GREAT article on ins. co. denying WLS!!!

I am *this* close to self-paying and not fighting my insurance company's exclusion. With the surgeon being out of network (and hospital), even if it's covered, I figure I'd still be paying approx. $5,000-6,000 in co-pays, deductibles, overages on customary charges, and lawyer's fees). The Wish Center in Illinois charges $11,000 for the lap-band (includes everything but fills). For $5-6,000, I don't think it's worth the stress of fighting and waiting, only to be possibly told that it might not be covered anyway. In some ways, this is a relief! I don't want to spend a year or more in this state of being, waiting and wondering and worrying about coverage. Anyway, here's a great article on this subject: http://health.tbo.com/health/MGBFC52424E.html Elizabeth

I couldn't access the article. Do you have an exclusion for surgery in general, or just the lap band? I really admire your attitude in wanting to move forward in your life, and finding a way to make it happen. You can always have the surgery, and then continue to appeal while you're on your way to a thinner, healthier you! Good luck to you, whatever you decide.

Hi Roberta, My exclusion sorta covers it all: For the treatment of obesity, morbid obesity, and for weight loss purposes. It's a CATCH ALL! Elizabeth

You know the one good thing about OH is how everyone is so positive and always wishing the best for each other. I say to anyone who has an exclusion, Not to give up and fight as far and hard as you can!! Ruthann Jones

IF YOU FEEL THIS IS THE WAY FOR YOU, DON'T GIVE UP. DO WHATEVER YOU HAVE TO DO. I WILL HAVE BEEN FIGHTING MY INSURANCE COMPANY FOR 3 YRS. COME THIS OCT. 2005. I AM NOW IN THE PROCESS OF GOING THROUGH THE TEXAS BOARD OF INSURANCE, WHICH MY INS. COMPANY SAID IS THE NEXT STEP. AFTER THAT, THE NEXT STEP IS LAWYER (IF THIS BOARD ALSO DENIES ME) I HAVE TO ADMIT, WITH ALL MY HEALTH ISSUES, I HAVE BEEN TIRED LATELY, AND HAVE NOT PURSUED THE BOARD, BUT FEEL LIKE I AM GETTING MENTALLY READY TO GO AT IT AGAIN. GOD BLESS AND BEST OF LUCK TO YOU...