Have 2 insurances but neither cover WLS at all/private pay?

Hi, I am new here, looking for anyone who has to pay privately or any one who has a situation similar to mine. I have GH and Premera. Both of my plans, in bold, say WLS not covered for any reason. I have also spoken with them and they both state my plan doesn't cover WLS no matter what. So..... has anyone gone private pay? We are considering taking a huge amount of our retirement and using that. My biggest worry is that I will have complications and my insurances both say any complication that they believe stems from the WLS will be denied. My surgeon has also told me that my insurance will prob be difficult for a while regarding any medical issues I have after I have my surgery.  Can anyone give me any tips, ideas, positive facts or anything that will help me in my search for information. We are not wealthy by any means and this would prob drain most of what we have saved for retirement. I have been researching for months and months and have a really good surgeon, I have jumped through the hoops but am at the point of can I do this and risk losing all we have or is it not that dire?  I appreciate any comments.... Thanks, Cheryl

Dear Cheryl, I am in a similar boat swimming in the cess pool of insurance.  I have 2 Premera plans and both have a direct exclusion for surgery.  My surgey is scheduled for August 7th.  What am I going to do?  My co-morbidities are stacking up, I will die from being obese or I take a chance on life.  I am taking a chance on the rest of my life.  diane

Hi Diane, Thank you for your reply. I was starting to think I was the only one. I get so angry thinking about the insurance not covering this surgery and all that goes with it. Your comment about "taking a chance on the rest of my life" is what I think too, but then I remember about all of the chances I'm taking and I worry about "what if?" I am so tired of being ill and just want to enjoy the otherwise very happy life I have. Thanks again, and I'll be thinking of you around and on August 7th. Cheryl

i had a simular prob my insurance would cover it but it would be like a year of jumping thru hoops and i felt like this fat has taken enough of my life and was not getting another year lol.. so i got my surgery done in mexico by dr juan lopez corvala the total cost was $8000.00 and they provide financing.. i pay $300.00 a month. dont let the insurance stop u.. your life is too impprtant!!! the hospital was soo nice cleaner than most i have seen here in the states... the staff was great i have had zero problems with my band,, let me know if u would like info

Thanks for your reply. I had wondered about that and I'm glad to hear your's went well.  I agree, life is too short and I am tired living it like this! I will probably do it here in Spokane, just trying to figure out how we'd handle the complications if they came up. Continued good luck to you! Cheryl

Hello Cheryl, I am also in that same boat.  I have Pacific Care and Carpenters Trust First Choice.  They both have a weight loss exclusion on their policy's.  I was devistated!  My surgery is costing me over $25000.00 but so worth it!  I just started my diet and already see a weight loss.  I have always been heavy and can't wait to see the difference in my body. Good luck with your search! Jamie

Thank you so much for your positive comments! I am still taking it a day at a time and have completed the necessary tests and have a follow-up appt with my dr. on July 2nd. Good Luck and keep me posted! Cheryl

Cheryl, Deja Vu all over again . .. I hang out on the Over Fifty Forum mostly (as I'm of a certain age!) Just stopped by to check up on WA. . . My insurance, Uniform Medical Plan wouldn't cover WLS "even if medically necessary!")  Direct quote from their manual. So on 2/16/05 I was a self pay LAP RNY with Dr. Lauter in Kirkland. Best decision I ever made. It was scary to think about possible complications. Luckily I have had none. My 93 yr old mom "loaned" me the money. Now as of 1/1/07 Uniform Medical does cover the surgery. I think you have to jump through lots of hoops but at least there's a chance. They said since Medicare now covers it that is why they do. . . . I had tons of co morbidities but didn't do any good. I went through all the appeals right to the insurance commissioner. Basically they said Insurance contracts are individual and they can write them however they want.  Needless to say, Uniform Medical is not in very good graces with me.  However, I would not trade the last two years for anything.  Does your insurance have a "medical necessity clause"? Ask them that specifically. If they do you may have a chance. Good luck,

Hi Karen, Thanks for sharing your story. Does sound so much like mine and so gives me some hope. Thank you. To add to my "issues" I have had 2 previous Nissens, which are surgeries to repair the damage caused by reflux.  So, my Dr will have to undo these to do the RNY. He says if I was a skinny person my insurance would do the RNY for my reflux, but since I'm not they won't as they deem it WLS. Which it is also. So I can also look at it as curring an illness that I have always had even when I was not overweight. But.... yes, my understanding is that it is my company I work for and my husbands company that chose this policy which excludes the WLD surgery. My sis is having hers (her insurance pays) on July 30 and we will both have a tough time if she has it and I don't. I will check into the Medical necessity clause you mentioned, but I believe it not only was in bold writing and glowing red hot on the page that nothing was covered for any reason including co morbidities. I did well with my other surgeries and my Dr. seems to think he can do this well sooooo.... Thanks again, Cheryl

Hi Karen, I have been trying to find the over 50 forum and only see the 20s, 30s, and 40s. Can you guide me there as I'm of that certain age too. Thanks, Cheryl