Insurance will not cover surgery!!!!
Is it a group or individual policy??
If it's an individual policy I'm not aware of any of them that cover bariatrics. I'm sure there are some out there but I bet the are SUPER pricey! Look at long term costs and decide if paying OOP for surgery might not be cheaper in the long run over paying for a super pricey policy.
Also, if you have an individual policy make sure you are happy with it as once you have had bariatrics you pretty much have to stay with whoever you have at that time since it's REALLY hard to find another company that will take you for about 5 years since WLS is considered such a drastic thing. This is the boat that I am in right now. Athemn upped my rates by almost $200 per month AND I can't use a few of my doctors and hospital of choice since they don't want to play nice with Norton's right now.
Both my husband and I were self-pay for our bands and while it was a HUGE chunk to swallow the benefit to our lives is invaluable. I didn't think we could afford it but then my husband figured out a way to make it happen not once but twice! For my surgery we used our home equity line. For his surgery we sold a vintage car.
Good luck on your journey!
If it's an individual policy I'm not aware of any of them that cover bariatrics. I'm sure there are some out there but I bet the are SUPER pricey! Look at long term costs and decide if paying OOP for surgery might not be cheaper in the long run over paying for a super pricey policy.
Also, if you have an individual policy make sure you are happy with it as once you have had bariatrics you pretty much have to stay with whoever you have at that time since it's REALLY hard to find another company that will take you for about 5 years since WLS is considered such a drastic thing. This is the boat that I am in right now. Athemn upped my rates by almost $200 per month AND I can't use a few of my doctors and hospital of choice since they don't want to play nice with Norton's right now.
Both my husband and I were self-pay for our bands and while it was a HUGE chunk to swallow the benefit to our lives is invaluable. I didn't think we could afford it but then my husband figured out a way to make it happen not once but twice! For my surgery we used our home equity line. For his surgery we sold a vintage car.
Good luck on your journey!
~BECKA~ Start - 254 / Current - 172.6 / Goal - 160
Just another Bariatric Babe!!
Just another Bariatric Babe!! 
You can appeal Anthem's decision to the Kentucky Department of Insurance. Get on Google and check for their number. You do have to file an appeal to Anthem and then if they deny your appeal, you can ask the KDOI to an External Appeal. It cost $25 but it's worth it if you get them to approve it.
Sharley
Sharley
I have insurance with Humana and weight loss surgery is a specific exclusion in our policy. If your policy has the same exclusion, I don't think there's much you can do to fight it. I know I couldn't do anything with mine -- I ended up having to pay out-of-pocket for my surgery.
As far as looking for a different policy goes, I have some thoughts. Usually you can only switch plans at work during an open enrollment period. If you're not within that timeframe, you can't just switch because you want to. If you have an individual policy, it's very hard to find one that will cover pre-existing conditions. I have a friend at work who is going through this right now. He's overweight, but not even close to qualifying for weight loss surgery, and he can't find anyone willing to give him a policy at all because of his weight. He has no other health problems and is young (under 30).
I had my surgery with Dr. Geller here in Louisville and paid a tad over $20,000 for it. That is a special self-pay price and doesn't include any costs you may have for pre-op testing.
I'm sorry that you're in this situation and I sure do understand what that's like since I was in the same boat!
As far as looking for a different policy goes, I have some thoughts. Usually you can only switch plans at work during an open enrollment period. If you're not within that timeframe, you can't just switch because you want to. If you have an individual policy, it's very hard to find one that will cover pre-existing conditions. I have a friend at work who is going through this right now. He's overweight, but not even close to qualifying for weight loss surgery, and he can't find anyone willing to give him a policy at all because of his weight. He has no other health problems and is young (under 30).
I had my surgery with Dr. Geller here in Louisville and paid a tad over $20,000 for it. That is a special self-pay price and doesn't include any costs you may have for pre-op testing.
I'm sorry that you're in this situation and I sure do understand what that's like since I was in the same boat!
(deactivated member)
on 9/13/09 12:55 pm - LOUISVILLE, KY
on 9/13/09 12:55 pm - LOUISVILLE, KY
hey tell your friend (speaking from experience) that if you have an individual plan and they deny you, you can apply through Ky. Access they do cover wls. Its on an individual basis to determine what you have to do to get covered. But its your choice if you want to come out of pocket to pay for the ins. to cover it, because its very costly. I personally have an exclusion in my plan, but I have a union so I'm in the process of getting all my info together to appeal, and sometimes, you never know you can fight for it,if its what you really want. I'm not gonna come out of pocket to pay for something that should be paid for. If you believe, it can happen. Its just takes alot of patience, and lots of research and support to get you through. Hang in there!!
Most Active
Recent Topics
