I used United Healthcare and it was so easy it was scary. I mean I still had to see all the dr's and do all the required things but they approved me in 1 week. I only paid a few of my co-pays out of pocket expenses and they paid for everything. I had my surgery in Alabama but I have heard BCBS is a nightmare they require a 6 month mandatory program first before they will even consider the surgery and hardly ever pay even after all that. If you can get United Healthcare I know they are great! As far as needing the surgery you should be able to use the charts to get your BMI surgery is based on that .. at least in Alabama it is. If you have co-morbidities that will help for sure. I had to have a letter from my PCP stating medical necessity, a letter from my PCP stating I was cleared and healthy enough to undergo the surgery, I had to have all my blood work done, EKG, Chest X-Ray, Sleep Study, 4 hr. visit with the Psych Dr. for my evaluation, I had to take nutrition classes at the hsp. that were mandatory they totalled 10 hrs. I had two 5 hr. sessions, I had to also get certificates from 2 support group meetings. As you can see there is a lot to getting it done even for Insurance but it is worth every single thing you will do! Good Luck!

Shannon, I just checked your BMI which at 5'6" & 225lbs. your NOT going to have much luck in getting any insurance to Approve you. Your BMI is 36.5 Your best bet is to just get strict with a diet like Weigh****cher. Mike

Well the diets haven't helped. That's why I'm considering surgery. I've been on weigh****chers, atkins, 6 week body makeover and at MOST lost 30 pounds.. gained it back plus more. I exercise, but I have slow metabolism. This is more of a preventative measure so that I don't get to a BMI of over 40, which I'm sure will happen if I don't take serious action. My diabetes is only getting worse, etc. But Mike, thanks for your opinion, it's like so many others, just because I'm not a BMI over 40, I don't deserve the surgery. I think I do. Shannon (ps- I also have United, but WLS is excluded from policy)

Typically, you have to have a BMI over 40 or be 100lbs overweight. Some insurances may cover if you have a 35-40 BMI and severe co-morbs. If doing self-pay or other routes, I'm not sure what guidelines a surgeon would go with for surgery on a BMI of 36. Sometimes exclusions can be overturned for medical neccessity. I had a policy with Cigna last year that stated a pretty iron clad no obesity treatment included morbid obesity and surgery exclusion. I was seeing a surgeon for a second opinion on my hernia repair/PS and he brought up revision again. I said my policy didn't cover WLS, but his insurance lady called to check and they told her they did if it was medically neccessary. I asked my HR woman about it...and she said of course...exclusions don't count if something is medically neccessary...I was like what? Sarah