HELP! I'm holding back the tears...

help: I currently have AvMed insurance and earlier in the year I talked with two of their reps that said NO WAY will AvMed cover WLS. I was advised by them to not even try. I was crushed...BUT I knew open enrollment was coming in Oct. and planned to change insurance companies at that time. United Healthcare seemed like a good choice to me since I have heard nothing but great reviews frome WLS patients regarding speedy approvals etc. Sooooo open enrollment came and it was announced that United HC will no longer be offered!!! OUCH! So I had to do some quick research as I had only 2 days left to enroll. I contacted Humana HMO and asked if they would cover WLS in 2005 and was given an emphatic YES! YAAAAAY!! In the meen time I also called Idependent Blue Cross POS (IBC) and they too said that they would cover WLS in 2005. Ultimately I chose Humana HMO because it meant much less outta pocket expense for me. OK!!! Now to the point at hand... Today I called Dr. Thoburn's office and something the Administrator said made me decide to "double check" on Humana's 2005 approval. So I called this afternoon and they promptly informed me that NO they WILL NOT cover WLS in 2005 I was stunned as I had already enrolled with them on this pretense!! I don't know what to do. I feel certain that I can get my hubby's HR to let me switch insurance but to what?? I could try and fight it out with Avmed but in 45 days?? Can one get approval that fast? AND surgery? sniffle sniffle. I have no clue where to go from here? ANY suggestions would be welcomed as I have to move FAST. Prayers are ALWAYS welcomed too! BTW, I also learned that huby's employer will not be offering WLS as benefit in 2005 too. Meaning I have to do this with AvMed now?? I dunno...

........Just DON"T give up! LuvitsunnyV@goal

All this insurance stuff makes me crazy and I don't understand their reasonings. I have no advice but to research and maybe someone else knows something to help. I will just offer my good thoughts and prayers for you to get the surgery if that is what you want. Carol -28#

I don't know if this will help at all, but I would advise that you fight with AvMed now. Make sure you get all your info from your doctor together.. a letter of recommendation from the doctor, and bloodwork, so on. Then you need to read your policy to see if there is coverage for anything called "medically necessary treatment for morbid obesity". If that's in there anywhere, you have a valid fight on your hands. Don't give up, if you yell long enough, they'll listen. Please don't think I'm taking this lightly, b/c I've been in your shoes, only my insurance refused to cover for nutritional visits. I could have paid lawyers to get involved b/c of the way the policy was written, but couldn't afford it. Now I can look back and see what I should have done. Submit a request, then submit an appeal, etc. in the little time you have. Get on the phone and bug them every day. Take it from someone who used to work in dental insurance in the CS dept, it is true that the squeaky wheel gets the grease. Sometimes they'll cover you just to get you to leave them alone. But ALWAYS make sure you get it in writing. Hope this helps a little.

I have AvMed and they DO cover WLS (although they refused to cover my DS) under my employer's (State of Florida) contract. They may not under yours, but NEVER take the word of a customer service rep. What does your contract say under exclusions? If it is covered, it will likely be listed under obesity services or treatment in the exclusions section, but may contain language indicating it is excluded "unless medically necessary." If it is covered under your policy, you may very well be able to do it in 45 days. Check your Humana policy also for the same reason. If you are taking the word of their rep rather than looking at the specific language of the policy, you may very well be getting incorrect information. If you don't have the contract, ask your HR department for it. Janice

i too was turned down by avmed - check with your local vocational rehabilitation office - they payed 100% for my surgery -

THANK-YOU ALL! for you that replied (and those of you that just need one) I was so encouraged by you guys NOT to give up and so I didn't! I have been on the rampage these past few days. I might have a solution... Different insurance! AETNA CHOICE POS II says they will cover WLS but I am not sure just how much outta pocket that will mean. Nevertheless, it sure is looking alot better than when I first posted this ...in tears. You guys are such inspirations and I thank-you from the bottom of my heart! Big Ole Group HUG, Kendra