Insurance exclusion 2015. Allowed 2016

Bradin9855
on 11/20/15 10:42 am

Hello all. I had surgery 10/21/15. At that time my insurance excluded bariatric surgery in Cincinnati but covered it in Cleveland. I filed appeals but of course was denied. So we took out a home equity loan and pulled the trigger. 

Guess what? They are covering it in 2016! I'm beside myself and owe S15,300! Do I have any recourse? Can I sue them for coverage or something?

Thanks!

hollykim
on 11/20/15 12:42 pm - Nashville, TN
Revision on 03/18/15
On November 20, 2015 at 6:42 PM Pacific Time, Bradin9855 wrote:

Hello all. I had surgery 10/21/15. At that time my insurance excluded bariatric surgery in Cincinnati but covered it in Cleveland. I filed appeals but of course was denied. So we took out a home equity loan and pulled the trigger. 

Guess what? They are covering it in 2016! I'm beside myself and owe S15,300! Do I have any recourse? Can I sue them for coverage or something?

Thanks!

no you can't sue them. It is entirely your employers choice whether to buy the coverage for their employees or not.  There is nothing to sue over,you can't win and would just be out attorney's fees. 

 


          

 

Bradin9855
on 11/20/15 12:46 pm

it's Obamacare, not an employer

Oneillch
on 11/20/15 6:45 pm
VSG on 02/04/15

Unfortunately, it's the employer's choice. This was told to me by HR when I asked why they didn't cover WLS and my husband's employer (with the same insurance company) did.

Gwen M.
on 11/20/15 1:19 pm
VSG on 03/13/14

Sadly this is a risk you took.  Sorry :/

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

Sherrie P.
on 11/24/15 6:13 pm
RNY on 02/06/13

No - sorry. They won't do anything retroactively because it was a plan exclusion at the time. 

Even Obamacare.

Revision Lapband to RNY 2-6-2013   HW: 286  Pre-Op Diet: 277  Surgery Day: 265  Goal: 155  CW: 155

Plastic surgery 8/28/2014: Brachioplasty, mastopexy, & abdominoplasty.

Plastic surgery 1/27/2015: Butt Lift

    

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