I want to cry!(and kick and scream and break something) vent vent vent

I AM SOOOOO FRUSTRATED AND DEPRESSED AND ANGRY AND AND..... I can't even think of how I feel right now I'm so ughhhhh.......  Sooooooo - way back in Feb 07, Dr. Kane's group called my insurance company about my benefits and they told me that I need to do a 6 month supervised, psych eval and dietition visit.  After some minor and major set back's, I have completed all requirements and all info was sent to the insurance company for review.  Today, the insurance company informs them that in no way do they cover any weight loss anything.  WHAT???????????? WHY ON GOD'S GREEN EARTH WOULD THEY TELL ME I NEEDED TO DO 6 MONTHS SUPERVISED ETC...??????  I am now out hundreds of dollars in Dr. visits and psych eval costs and prescriptions and they are going to do nothing for me?  What the &^%# is that all about???  Is this just standard operating procedure or am I really at the end of the road here?  I am so hurt and hopeless right now I just want to cry.  Does anyone have any words of wisdom for me? Do I keep pressing for the insurance company to cover this or do I just roll over and die???  Thanks, Kari

 

Dear Kari: I feel your pain, I was once there myself. Unfortunately, it IS standard operating procedure for a lot of insurance companies.  Most of them will tell you NO on the first attempt hoping that you will go away. FIGHT THEM LIKE CRAZY!!!!!  Do NOT take NO for an answer!!!!! Ask for a supervisor and ask them these questions. YOu don't say who your insurance is, but fight them all the way!!!!  I went through 2 insurance companies and took the first one all the way to the Attorney General's office.  Take a few deep breaths and get ready to fight for what you need.

What insurance company do you have?   Sometimes (like in BCBS-IL case) insurers deny on the first try in hopes that they will get you to go away.  

I guess in my fit of rage, I forgot to say that I have United HealthCare as my ins provider... Sorry, Kari

Also with the new year coming up, is it possible for you to get a different insurance provider for '08? And don't worry about changing providers mid-stream...as long as you have had continuous coverage, they cannot deny you for being a new client and you wouldn't have to do the six months over again, either.   Just a thought... 

Unfortunately - my insurance is through my company.

I had to ask...some companies have more than one choice for their employees.  At my company, we have a total of three different health insurance options (Two are different 'flavors' of BCBS-IL.)

Ask your company HR rep for a copy of the health insurance summary plan description (SPD).  This will tell you everything your insurance covers and doesn't cover. Check out the section regarding weightloss surgery.  Some explicitly say no way no how. Then others will say only with BMI over 40, co-morbidies, yada yada yada. Once you find out what is covered then you have something to fight with. If, however, there is an exclusion in your plan (they don't cover any weight related surgery), then I'm afraid there is not much you can do. Good luck!

I have United Health Care and was approved 80/20 however, it was not excluded by my employers plan.  That's the puzzle peice you will have to find out.  Does your employer have an exclusion from the policy. Good Luck and Hang in there.  I feel your pain. Christina

Hi Kari, I'm terribly sorry that this is happening to you.  Have you talked to your insurance company directly?  Or are you going by what the Drs office says??  You need to call them directly, and ask if "Medically necessary weight loss surgery" is a covered benefit.  And if they say yes, ask what the criteria is.  They usually will respond more fully to the patient than to the Dr office, because you are their customer.  Unless your employer has a 'direct exclusion', weight loss surgery is covered by almost all insurance companies.  Good luck, Suzy