Help Please!!

Greetings everyone. I am in desperate need of some assistance and appreciate any feedback that I receive.

I have been battling my weight all of my life and have reached an all time low due to my weight and current health concerns. I am only 24 years old, have a BMI over 53, heart disease, sleep apnea, chondromalacia of the patella due to my weight, back problems, asthma, diabetes, etc etc etc. This surgey has gone from being a good idea for weight loss, to an absolute necessity in my life.

My problem is this.....My insurance company denied my surgery last February after going through all of the pre-op processes. I'm not going to battle them over it because my policy will only pay for 50% of the charges up to $5,000 if they approve it. Even then,  the doctors / hospital need the rest up front when they found this out so I still have to private pay for the remaining 13,000. I do not have good credit and have already been denied for Care Credit - I don't even have anyone who I can use as a co-applicant.

I have called several offices around town and they have payment plans, but the hospitals do not and require payment in full. I am at a dead end and don't know where to turn for assistance in paying for my lapband. Does anyone have any ideas or know of anyone in this same situation that was able to get assistance from anywhere? Thank you for your help!!!!!

I was self pay too becaue my insurance feels that WLS in general is an optional surgery. there are cheaper options out there though than the price tag you are looking at.

I chose my MD in Denver because it was $9999. That included MD, Follow up, hospital, anesthesia, psych eval, nutrition class....
http://coloradobariatric1.reachlocal.net/

There are even cheaper options in Mexico if you look around. But remember that cheaper is not always better when it comes to surgery on your body. But there are great surgeons south of the border!

If you want it badly enough, talk to your friends and family. Hold a fundraiser or an on-line auction, get a second job. This is what I did!

Tough situation. I don't know the answer, but an OH member who worked in the insurance field before retiring and who volunteers her time helping other people seeking WLS has given me permission to post her contact information. See below.

Good luck!
Jean

[email protected]

Im so sorry you are having so many problems.

I dont want you to take this the wrong way so please dont on what Im going to say it's for your own good especially about the money .

I am self pay for the lapband and I paid about 20 grand for all of it.   I have back up plans if something  happens to my band  and it needs to come out .  I have already talked to my banker and if worse comes to worse and something happens I can get a loan with a snap of a my finger for the surgery if it  comes down to it.

You also need to think about fills.  Now since Im self pay my first yr fills are included and my doc because I am self pay only charges me 75 bucks for fills but I have seen some girls as high as 200-500 bucks for fills so you need to check that out also . 

Your first yr is your most important and see right now Im skipping fills because I dont need them and there is no credit if I dont use them so if I go my first yr with hardly any fills but need them after my first yr then I will have to pay for them so please think of that also.


Also you need to see if you have any problems like port flips or anything like that if your doc covers them .  My first yr if anything happens to the port or band my doc does the surgery for free no out of expense to me but that is the only first yr.

Im really not trying to talk you out of the band I love my band and Im so glad I got it .  Im losing my two pound per week but it really scares me because you are being so honest with your credit problems if the band is the right choice for you because if you are having money problems now getting the band what are you going to do for the after care that is sooo important for band people and if something happens to your band.

I wish you luck though and hope you can find something to work out for you .

is there a way you can apply for Medicaid?  Depending on your health problems, and it looks like you have the major ones, you may qualify.  Then depending if your surgeon works out of a center of excellence, Medicaid will cover your hospital stay.

If you don't mind me asking, where are you located?  States vary from state to state but I know NJ Medicaid/Medicare covers it 100% depending on which surgeon you choose.

Good luck to you and hope you find your way...
Take care,
Jan

I'm sorry you're going thru this emotional frustration of not having the finances to cover your option for weight loss surgery. But please remember that financial responsibility for your choice of surgery doesn't stop when you have the surgery. You're talking about a life time of financial obligations, sometimes out of the blue, for the type of surgery you're wanting. Like steelerfan1 pointed out, banding expenses going on and on way after having the surgery to have the band placed. Then gosh darn if you have a port flip, port &/or tube leakage, slippage, misplacement, or severe irritation from the lining when you receive a fill that you literally can't swallow your own spit & have to have the band taken off. Those are all things you kinda need to take into consideration also.

But if your very sincere in wanting the band - where there's a will there's a way. There's a website where people make up accounts that people donate money to for all kinds of things. From plastic surgery (boobs mostly) to car repairs. That could be an option. Also, ask your HR person if your employer offers special cir****tances for pay advancements (if that's an option you'd feel comfortable to explore). I really hope you do find a financial system that works for you... no matter what wls you have. There's a lot that can go wrong w/any of the surgeries and unfortunately it usually requires money to fix them. Hang in there & I hope you have luck finding help.

I do not have an answer  to your question  but I would recommend you contact your insurer
about appealing their decision.  This is why:  First 50 percent is a pretty hefty sum.  The main reason is that if they file with your insurance, they must  charge you at the rate your insurance dictates.  This will be significantly lower than what you would have to pay cash only. 

Look at your insurance paperwork and see why they disapproved.  Perhaps its something you can fix.

I know how frustrating it can be trying to get to surgery!  I was in your same position in April 2007.  We found out that I would have to wait 6 months before my insurance would even consider surgery and during that time, i had to see a physician and a dietician for 6 months and have everything documented.  My fear was that my health was so poor that I didnt have 6 months to wait around for surgery...i needed it NOW!  and if i completed all their requests for 6 months that they would end up denying me anyway.....but i couldn't find other financing options!  I called capital one, care credit and even our local banks and couldn't get a loan anywhere.....so we took our last option.  we borrowed against my hubbys 401k thru work....probably wasnt the best financial decision, but i dont regret it!  in fact, i would do it again!  it saved my life!  i ended up loosing 115 lbs total within a year and 3 months and was able to get pregnant with my second beautiful daughter!  Good luck to u!