~~Hi everyone for taking the time to read this topic. I am asking for help. Yesterday I went to my first seminar at Dukes in Durham NC. It went great, but when I called my insurance I found out that my insurance wont cover the surgery. UHC said that my job has excluded the surgery from the policy I have :-(  so I ask the Nurse If  I could fill out the application and he said no until I have an answer of approval of my insurance. If not that will be a waste of time, Anyway  UHC told me that I can send a letter to them to appeal it. I dont know where to start of how so I need help writing my first  letter to the insurance to appeal for an approval. If any of you went to the same thing can you please  give me an advice how I can start please??~~

The thing with appeals is that you can appeal anything.  You can have a doctor's order to eat lobster for every single meal but that doesn't mean ins will cover it or that appealing would help. :o(

If you do not have the coverage your appeal would be based on the following, your employer didn't buy the WLS portion but you want WLS anyway.  See what I mean?  Sadly, that isn't going to help.

Did you know that MOST people do not have bariatric coverage? It's expensive. The above poster is right.

If you do not have another ins plan to choose from you are left with self pay.

Maybe do what I did. Go to Mexico. Smaller loans are easier to get than larger loans.

The problem with your ins is that you likely have a plan through your employer. If they do not pay an additional premium for WLS, it isn't going to be covered. Perhaps go to your employer and ask them to add this? Don't bank on it happening because it's expensive and they can't just get you covered, it would be the entire company.

Hello, just a little background info on me first.

I am 23, female. 5'9", 360lbs. Size 22/24. BMI of 53.X. 

I have gained 180lbs in the past 8 years. I've had thyroid testing twice, that's not the problem. 

I tried gym/home dieting from 2005-2006. I've tried medically assisted weight loss 3 times with one facility between 2006-2007. I tried Medi-Fast in 2007. I tried Metabolic Research Center for 4 months in 2008. I talked to a psychologist re: emotional eating for 6 months in 2008. I tried hypnosis in 2009. I then tried medically-assisted weight loss in 2009 for a few months again. I also tried the HCG fad in 2010. I then got a dietitian in 2010. I've lost, at a most, 15lbs, but put it all back on and then some. I've been on prescription drugs for anxiety/depression due to this personal failure since 2005.

I don't have diabetes, high blood pressure, high cholesterol. I do have depression, anxiety, skin problems, and underwent a sleep study and was diagnosed with sleep apnea this year. I sleep with a CPAP machine. I do it faithfully as I know without it, I will fall asleep throughout the day. But because of my extremely sensitive skin, I have switched facial masks 3 times, but I am getting horrible skin reactions on my face from it. I have put fabric barriers over the plastic pieces to stop irritating my skin, but my skin is still irritated and I've had to purchase very expensive creams for my skin to relieve the irritations as they are the only things that work.

My gynecologist referred me to a bariatric surgeon two weeks ago. I went to a seminar that outlines the obesity information, types of surgeries performed, etc. 

It all sounds great. I'd like to proceed with a RNY Gastric Bypass. However, my insurance is with BCBS Arkansas Advantage and it specifically excludes any type of weight loss treatment, surgery, medication, etc. for obesity and morbid obesity.

My insurance company is so ridiculous that when I went to the doctor for my depression, when the doctor had put one of my diagnosis as "obesity" (which he always does?); the insurance company denied the bill. Citing they do not cover charges relating to obesity. I wrote a letter back informing them that 33% of people in my state are obese and if every one of their bills was denied simply for the fact they were overweight, then they should be informed of such when they were accepted as a member and their money should be refunded. They paid the bill.

So, therein lies the problem.

1. My insurance doesn't cover the surgery.

2. I applied for a loan through CareCredit to self-pay for the SX ($18,500 inclusive of surgeon/anes/asst. surgeon/pathology/OP facility). I was denied. (Probably because I have two car loans.)

3. I don't have a house to refinance to get extra money?

4. What can I do now? What are my options?

 

Thanks.  :)

Hey ladies, I am off my way on my JOURNEY.  Initially I was declined because my BMI was under 40.... But I have SLEEP APNEA and GERD. But, because my BMI was under 40 CIGNA still denied me.  I gained... get this......  7+ pounds (under 10 lbs), and that put my BMI at 40.4 (I am only 5 feet tall). I went in to be re-weighed, and took this letter to my PCP, and the PCP signed the letter, and the surgeon faxed it over on Monday--August 30th, and I was approved on Friday-- Sept. 3, 2010!   

I HOPE IT WORKS FOR YOU, THE WAY IT HAS WORKED FOR ME!!!