Keep Getting Denials for Insurance

Hi everyone. I am new to ObesityHelp. I have been denied insurance over and over and over again because of my weight and height. It is IMPOSSIBLE to pay for WLS out of my pocket, and now i'm at the point of not knowing what to do or just giving up? Have anyone ever felt this way or ever had this happened to them?

Signed

Angry and Upset Obese Diva

Meaning that your BMI is not high enough?  Can I ask what it is?  Do you have co-morbidities?   Have you submitted for pre-approval, or has your surgeon's office submitted?  Have you had a consult with a surgeon yet? 

I haven't had a consult yet...I do have high blood pressure and my PCP thinks I may be a diabetic. It wouldn't be any use of submitting if I keep getting denials to have any insurance. Blue Cross Blue Shield will deny you insurance based on your height and weight, and there are other companies who will do the same. Self Pay is basically taking out a loan and paying back on it. My credit isn't decent enough for me to take out any more loans.

But that is what I am asking - what is your BMI (or height and weight)?  If it is over 40, then it probably is covered by insurance, even though there may be steps you need to take to ensure you qualify (a 6-month doctor supervised diet, exercise regimen, etc.)  If it is between 35-40, it might be high enough if you have 2 comorbidities (whatever BCBS says are comorbidities). 

I would go for a consult and see what a WLS clinic has to say.  They are the ones that might know how to submit to your insurance correctly.  It all comes down to what your physical insurance policy says.  I have never had to deal with my insurance company - my surgeon did it all for me.

Which insurance company do you use? Would the insurance company require for me to be on a six month diet or would that come from a nutritionist? My PCP referred me to a nutritionist but i don't know how long that would be.

I have Aetna, but even different people within Aetna have different policies. 

Your insurance company will likely have the requirement for a doctor-supervised diet prior to surgery approval.  Alternatively, your surgeon might have his own requirement.  For instance, one of the top surgeons here has a requirement that all his patients participate in a specific diet-class-exercise regimen/program prior to surgery.  This could also be used to meet the insurance requirement.  However, some of his patients have done the insurance requirement first, on their own, and it was not a strict enough program, so the surgeon made them do it all over again. 

If you go to a consult, likely the surgeon's office will have an insurance coordinator on staff who knows the ins and outs of what is specifically required for you.  And then they can help you navigate those waters.  Good luck.  It can be a frustrating journey, yet so worth it.

So you are saying that if I go to a WL surgeon, an insurance coordinator can help me determine which insurance would be better suited for me?

Do you not have insurance right now?  What about BCBS?  You could certainly try, but as I said multiple times before, it really depends on each individual's policy.  If you currently have insurance, you could go to a WL surgeon, and his/her insurance coordinator will look at your policy, contact your insurance company and determine what, if anything, you need to do to get WLS approved.  If you don't currently have insurance (then I am confused based on your opening post), or you are in a position to change companies, it certainly couldn't hurt to try to ask the coordinator which company is best, but they might not tell you since, again, each policy is, in and of itself, different.

I don't have a policy as of yet. I'm self employed. I have tried BCBS so many times (individual policy) and they denied me. I had Humana 4 years ago. I spoke with them and they said they could probably get me approved, but highly doubt it.

Oh, I understand now - you have applied to get medical insurance, and you have been denied the actual insurance because of your weight.  I thought you were denied the surgery by an insurance company you already have.  My mistake, and I apologize.

I don't really know what to say.  I don't know how to get an insurance company to cover you.  The WLS's office likely wouldn't be able to help you out with this inquiry.  I'm sorry.  I would contact your state's department of insurance and see if they have any information they can give you.

I wish you luck.