Trying to help my wife...any suggestions please

We just found out today, after attending a wonderful seminar that was lead by Dr. Gary Anthone, that our insurance provider does not cover any kind of obesity surgery, it is considered an exclusion. She is devasted...and I don't know where to begin to make things better.... Can anyone offer any suggestions please.... I really want to make this happen for her....

Wow.. that's tough!! I know of some people who have mortaged their homes to pay for the surgery and some people have taken out loans or changed insurance companys. There is also self pay ?? I would check into getting another insurance just on her. Good luck to you both !

A lady who works for one of the surgeons in the area, told me of some employers whos insurance does cover this type of surgery. So now I am actually contemplating leaving my current employer just so she can get this done, or she might get a job at one of those places. I found out late yesterday that my company used to pay for this surgery, but last year they felt it was being abused and the results of the patients were not justified or something like that. Anyway, this year is the first year that this procedure or anything like it are not covered. I really think employers and insurance companies need to realize that this type of surgery is more cost effective than treating issues related to obesity. There is just so much mis-information out there....

Hi Michael, Have you talked with your HR Benefits person and let them know the situation? If the company covered it previously, they may not be completely closed minded to it -especially if it is presented as a life saving operation for your wife. Exclusions can be overturned..rare- but I read a few posts where individuals have tried etc.. It is not impossible that with the proper education and information given to your HR people that they could reinstate the previous coverage- even if it is on a case-by-case basis. It is worth a try- and would be much easier to talk with them and let them know how important the insurance approval is for your wife than to change jobs etc.... Good Luck! Cindy K

Michael, Sometimes they have an exclusion for obesity, but will cover for MORBID obesity. Double check the wording. If not, you might want to get a lawyer to fight the exclusion. Try Larry Slade in Calif or Gary Viscio - these are the ones who have had much success lately in getting denials overturned. There is also a yahoo group (I think it is called DS-Insurance_Authorization_Problems) that might be helpful to you. Oh, and by the way... Dr. Anthone is awesome. He is quite conservative with a low mortality rate and is not in this for the money (truly does feel for the plight of morbidly obese individuals) - He is one of the most experienced wls surgeons in the US and taught at USC for well over 10 years before he returned in 2003 to his hometown of Omaha. I was getting ready to self pay AND fly from Southern Calif to Omaha when Blue Cross of Calif finally decided (after 2.5 years) that they would PAY for my Duodenal Switch surgery. I had my Duodenal Switch on November 30, 2004 and am down 49 pounds and feel great! Remember... This is SOOOO worth it. Don't give up the fight! Laurie in So Calif. DS 11/30/04 Dr. Anthone