insurance exclusions

I am 29 years old and I meet all of the criteria to be a candidate for the lapband surgery...my problem is the insurance company has told me that there is an exclusion in my policy and no matter what the Dr's say ..they will not cover it. Has anyone ever gotten the insurance to pay if there is an exclusion in their policy or is there just no hope at all?? Please Help! I am losing hope

I own a small business with 6 employees and we have a policy with United Healthcare.  They have an exclusion specifically for any surgery for "treatment of obesity".  Since I own the company I talked to my agent about the possibilities of getting an exception, and they pretty much told me there's no way.   I think the only way you can fight it and possibly win is if they are saying it's not medically necessary.  I can be proven that it is medically necessary, but if the surgery is specifically excluded I don't think there's anything that can be done.  I ended up borrowing the money. 

Hey, I just noticed you are in Cleveland, TN.  That's where I am from!  I'm in Knoxville now, but all my family is in Cleveland.

Yes, I am in Cleveland. I love it here. I used to live in FL. I hate that about the insurance exlusion, but thank you for replying. Do you think that it may be possible (since you own a company) to speak with my husbands employer about changing the exlusion at the time of open enrollment ..or not? So what made you move away from here and head to knoxville? My family and I are up that way often, taking our children to Dollywood Splash Country...

I forgot to ask, what does it cost if you have to be a private pay? I am in school right now and my hubby says no-way can I take out another loan. Thanks again for your reply.

I am just checking into the Lap Band surgery myself and my insurance excludes it also.  The best price that I have found, other than Mexico, is with The Gastric Band Institute in Chattanooga.  Here is the response I received form them "Approx 13,800 to 19,000 depending on criteria."  If I wasn't such a big chicken I would probably try Mexico....

It was also an exclusion on our policy. After fighting it for some time I gave up when I decided it really was not that much money to save my life. If you are not able to afford the surgery there are all sorts of financing options available. From second mortgage, home equity, and all types of lenders who offer medical loans. Check with your surgeon if you are not familiar with these. I just had my surgery 8/22/07 (this past wednesday) It goes so much faster when you are a self pay. From consultation to surgery date was about 5 weeks. Paul

When I looked into the self pay lap band surgery with Dr. Dyer the cost was $13500.00 and RNY was around $21000.00. Hopefully this helps.  Liz

I have been through so much with my insurance, Tn. Healthcare, last yr. they did not approve any weight lose surgery. Now thank the lord, they only cover the RNY.  Is there any of the other surgeries that they cover for weight lose?  Check every 3 mos.  policies change. Mine did. Just call them ask them about what do they approve for weight lose. It don't hurt to ask.Ours now, don't pay for Lapbanding at all. Barb

I am the human resources rep for a local university. When we were looking to make a change in our policy for our last open enrollment, we looked into adding WLS coverage to our plan. The rider to add this coverage would have driven the premiums up considerably for everyone on the plan. Even though we would have probably fewer than a dozen employees and/or family members make use of that particular benefit. In the end, it was decided that it was just too expensive to add to our policy. If there is a written exclusion on your policy, the insurance will not pay for the surgery or any follow up or complications arising from the surgery. I'm covered under my husband's company health insurance and I hate having to tell our employees that our plan does not cover any type of WLS. Especially when they comment on my success. Don't give up hope though. There is always the chance that your company will decide to add the coverage at some point. Or, like another poster said, there is always the option of self-pay.