Were can i get help??

I've been denied by my insurance to have WLS because its "excluded" from the plan. I've looked up alot of info on trying to get this denial overturned, but because its excluded, i've pretty much been told that its near impossible to get an excluded procedure covered. So my next question is how did  you guys either get you surgeries covered or how did you get it paid for? I've done the Math and realised that there is no way i can afford to pay for the surgery on my own. Are there organizations or state funding that anyone has heard of that help? What should my next step be? Im 28 and 250lbs overweight and am really starting to have some health issues with it. Any advice will be of big help!

I am almost certain it has to be an included part of your plan for it to be covered.

I had anthem and they told me not only was WLS excluded but if I paid for it myself and had complications at any point under thier insurance they wouldn't cover any doc/hospital visits or procedures. period.  if they were attributed to the surgery.

then my husband went back into the army and we obtained tricare. it was covered and paid for.

I'm going to guess your only option would be financing??

I am not aware of any state programs that provide this type of assistance, but if there are any, the folks that handle billing and insurance at Dr Maguire's office would know about them I would think...

Lora

that is the issues i dealt with with two insurance companies. If its an exclusion it doesnt matter how medically needed it is, it will not be covered. I finalyl was able to switch jobs and insurances and was able to get it through my new insuance.

It is true if you apy for it by yourslef your insurance company will not cover anything resulting from that precedure. I was told that clearly more than once by my insurance company.

Kaiser covered my VSG but absolutely would not cover my RNY transition even though it was planned. I switched to medical mutual who has covered it as acontinum of care because it was planned and I have been under medical supervision.

It took some time but by switching employers and insurance companies it finally happened.

Best wishes to you.