BAD NEWS! I was denied!

I only know a few of you but wanted to update you that my insurance has denied my surgery. I had called them before I ever started this process and was told WLS was covered based on medical necessity. So I pursued it and have lived my life thinking everything would soon be better. Now, after waiting 30 days for review and the insurance even asking for more information, they have told me there is an exclusion and the surgery is not covered, period. There doesn't seem to be much hope; Lacey @ Dr Bour's said if there is an exclusion not much can be done and we even checked with my husband's employer's benefits office and they confirmed there is an exclusion. I am sooooo sad. I don't really know how to go on from here. I'm trying to be optimistic as my husband and I pursue starting the non-surgical optisfast program. We have an appointment with the dietician tomorrow. Please keep us in your thoughts and prayers. I will miss you all dearly! Kathleen

Kathleen, I am sorry to hear that about your insurance. Don't give up girl! Somehow it will work out for you. I have a friend that was denied and she is changing insurance carriers... is there anyway you can do that? I hate insurance companies that would rather pay for all the illness that being overweight give us instead of paying for a surgery that will help them pay out less money in the long run. I really don't understand them!!! Pam

Kathleen! im so sorry!!!! i know how that feels. ours is a written exclusion as well.. were changing insurance now to First Health, which is a sub of metlife.. and they pay.. The non-surgical program is awesome as well! I know someone who has lost 70 lbs on it.. so there is hope!!! and why will you miss us?!?! Just because you arent having your stomach cut open doesnt mean you cant hang out with us?!?!? LOL.. You better still hang with us! We like yall too much for ya not to! Jen

Ditto Ditto on what they said. Insurance sucks and please don't leave us! We are all in this together! Kathy

I am sooo sooo sorry to hear this. It really upsets me that insurance companies are more concerned with saving a buck, and are so short sighted that they are happy to pay for diabetes meds and testing supplies, even up to dialysis, and transplantation and the anti rejection meds, but won't cover a life saving procedure?? It really , really irritates me. Do not give up!! I was told by several insurance companies when researching info on denials, that sometimes it is denied because the surgeon may or may not have enough procedures, and if you go to a "center of excellence" then they will cover it. Do you have Blue Cross/Blue Shield? MUSC is a center of excellence, and if it means getting the surgery or not getting your surgery, it may be worth driving the extra part. You can email Amanda Budak at MUSC, she is the program manager and has gotten many people who were denied at other places approved. Keep trying! Here is Amanda's email: its worth a try!! Also, there is a set price if you pay cash, and its much lower, and you can go through Capitol One for medical financing , and I heard they were easy to get approved by. Here is Amanda's Email: [email protected] Another option is to go to Mexico to have it done. I have talked with lots of people who had it done there, and it is much cheaper too. Go to www.plasticsurgeryjourneys.com Good Luck God Bless!! Deborah

WOW! What a wealth of knowledge - thank you so much for all that info, it sounds great! And how sweet of you to share all this with me when you have only been home from the hospital 1 day (I just read your update on the other thread) and are trying to recover from your own issues. Thanks so much for your kindness!!!!! It means to world! Take care! Kathleen

I'm so sorry. But, be persistant. Don't give up. And good luck with the non-surgical route....please come hang out with us. We like having you around. Rachel

Hi Kathleen, I'm so sorry this has happened to you.. I hate hearing about this type of red-tape. Seems the insurance companies just don't "GET IT" or companies are just to cheap to pay for a decent insurance plan. Keep pluggin away.. and don't give up!

Oh no!! I am sooo sorry!! Please don't go...this forum is for non-ops too! So don't feel you have to leave! No matter what route you have to take, we will be here to encourage and support you!!! (((HUGS))) Love, Elizabeth

Kathleen, Please pardon my lateness ... was out of town for a long weekend ... I wanted to let you know how disappointed I was to read about your insurance written exclusion. We had just talked about what a great company UHC is to work with. I am incredibly lucky that Fluor has no written exclusion for WLS. (YET.) In GA, where my sister works, so many people in her company had WLS one year, the next year her company put in one of those nasty exclusions! Too bad for her, she didn't have the surgery when everybody else did ... now she can't. Don't even think about leaving this board, or our group! I told you before, you and Jimmy fit with us from the beginning! We'll support you on the Optifast program, and cheer you on as you celebrate your weight loss together! Hope to see you soon ... Dawn