Dealing with insurance company...

GM all, Well, I called my insurance company and they said I have no coverage for WLS, no surgical coverage even if medically necessary. Could that be ?!! Man, what a bummer. I had so much hope that finally I could get help. What a let down with one quick call. Has anyone ever had this happen but still manage to get coverage ???? Is there a trick to this !/ Please let there be.... Joni

Joni, I have made several calls to Anthem, and it seems like a lot of people don't know what is going on. Some say yes, some say no. My policy had a written exclusion for "any treatment of obesity, even morbid obesity, including nutrition and surgery," or something to that effect. I went to the surgeon, they submitted the paperwork and I was approved in a day. Sometimes it depends on your employer, too. Insurance companies have many different policies, and one employer may cover WLS while another doesn't. Don't give up yet. Try going for the consult and have them put it through to the insurance company for approval and see waht happens. Surgeons are great at wording things for approval, and their offices know how the insurance companies work. Good luck! Carrie

GM Carrie, Thank you so much for your email/replies. I was so bummed out yesterday after hearing them say no. I felt it was like my last hope gone. I really kept thinking how can they not....that there must be a way...some how !?! You've given me hope again - I will try that route. I am really not up on all the insurance stuff (single mom, ex has the insurance coverage. It is Matthew Thorton Blue, an HMO) What is a PPO ? I did check our Dr listings book and both the dr and hosp I was thinking of using is in the insurance network. So you think I should just call the dr who will proform the surgery and get their imput? Thank you so much for the info - and renewed hope ! Joni

DONT GIVE UP!!!!!!!! I had the same problem, I have been told that Cigna was not going to cover wls after last new year, I kept on going with all the requirements of the program, and the usual insurance requirements....6+ month weight loss trial.....etc etc....I also got letters from all my doctors explaining how this surgery would help me. I got denied twice, and then on the 3rd and final appeal.....I got approved. This entire process took about 1 year.....I did not give up.....the insurance companies expect people to give up before then. So........keep your chin up. Take care, Jane Post-op 2 months