Is this a dead end?? Insurance trouble!

After lots of careful research and decision making, I decided to proceed with the Gastric Bypass at Lowell General. I met with my PCP, have attended some classes and had an appt scheduled with the Nurse Practitioner at LGH. I contacted my Insurance co- (FiServ/Benefit Planners) and was told that WLS is completely excluded and there is no point in appeal. I spoke with Joyce at the LGH Program who handles Insurance denials and she spoke with them also. Unfortunately, it looks like there is no hope in even appealing. They will not cover ANYTHING!!! :"( I had to cancel my appt with the Nurse Practiotioner at the program and am now totally bummed. Joyce at LGH said that she has had pts. purchase an Insurance policy privately and then the surgery has been covered. I looked at Anthem and after tons of questions, was denied coverage because my Ht -5'10 and Wt- 301 are beyond the underwriters guidelines. I have no idea how to proceed! My husband said we could figure out a way to do self pay, however Joyce at LGH said that they REALLY do not like to do that due to the potential expense of ongoing issues.... Has anyone encountered this "exclusion" problem? Bought new insurance? Paid self pay?? Any other ideas or experiences would be GREATLY appreciated!! I am sooooooo disappointed right now. Thanks- Carolyn

Unless it was through a company pre-op I was always turned down for insurance just based on weight. Some states have insurance policies you can purchase through the state insurance commissioner's office http://www.cobrahealth.com/statehighriskpools.html or there's always self pay (in the states or like I did SOTB) I can give you some financing sites links if that would help. ~Michelle OH Member Services

Hi Carolyn, My insurance wanted me to do a physicians assisted diet for 1 year before they would pay for the surgery. I have dieted for 20 years...how long do they need? I didn't want to wait a whole year....I was having severe anxiety attacks due to worrying that I was going to have a heart attack or some other weight related fatal illness. So I paid for the surgery myself. I am from NH, but I had my surgery in RI. I wanted to have my surgery done at a "center of excellence" according to the American Society for Bariatric Surgery (ASBS). Dr. Pohl is a great surgeon and I chose him way before I found out that my insurance wouldn't pay without the diet. As it was, I didn't pay nearly as much as I thought I was. I thought it would cost me somewhere around $40,000. My surgery cost me a total of $13,000. That included 3 full days in the hospital. My surgery was 4/10/07 and I feel great! If you have any questions that I can answer, just send me a message. I would be glad to help in any way I can. Many many people have fought insurance companies and won and many have changed insurances too. My suggestion would be two fold. One is to contact Obesity Help on the phone. They can help. They helped me find a surgeon. Also post this on the main board. There are so many more people that post daily that can help!!! Good luck and God bless!! Patti

Carolyn, First of all I'd like to say Hello. I also have an insurance that excludes the surgery. My husbands employer had changed insurnace companies after I had already started the program. I didn't get that far into it, but it was still upsetting and depressing! Please keep me updated if you find any alternatives, and I will do the same.... Keep your chin up.... Thanks Stacey