Written exclusion..considering self pay

I have Anthem BC/BS (Blue Access) & it has a written exclusion for treatment of weight loss & obesity. I've read a lot on this site and the general concensus is that I don't have a snowball's chance in he** of getting my insurance to cover wls. I've heard of the fight about the term "obesity" vs. "morbid obesity", but has anyone actually won that one? If so, PLEASE SHARE!! So, I am looking at self-pay. Need to know the cost of lap gastric bypass. Since hospital stay is shorter, cost should be less that the $30,000 to $40,000 I have been quoted for open bypass. No possibility of paying $30-$40,000 for me! Also, has anyone approached a surgeon for a break in cost equal to what contracted insurance companies receive? And, finally, is it cheaper to go out of the country for lap gastric bypass (don't want lap band)? Thanks for ANY help!

Vicki, I also have a written exclusion in my insurance plan I have hired Roberta Apte to write an appeal for me and we are fighting based on the fact that obesiity and morbid obesity are two different codes. some people think that is like splitting hairs, but if an insurance company has an exclusion it needs to be clearly and unambiguoussly stated. otherwise I believe you as I do have a snowballs cahnce in he** The only thing you can do is try. I have two sisters who have recently bolth had Rny laporoscopic bypass, they had no trouble getting approved by their insurance co. If my appeal is denied for the second time I will consider self pay, However Even though the surgery costs 30,000 to 40,000 You can negotiate with the hospital to get the price down considerably. My sisters bolth had united Health care and when all was said and done my older sisters ins paid 12,000 and my twin sisters ins paid 10,000 the rest was written off by the hospital, so I will try to get the surgery for the same price as the ins paid on my sisters surgerys. Dont give up! It is important not to let those insurance companies mess with your life this way.

Hi Wanda, I have a question for you. When you mention $10,000-12,000 for hospital, do you mean the stay at the hospital, and how much for lap RNY surgery did your sisters pay? Thanks for your help!

Vicki, The 10 to 12 thousand was the total cost. It included the hospital, the dr's fee and the anesthesiologist. You can negotiate with the hospital. Especially if it is a big hospital (not privately owned) smaller hospitals.You would probably have to have the cash up front if you are going to self pay. Let me know if you have any more questions. Wanda