self pays, insurance fighters please help me!

Hello all. I am trying to have wls (lap band most likely) My insurance is medical mutual super med plus and I called them today and asked if they covered wls and what the requirements are. The lady told me to hold on and then came back and said that wls is excluded as well as complications from wls. I have read so many good things about medical mutual and I was really thinking that getting ins to pay would be the least of my problems. I am very dissapointed to learn this. Does excluded mean NO- NEVER- NOT POSSIBLE FOR ANY REASON WHAT SO EVER??? I dont understand. I even asked her even if it was medically necessary is it still excluded and she said yes. Is there anyway to get around this? WOW i am very sickened and upset, Im afraid for my future if I cant get healthy somehow...My obesity is really getting to me. My bones ache, my knees and ankles are bothering me, my feet HURT SOOOOOO BAD when I stand for any longer then an hour, my thyroid is underactive and I just feel like crap all the time. I weigh 260 lbs for goodness sake! Ive been MO since I was like 11 years old! So just like that the ins can deny me and my health care needs? Just dont seem right. OK so if ins wont pay, what can I do? What is the average price for wls here in Ohio? Do most surgeons offer some type of loan or payment plans? Im sure no one really has that kind of money lying around but I really dont. We have some money in savings and stock but Im sure my husband wouldnt want to spend his retirement. I am afraid to go on another diet. I do good at first but then, the minute I stop the diet or even pause it for that matter I gain back every pound that I lost plus more. ooooh Im scared. Someone please tell me that there is something I can do. There is no other insurance option for us so thats not even a possibility and Im not going to mexico to have surgery. And another thing, say I do self pay for lap band, what about fills and unfills is that included or is each fill/unfill extra cost and if so, what might those costs be. Anyone have any info?? Thanks for reading, Tiffany

Look for your policy. Call and ask for a new policy book and all new add ons. I cANT BELEIVE THERE IS A EXCULISION ON A MEDICAL NECESARRY. I think you need to do more research. She might not know what she is talking about. Also most insurance companies do not pay for the lap band. I know I have medical mutual and they dont because it is still expreimentail. They say. You need to do the research yourself. They wont tell you nothing Take Care and never give up Barb

I have the exact same insurance and they will not pay for my surgery either. I just found out today.... I am going self pay. The Cleveland Clinic costs $30,000 but St. Vincent Charity costs $19,000. I just don't know if appealing will do any good whatsoever, I would rather pay then having to wait another year or two. I wish you the best of luck!

Tiffany, Although 2 people may have MM super med plus, for example, they may not have the same coverage. A lot of it depends on your employer. They are the ones putting the exclusion on not neccesaryily the insurance company. I I have MM HMO Health OHio and my husband works for Ford. It is NOT excluded but I was told by a union rep that when the contract runs out in 06 that it very well many be excluded. I was approved and had my surgery on June 1st so it won't affect me. I would call your employer and find out.......if it isn't an exclusion by them then talk to MM again and ask them why it is if it is not written that way for the employer. I hope that this make sense! And....GOOD LUCK! Where there is a will there is a way! Sue

If either of you work for the State of OH, it is covered and let me know if you want more details on how to make them pay, I did!