I am so angry

Well I was talking with a friend of mine who has recently had RUnY surgery...turns out our insurance (Sagamore/Advantage) makes you have 6 months of consecutive physican consults and a diet plan before being considered. Then after that even if you have multiple co-morbidies as in diabetes, sleep apnea, arthritis, etc...they still turn you down....after mutliple letters from physicians and others including documented family history she was still turned down and finally paid for it out of her pocket. I am now looking at other physicians and hospitals...it will be frugal attempt to get all of this and then have them laugh in my face. I can not afford to pay out of my pocket for my surgery...Well I have not given up...I am going to call my insurance carrier and find out the truth and then I am going to look at other avenues...Has anyone else had this problem and what did you do?

i know they will approve...many ins co require the diets, appeal, appeal, appeal, and fight it...sooner or later that will have to approve you.....

A little bit of advise... First, before submitting any paperwork to the insurance company, call them and ask them to send you a packet with their requirements for weight lodd surgery. If they have no packet, then ask for specifics over the phone. If you need to do this, be sure you get the rep's full name that is giving you this information. Once you have evidence of all that theyrequire, send in your paperwork. If you are denied, and each time you are denied, be sure you ask for any and all reasons for the denial in writing. When you have sufficient evidence that the reason(s) they quoted no longer exists, appeal it. If they pop up with some other excuse, remind them that you have their statement of what the reason(s) was/were and that you have supplied evidence that those issue(s) no longer exist. I, personally, would go as far as asking if I needed to get a lawyer involved. Unless an insurance policy specifically states that it won't cover anything for overweight or weight loss, jump the hoops with the insurance. If they still deny after you jumping the hoops, do get a lawyer involved. It would be cheaper to pay him/her $1000 than to pay for the surgery out of pocket. Good luck! Sherri

I agree with Sherri Call them that's what I did. They are very up front. I was lucky I had a BMI over 40 with a few comorbitities and didn't have to go thru the 6 months. But I know each employers plan is different. From what I understand with Sagamore if you hang in there and be persistent they will cover. Good Luck Tina 271/208/165

It took me 6 months of requests, phone calls and paperwork to find out that while I met all of the requirements for my insurance company, they kept denying me because the contract with my employer excluded bariatric intervention. I finally got my coporate HR rep on a 3-way call with the an insurance rep and was able to determine that I could be on my deathbed, my surgeon could call them telling them the only hope of survival was WLS and they would not approve it. Contractually excluded. Because it's an ERSA (or whatever) plan, it is excluded from the state law requiring WLS coverage.