Insurance exclusion
Hey everyone.. I am new and I have been wanting to have WLS for a little over a year now.. I have a exclusion on my insurance but I read on here that someone else had been approved after writing a letter and also the doctor writing one.. I am through Hummana on my husbands insurance.. Can annyone help me with this.. I really need this.. I am only 26, 5'5, and weigh 400 pounds..
If there is an exclusion....then that's pretty much it.
Don't think it can't be done, especially if you have a lot of co-mo's. But just know, you have a very long, very ugly fight on your hands. I would think you'd have to get an attorney...IMO
Is self-pay an option for you?
Make sure you research ALL of your WLS options. Take a look @ the DS forum too!http://www.obesityhelp.com/forums/DS/
Good luck to you!
(oh....are you on medicade (sp???), or maybe could get on it? They pay for WLS)
Don't think it can't be done, especially if you have a lot of co-mo's. But just know, you have a very long, very ugly fight on your hands. I would think you'd have to get an attorney...IMO
Is self-pay an option for you?
Make sure you research ALL of your WLS options. Take a look @ the DS forum too!http://www.obesityhelp.com/forums/DS/
Good luck to you!
(oh....are you on medicade (sp???), or maybe could get on it? They pay for WLS)
Diana DS Revision from '99 RNY
UHC Denied Jan'09/APPROVED Feb'09
DS-SW287; CW/190 GW/152
Sorry to hear about your exclusion, but I think you're out of luck. Your insurance benifits are contractual. What you get is what you agreed to pay for during your open enrollment. By signing up for the plan, you agreed to accept whatever benefits they offered.
Think of it like buying a house. You can't go back after closing and ask them to add a fireplace because you really wanted one. I know a fireplace is not the same as your health, but you get the point...
Here are your options...
1. Appeal to the insurance company. Slim chance of getting them to approve it, but you can always appeal.
2. Get a lawyer. Still slim chance of approval. Would cost you money which may be wasted.
3. Check to see if his employer offers ANY plans that cover wls. My employer, State of GA, doesn't cover wls for the HMO plans, but offers coverage if anyone in his office has had wls, ask them what insurance they closed.
4. Speak with the Human Resources dept and ask them to add coverage for next year. Your employer determines what the insurance will cover.
5. Self pay. Definitely not an option for me because of my finances, but many people do. You can borrow from 401k, take out a loan, take second mortg, , use the kids college fund, borrow from relatives, etc...
6. I pray that God will open a window and allow you to have your surgery. I pray that your health will be sustained while you wait. I pray you will have the strength and courage to endure this journey to a healthy new body.
" Jesus looked at them and said, With man this is impossible, but with God all things are possible." Matthew 10:26.
"For I know the plans I have for you says the Lord. They are plans for good and not for disaster, to give you a future and a hope" Jeremiah 29:11
Best wishes!!!
Think of it like buying a house. You can't go back after closing and ask them to add a fireplace because you really wanted one. I know a fireplace is not the same as your health, but you get the point...
Here are your options...
1. Appeal to the insurance company. Slim chance of getting them to approve it, but you can always appeal.
2. Get a lawyer. Still slim chance of approval. Would cost you money which may be wasted.
3. Check to see if his employer offers ANY plans that cover wls. My employer, State of GA, doesn't cover wls for the HMO plans, but offers coverage if anyone in his office has had wls, ask them what insurance they closed.
4. Speak with the Human Resources dept and ask them to add coverage for next year. Your employer determines what the insurance will cover.
5. Self pay. Definitely not an option for me because of my finances, but many people do. You can borrow from 401k, take out a loan, take second mortg, , use the kids college fund, borrow from relatives, etc...
6. I pray that God will open a window and allow you to have your surgery. I pray that your health will be sustained while you wait. I pray you will have the strength and courage to endure this journey to a healthy new body.
" Jesus looked at them and said, With man this is impossible, but with God all things are possible." Matthew 10:26.
"For I know the plans I have for you says the Lord. They are plans for good and not for disaster, to give you a future and a hope" Jeremiah 29:11
Best wishes!!!
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I 
MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
I am getting a little on both sides of posibilities.. I have spoken to someone on here, with my insurance, that also ahd the exclusion, but ended up having it approved.. Maybe I can also.. But if not can anyone recomend a insurance company that may pay for it.. I cannot afford to pay on my own... I pay over 200 on my insurance now, so maybe I can find a company that works.. Any suggestions?
It's not the insurance company that decides, it's your employer. Most all insurance comapnies cover wls. but your employer may elect to exclude coverage.
One person may have a Cigna plan that covers it and another may have a Cigna plan that excludes it.
Changing your plan won't do any good if your company doesn't offer any plans that cover wls.
You likely won't have much luck getting private insurance to cover you because of your weight. Meaning you go out and get a plan on your own not through your employer. If you were lucky enough to find a private plan that would cover you, it would be very expensive, and likely still wouldn't cover wls, but you certainly could do your research and try.
Many companies are not offering coverage to overweight people, so it will be hard to find one to cover you.
One person may have a Cigna plan that covers it and another may have a Cigna plan that excludes it.
Changing your plan won't do any good if your company doesn't offer any plans that cover wls.
You likely won't have much luck getting private insurance to cover you because of your weight. Meaning you go out and get a plan on your own not through your employer. If you were lucky enough to find a private plan that would cover you, it would be very expensive, and likely still wouldn't cover wls, but you certainly could do your research and try.
Many companies are not offering coverage to overweight people, so it will be hard to find one to cover you.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
I am getting a little on both sides of posibilities.. I have spoken to someone on here, with my insurance, that also ahd the exclusion, but ended up having it approved.. Maybe I can also.. But if not can anyone recomend a insurance company that may pay for it.. I cannot afford to pay on my own... I pay over 200 on my insurance now, so maybe I can find a company that works.. Any suggestions?
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