New to this forum and looking for guidance. same post as in the ct board.

Hi everyone,

My name is Veronica (age 37) and I'm just now beginning to look into WLS. My family is on the heavy side and at 5 feet 1in. I tend to look quite heavy myself (185 -190). I have type II diabetes, have pcos and hypertension. I was diagnosed with diabetes back in 2003 as I was undergoing IVF to have my children. My hypertensioon came after the birth of my fist son in 9/2004.

I've had to friends see Dr. Aranow in middlesex hospital and they look fabulous.
I did call my insurance company (united healthcare choice plus throught at&t) and was told my policy excluded weight loss surgery. Dr. Aranow does show up as in network so I'm wondering if there is something that can be done to have this kind of surgery covered.

I wondered also if I should just make an appointment first to see if I even qualify before starting the whole appeal proceedure.

Any guidance is greatly appreciated.

I have BCBS of IL through my work and I know that ANY weight loss program (surgery, RX, supervised diets, etc) is considered an exclusion to my policy. There is no way around it. My doctor is extremely esteemed in the WLS field and knows several "higher ups" at insurance companies and he said that not even he could pull strings in order to have it covered. The only way around it would be to find another insurance which sucks major b/c if you qualify for WLS then you are disqualified from purchasing an individual policy that would cover the surgery due to risk of a high BMI. I'm going to self-pay because it's my only real option, but good luck on your weight loss journey.

Thanks everyone for taking the time to post a reply.

A special thanks to Carmelita for for giving me the extra courage to fight against all odds. Your words are greatly appreciated and needed.

I'm going to call to see when the next seminar is and I'll just take it from there. I need to change my life for the better not just for me but for my children.

Thanks again everyone!

If you have an exclusion, what that usually means is that your employer opted to exclude WLS from your insurance coverage.  They do this so premiums will be cheaper.  The only thing you can do is ask your employer to offer an insurance plan that does cover WLS.  Appealing won't help, because you've purchased an insurance plan that does not include WLS.  You aren't paying the premiums that cover WLS, so they aren't going to cover it.

Kelly

Hi Veronica!

My name is Allison, and I just turned 40  on Oct. 17th.  I also live in CT.  I have ConnectiCare, and my policy has a rider that excludes WLS as well. 

I've already been through all of the pre-op testing because my company told me they were going to take the rider out but at the 12th hour decided not to.  Our new policy went into effect on 11/1. 

My plane is to appeal, appeal, appeal!!!!!!!  If the insurance company says no, then I'm taking my case to the Insurance Comissioner. 

I feel very overwhelmed, but I've made up my mind and I'm ready to fight!  I have an appointment to have meet with Dr. Aranow on Nov. 17th.  I was originally going to go with Dr. Raftopolous at St. Francis Hospital and Medical Center, but I'm not sure his staff is really committed to fighting for me. 

It seems like we're in the same boat so to speak so please feel free to email me anytime.

Good luck!!