Insurance Bummer

Hello everyone!

My name is Dana and I've wanted to have Roux-en-Y surgery for a couple years now. I've finally contacted a couple different surgeons in the area (Austell/Marietta, GA) and came across a Dr. Dennis Smith and a Dr. Champion. I contacted Dr. Smith first because I work for Wellstar Heath System and he is a Wellstar surgeon, I was also hoping that because he is part of my healthcare system it would be no problem with insurance. Boy was I wrong. They called me today and told me that my insurance won't cover the surgery and I will have to be self pay. Honestly I am crushed. I have a BMI of 56 and I have been on EVERY diet and taken EVERY pill. I don't understand why they wouldn't cover this procedure and wanted to know if anyone has ever gone through any of this and if so what can I do. My insurance is Humana if that helps. Please help me!!!

Dana, I am in the same boat. The good thing for me is that I can change insurance during open enrollment. I currently have Blue Cross Blue Shield, I will be signing up for United Health Care during open enrollment who covers weight loss surgery. Maybe you should check out your options during open enrollment. Don't give up....

i met all my requirements and summited then was told that the dr. could do my surgery but not in that hopsital so i had to change and got the letter saying i was approved  i only had to change drs... and all my requirements were good... took 3 days to get approved with Dr. Macik in Atlanta........ so April 25th, 2012 i hope to have surgery

Dana, try Dr. Champion's office.  I am using him and have surgery scheduled for July.  They are very professional and knew about all insurance requirements right up front.  My insurance will only cover the surgery at a hospital of excellence.  They don't tell you that up front.  If you ask about another hospital they just say not covered.  It is worth a try.  From what I have read there is not a blanket exclusion with Humana.  Good Luck!!
   

Humana:

Per Policy Bulletin insurance requires 6 month medically supervised diet, Primary Care Physician clearance and psych evaluation.  Sleeve and StomaphyX are investigational and not covered.

Or you can try Dr. Larry Hobson, I am having surgery with him. The other doc is Titus Duncan. They take Humana. because I have Humana Medicare. My first option was Dr. Smith, went through the seminar, application and all, and he turned me dwn, due to me having cardiomyopathy, he thought I would be a better candidate at a "teaching facility" like Emory or Atlanta Medical. I think he just wasnt comfortable with my condition. I was mad at first but I thought about it and mow Im thankful because if he wasnt comfortable operating on my, I wouldnt want him to do so anyways.

Thanks everyone for your suggestions! I really, Really appreciate I am going to look into these other doctors and I hope to hear good news back. Thank you again.

This is just a little update but I just found out that the coverage I have through my job at Wellstar doesn't cover Morbid Obesity and or the problems associated with it. They only use Humana and so I couldn't even switch during open enrollment. Does anyone know if there is a way to appeal that or am I just stuck now?

I would contact Humana and ask if THEY cover WLS not if your plan does.  Typically it is the employer who opts out of covering things like WLS and not the provider.  Once you have that answer you could contact your HR or Benefits department and find out why they don't cover it and possibly submit an appeal, which may work if your company is self funded.