Last hopes...

GM all, I have a quick question - I hope I can get an answer for before 9am tomorrow (2/21) I have checked with my insurance company and they say I have no coverage for the WLS, I was told to check if there was a rider on my policy ex:if I meet 2 (or any) of the criterias, there is no riders either....my question is - I have my yearly physical tomorrow with my primary care dr. Is there something she can do or it hopeless because the insurance company says there is no coverage for this surgery? Any suggestions ....thank you all for any help! Joni

Joni, I don't have an answer for you, but you should post this on the main messageboard, I know there is a lot of people out there in your situation fighting their insurance companies. Jennie

Hi Jennie, Thanks for the suggestion ...good idea I will do just that !!! Joni

Hi, Joni, find out if your company is self insured. Then your HR dept can become involved if they are and can speak to the insurance company on your behalf (or against you if they are jerks like mine was). On an upbeat note, I know someone who had everyone at the insurance company tell her no, absolutely not, and after an appeal she was approved. I think all in all it took her about six months to get approval. So there is always a chance...don't give up hope...I have been at this for years now and I still have hope! Grace, love, and light, Karen

Hi Karen, Thanks for the post - It is encouraging! I am so bummed about the insurance not covering it. I really need help! The insurance company told me it was (my ex husband's) employer who decides what plan they want and what coverage they will pay for and WLS is not part of their plan. So ??? I am not sure...would an appeal still apply if it is not part of the plan the employer is getting from the insurance co? How does the appeal work - does my dr have to submit something asking if I am covered and get some sort of denial or rejection? I've only made phone calls to check into it. Joni

Hi, Joni, yes, you need to submit first. Get the letter stating denial first...then go from there. Submit EVERYTHING you possibly can. History for as long as you've been overweight, all your diet plans, proof of all co-morbidities. Keep a binder of all your contact with the insurance company and do as much research as you can on the insurance company. Definitely find out if your company is self insured. If they are not then you are up against the insurance company...not your employer...which is a good thing. You may want to have a heart to heart with your HR person as well. But I would first get the denial in hand. Good luck...and please feel free to email me for support. I've been at this for more than three years...and may be (hopefully) having surgery this year finally. So I am living proof it can happen even when there seems to be no hope. Read my profile when you have a few hours...lol. Best wishes to you... Karen