Bad News..Lifewise said no..no...and no..Please give suggestions for self pay!!!!

Lifewise had basically a double exclusion on bariatric surgery. First, they have an exclusion on anykind of WLS and any post care for complications or anything resulting. Second, they exclude anything having to do with weight loss. Here is a log of my conversation; 1/20/06 Talked to Josh. He said it's an exclusion on our current plan. But, if it is medical necessity then they can allow coverage. Through a preferred provider on an out patient procedure covered at 90% of allowed amount subject to $300 deductable. He suggests to contact doctor and have them call in and have him talk to the care management department and they will start the process. They need chart notes and documentation showing that the surgery is a medical necessity. 1/24/06- Talked to Jessica @ Lifewise in Care Management Department. She said Bariatric surgery and everything related to obesity is an exclusion. She said even if it is medical necessity. She said 100% of Doctor's requests based on medical necessity are denied. Looks like I am going to be a self pay. Please give reccomendations and approx costs. My parents insist that I go to OHSU since they are the best, but here is my conversation with them; 1/20/06- Talked to June. She asked if Lifewise covered the surgery. I said not normally. She said if it is an exclusion than under no cir****tances will Lifewise cover it. Price is $25,500 to OHSU upfront for surgery (w/o complications). Surgeon's fee $3-4,000. Anesthesia is $1,800 deposit and billed for the balance.

OHSU is the best, in my opinion. Think of the cost as the equivalent of buying a new car. Try approaching credit unions in your area for a medical loan. If you are a homeowner, an equity loan or line of credit can be paid off in ten years or so. That is less costly per month than a car loan. Also, labor unions often have loans and 401K's can also be used for medical reasons. good luck, tee