Desperate need of help

sajoels
on 11/12/08 1:13 pm - Sanford, FL

I STARTED ON THIS WEIGHT LOSS JOURNEY 11 MONTHS AGO.  MY DOCTOR SUBMITTED MY PAPERWORK TO AETNA.  WE WERE DENIED ON THE FIRST TRY, THE INSURANCE COMPANY SAID I NEEDED TO DO A 6 MONTHS SUPERVISED DIET, I WENT AHEAD AND STARTED SEEING A DR PAYING $85 A MONTH.. AND JUST COMPLETED THE PROGRAM,  i WAS SO EXCITED BECAUSE i DID WHAT THEY ASKED AND NOW FOR SURE THEY WOULD APPROVE ME SINCE I S=ALSO HAD OTHER COMMODITIES.   MY DRS OFFICE SUBMITTED THE FORM AGAIN AND NOW THE INSURANCE COMPANY IS SAYING THAT BARIATRIC SURGERY IS NOT COVERED BY MY EMPLOYER...WHAT!!!!!!!!!!!! HOW IS THAT POSSIBLE AFTER YOU TOLD ME THAT ALL I NEEDED TO DO WAS THE 6 MONTHS DR SUPERVISED DIET...THIS IS CAUSING ME ALOT OF MENTAL ANGRISH NOT TO MENTION I AM OUT $510 AND OTHER MONIES TO GO ON THIS DR SUPERVISED DIET THEY REQUESTED THAT I DO.. CAN SOMEONE PLEASE HELP ME,I NEED TO KNOW WHAT I CAN DO..THEY SHOULD HAVE SAID FROM THE ONSET THAT I WAS NOT COVERED..WHY PUT ME THROUGH THIS...  ANY IDEAS?   I WAS THINKING ABOUT CONTACTING AN ATTORNEY AS I DO HAVE THE LETTER ADVISING ME TO DO THE SUPERVISED DIET.

saletiajohnson
on 11/12/08 2:57 pm - anchorage, AK
Maybe you employer excluded weightloss surgery to save money. You should ask your HR dept what happend because obviously it was covered b4!!!
sajoels
on 11/12/08 8:21 pm - Sanford, FL
the insurance company says that it was excluded since 2007..  i started this journey in 2008, they should have siad it was excluded from the onset... it didnt miraculously happen mid year..l plans dont change like that.
(deactivated member)
on 11/12/08 2:57 pm - sunny, CA
 Get a copy of your medical policy and see what it says. Is your insurance self funded? If it is then  you can contact your HR dept and ask them. If it  is a covered benefit then what you need to do is write an appeal. What insurance do you have? Is it an HMO or PPO? Can you get a copy of your med. policy online? Don't believe what those insurance reps tell you, they change their stories more than their underwear. Get you policy in your hand and take it from there. This is just more insurance bullcrap. They want you to get frustrated and give up or die before they have to pay for  your surgery. Take a deep breath, it will work out.  What does the denial letter say specifically?
GorgeousIsa
on 11/18/08 3:33 am - Philly-delphia, PA
I do not know if this will help out for you aftter the fact but it may help others. After my initial consultation I was given the mdical codes that the bariatric surgeries would fall under. I called my insurance company and gave them the codes for ach one. There have been about 2 people at my job who have had the surgery and I checked to to know that I was okay. I feel bad and would be very upset myself and yes they should have informed you when it was denied the 1st time that it was not covered. I would use that as a way to try to get compensated for what was put out.
HIGH-294CURRENT-151 GOAL-150LBS GONE-143LBS 2 GO-1 (Last weigh in 7/14)   Platics Done: Breast Reduction (5/14) Extended Tummy Tuck w/ Anchor & Brachioplasty (5/29)
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