Wait, Wait, Wait, and Wait some more

Hi everyone, I am seeing Dr. Miller at Mid Ohio Surgical Associates. I have everything ready to go and ready to get a date scheduled and Carrie calls me and tells me that I have to pay $13,000 before they will even schedule the surgery. This really sucks, my insurance put a cap on the surgery and I didn't even know it. The girl at work that deals with insurance did not get the new policy to us. Now insurance has also put a deadline on me, July 1, 2004 they will no longer cover this surgery at all. This was approved as a medical necessity, not elective and it burns me up that they can just take it out from underneath me like that. There are other companies here in my hometown that carry the same insurance but have better policies and are not effected by this change. But they are larger companies and can afford to pay the extra to get the better insurance. So now I am facing the fact that I will either have to switch doctors again and pay for it myself at a cheaper place or not get the surgery at all and suffer for the rest of my life. Trying to save that kind of money is next to impossible for me as my credit sucks, no family or friends with that kind of money nor do I have any savings. I just don't know what to do, I guess I'm going to try to contact this Dr. Spier? I've seen that name on here and seen that he is in Springfield and allows payment arrangements. Financing is out of the question for me as I said my credit is shot. Any suggestions, let me know please. I'm getting desperate!!!!!! Traci

Oh Traci, my heart goes out to you. Is it possible for you to change insurance companies instead of switching doctors? Maybe to one that won't require you to pay anything out of pocket? I have Kaiser and my co-pay was $1,000 dollars up front. Some patients didn't have a co-pay at all, but I'm not sure who their carriers were. Please keep trying Traci. Don't give up. I want you to experience the joys of losing weight and all the perks that come with it. Tammara Faye

Traci - My doc is Dr.Spier and he doesn't take payments .. he requires his fee up front before surgery ... I am self pay .. and Mercy Hospital is allowing me to finance the whole thing over 5 years because I have low-income ( self-employed ). It sounds like they will pay Dr. Spier for me .. but this is not through him .. I still may find out that I am not understanding right .. and the sky will fall in .. As I am the only one who has mentioned Dr.Spier lately on this board, I wanted to make sure I clarified this to you ... Meaghan

Your employer chose this plan. My company dropped the coverage for gastric bypass in January of this year. Also no plastic surgery. I would look at a bigger city. Are you close to Columbus or Dr Curry or one of the other doctors in Dayton or Cinti?

hi Traci - seems like many of us are in the same boat. My Hubby has Aetna. when I began investigating WLS, I was assured by Barix that our insurance covered it. well..... it doesn't... unless you have jumped through thier hoop of a 2 year weigh loss regime that was set up by my hubby's employer... (ohhh the details are too darn mind boggling!!!) We asked Barix to submit anyways so we could fight the rejection... they said no, that I would not qualify, so they would not submit... GRRR! I am also going to have to self pay...I am also looking for a new doc... I feel as if I were misled from the get-go by Barix.... I know how maddening this can be... many of hubby's coworkers and their families enjoyed full coverage just a year ago from the insurance... and then... BANG! they pull it out from under us! I Do not understand WHY insurance companies can not understand that WLS will PREVENT a lot of claims in the years to come by reducing our risks for heart disease, diabetes... etc... ~keep your chin up!!! HUGS~ Deb

Traci, I don't have any advice to offer, only sympathy. I have the same situation as you do: a cap on the coverage, no coverage after July 1 and no way to get $$ up front (no family, bad credit). My paperwork was just submitted and I fully expect to be denied. Even if I'm approved, I can't give them any money up front. I've been in a pretty bad depression for a while now because I realize I will have to live like this forever. I know how you feel and I'll keep you in my prayers. I know how awful this is! How unfair it is! We are teased with a light at the end of the tunnel and then it's ripped away. I told my surgeon all of my issues and I said to him "I canNOT live like this forever. If I can't get the surgery, I need your help" and he told me we can discuss "medical weight loss" (drugs). It's the only shred of hope I have left. And it's not too big of a shred. Hang in there! ~Trish

Hello all, Just a little FYI to whom ever has BCBS they too are pulling out of paying for WLS as of Jan 1, 05, I found this out last week and it really makes me mad cause I will not qualify for insurance till July and I have not started anything cause I dont want it to be a pre-existing cond so that they wont pay either. I am not sure if my PCP will even write the letter or not and dont know if I should even approach it now before I get my insurance in effect. If he says no then where do I even start to find another PCP close? I live in Logan OH about an HR from Columbus.