Dean Care insurance

Hello all! I am in the beginning stages of contemplating having the bariatric surgery. Has anyone ever heard of Dean Care insurance covering the cost of this surgery? I realize they have an exclusion policy, but my physician believes the surgeon may be able to get it authorized. However, when I contacted the insurance company myself, they flat out refused to cover/discuss it due to the exclusion. If anyone could offer some help/information that would be wonderful!!

Hi Janis, I am not familiar with Dean Care insurance, however I had United Healthcare who also had an exclusion clause in the policy. They would not cover this surgery no matter what the cir****tances, even with an appeal I was told. That is why it is written in a policy as an exclusion. There are other options however. Does your employer offer another plan you can switch to (that is what I ended up doing in an open enrollment time), or there is self pay which can be very costly. You can also appeal, but from reading many posts on here where people have appealed, few have won but it is a very long and exhausting process. I would also check with the surgeon's office to see if they have had any luck with that specific insurance agency. Sometimes they have a connection with someone there. I wish you all the best! Traci

Janis, I had Dean Care last year, and they would not cover it either. I stiwched to Cigna through my company, and they will if it is medically necessary. However when chatting with another Madison person. They said Dean will be covering them towards the end of this year. I think she said September. You may want to Give Dr. Hueppenbeckers office a call. They are at Dean West they may be able to give you more info on it. I have surgery scheduled with him the 16th of this month. He has been great to work with. Best of luck...

How about Physicians Plus? Have you heard anything about that? If Dean is going to cover, I sure will be looking for a job with Dean insurance. LOL

Janis, This note is not meant to discourage you, but I felt compelled to write to you. Since February of this year I have been involved with my insurance, Unity HMO in a battle over wls. It is listed as an exclusion for obesity in my HMO contract. I have three physicians telling them that I need this surgery for severe reflux disease and many other co-morbidities. My first appeal was denied as not medically necessary!!!! My surgeon wrote and asked for another consideration...and I hired an attorney! My seocnd appeal was also denied, for medical necessity even though my lawyer presented an excellent case argument. We are now in the process of asking for an independent review organization (IRO) review. NONE of the HMO's (DeanCare, Unity, Physicians Plus and GHC) currently cover wls. I have heard thru a reliable source that there is a meeting taking place this summer with the "fiercesome four" HMO's to discuss the coverage of wls. They are all afraid there is going to be a "run" on wls and therefore it will be hard to control the benefit and of course most importantly in their eyes...cost. I hope that we all succeed in our efforts! After 5 months of appeals, denials and the expense of a lawyer I am really no closer to having this surgery than when I started. Rumor has it that possibly things will change for the 2004 insurance contract year. We can always hope. Good luck.