Please help me!!!!

Some background. I'm a 26 year old teacher at a private school. I need this surgery and my PCP was the one who said so! The problem is the school's insurance, we have an exclusion in our policy on WLS. I called our insurance rep and was told that there's no way to overturn it, even if the school is in favor of me having it. What recourse do I have? I'm not even finished with school (one major exam in the summer is all I have left). I'm newly married and my husband is, for all intensive purposes, out of work right now. We are deep in debt and our credit is bad. So self pay will never be an option. What can I do? Please help!!!!!

Shana, Just because the Insurance rep says an exclusion can't be overturned doesn't mean it can't. I wouldn't just take their word for it. Get your PCP on the case and see if he/she will write a letter and refer you to a surgeon. Be sure you get all the referrals and authorizations required and try to get it submitted to the company. Ask them for the specific wording and for their criteria. You never know until you try. Good luck to you - it's such a frustrating process to fight the insurance, and the insurance companies want to discourage you so they can avoid paying. I think the first denial is almost automatic with most companies. Don't let them keep you from trying. Good luck!

I was told by someone from BCBS that my husbands insurance don't cover WLS, stopped covering it back in 2001. You know what I said to that I had started the process and kept right on fighting with Gary at my side and we WON!! Donna 338/256/? -82