No place to turn

I am writing this at a difficult time. I have tried to get approved for surgery for 2 years from my insurance, denied of course. I am tired of crying, begging, pleading for help. The policy is on my husbands insurance, an exclusion, so I am told there is no hope. That is how I feel tonite. I met this week with another place, and the cost out of pocket is more than we can afford. There isn't any way to get the money, over the long term. How can we pay for the RNY out of pocket, even if they only charge us 50% ? It is a cruel joke. I am tired. We have great credit and they still don't give us help.I can't even bring a lawsuit againest the insurance company. It is an open and shut case. It isn't winabe they told me. I just don't care anymore.

Rita! do you mind if i ask you what type of inc you have? mine has a exclusion to, and i was just speaking to someone the other day and they said theres had a exclusion to, but she was approved in one day, I dont understand these inc co playing with peoples lives, they dont understand how inportant it is for us, try posting this on the inc board see if you can get some answers there that mite help, Dont give up where there is a will there is hope!

Mine is United Health Care. There are UHC types that do pay for the surgery. I have a girlfriend you can have the surgery and she has UHC. It is the contract that my husbands employer purchased. It has a specific exclusion to weightloss surgery. It says it very plainly. I spoke with a lawyer who told me that the exclusion I have was iron clad. He sues companies to make them pay for surgeries, that is his speciality. He can get approval in almost all cases, except when it is written spcifically againest weightloss surgery. I have begged my husbands company on the phone and written them too. They won't change or talk to UHC to work out a deal with them.

Rita and Deliliah, It's not the insurance companiy's fault that there is an exclusion, that is the way your husband's company set up the insurance. Rita, see if you can talk to someone in your husband's HR department about the insurance and ask them if you can get the surgery approved through them. Some companies allow that. If there is a corporate office, beg the HR person to contact the corporate office and talk to them for you. Tell them your problems and why you really need the insurance. It won't hurt to ask. At least you'll be begging a little closer to home, LOL. Good Luck, Peggy

I am SO sorry that you're having this trouble! My husband's plan also had an exclusion which 99.9% of the tim eyou just cannot get around. Thankfully, I was able to change plans on January 1st because they offer more than one. (I have not submitted yet, though, so I could end up the same way with this one, I suppose.) Anyhow, the advantage you DO have is good credit. As a last resort, I know there are many many banks that finance surgery. It may be an option to look at if you really need to. I can't remember the name of the bank that doea it for my hospital, the Cleveland Clinic, but I know they are out there. Please keep us posted! Hugs, Karen

The problem is not your insurance company, it really is the employer who contracts with the insurance company. They are the ones who choose the exclusions so the right place to lobby is with the employees company that is carrying the insurance. My understanding is that in most cases you arent going to have any luck getting a change mid year since the coverage is determined on a yearly basis. My company had several different insurance coverage options for the employee to select. Based on the plan we select the out of pocket shared expense could be more or less. We had several insurance coverage plans to choose from Anthem and UHC. The Anthem insurance was cheaper but did not cover bypass. UHC cost more but covered the bypass...therefore I elected for UHC coverage. This meant I paid more out of pocket for the year as part of my shared insurance expense, but it certainly was worth it for me. I had the surgery 4/2005 but it took me several years before I was able to obtain the coverage I needed in order to have the surgery. Good luck and try not to get overly discouraged.