Crushed again!

Well here I am crushed by insurance again! On Friday I sat in on a conference call with my superintendent, assistant superintendent, treasurer and our UHC coordinator. I work for a very small school district and fully insured so that means that a rider or amendment can not be added to our policy which my district was willing to try to do. So from what I am understanding we would have to be self-insured to do this and we do not have the numbers to be self insured. We are in the middle of a contract so nothing is up for negotiation right now. I can still try the appeal process but it's ironclad with the written exclusion. I guess the next option would be looking into self-pay. I have no idea how I could manage that on a teacher salary. I would like to check into other options besides OSU especially with cost being an issue. Would anyone like to share self paying options with me? I know that is somewhat personal so feel free to email off the message board. Are there any foundations that help with the cost? I've had my woe is me party this weekend so now it's time to get my head on and see what else is out there. Is there a dating service out there that find a match for you with good insurance.......... Good thing I still have my sense of humor! Thanks everyone for listening! Kelly

I dont have any great insurance advice, but just wanted to offer some love. You can borrow the money but of course then you have to repay it, so you will want to go to a doctor that is good that is also cost effective which OSU is not. I know their are some good ones in Mexico also. OSU billed my insurance like 45, 000 just for the surgery. Cheryl

Hi Kelly - I attended the informational seminar at St. Vincents and they talked about self pay and the cost was $23,000. They stated that it included everything including up to thirty days after if there are complications. They also shared that they know of a bank that would possibly finance the surgery. Good Luck!! Stacey

Wow!!! I attended the St Vincent's seminar LAST March, and I'm still fighting MMO to get approval. But anyway, a friend of mine went with me and her ins co had an exclusion for WLS so she paid out of pocket in June 2004 and it was $14,000 at St. Vincents. We have the same surgeon, Dr. Schreiber. They really raised their fees for 2005!!! Pam...PS My friend is now down 96 lbs!!

Kelly, Even if your insurance excludes bariatric surgery, your insurance has a clause in it that says something about "medically necessary"...... If you have any co-morbidities like sleep apnea, asthma, allergies, high blood pressure, diabetes, joint pain, reflux, infertility, high cholestrol, urinary stress in continence, etc. then make a case in your appeal for the surgery being "medically necessary" for you. Have your personal care physician write a letter for you that states how you life can be improved by surgery. I also work in the schools and I have a very difficult time going up stairs without stopping to catch my breath and stop huffing and puffing. Some of the classrooms I supervise are on the 2nd and 3rd floors. Go to www.obesitylaw.com and look at all the info they have to help you effectively write an appeal. If that appeal doesn't work, there's always the Ohio Insurance Commission which will help you by investigating your insurance as to why they won't help you when it's "medically necessary" for you to have the surgery. Good Luck!!!! I'm working on my appeal as we chat. Feel free to e-mail me. I've done extensive research for my own case. Luann

Hi Kelly, First of all, never give up! Where my husband works and our insurance is with, they have twice the requirements for approval than what the insurance company has so meeting their requirements is practically impossible. Despite being told by a surgeon's insurance coordinator that I'd never be approved, I kept trying. My biggest problem was getting a surgeon to submit it so I could fight for approval. I contacted Dr. Curry in Cincinnati who agreed to submit on my behalf (not to mention a heck of a nice guy and great surgeon!). One of the first things I did was contact both of the obestity lawyers that folks talk about on this site. Both were very helpful and offered sound advice. One told me that despite there being exclusions, it could be fought that they are "excessive" and could be over ridden. With Dr. Curry's help, his staff's help and the advice of both the lawyers, I was finally approved after about 7 months. Mind you, the insurance company still played their little games citing I hadn't submitted what was needed when all along it was there, etc. but I did get the approval. My suggestion to you would be to talk to one or both of the obesity lawyers. They may have some suggestions which could work for you. My other suggestion would be to contact Dr. Curry in Cincinnati. I do know they have self payers and from what has been already quoted to you, if my memory is correct, he does not cost that much. I thought they had some type of financing available also. Good luck and hang in there! Beth

Never, Never, Never give up. They denied me twice. Most of them do before they approve. Good Luck, Richard