Need help with Insurance

I need some help in finding an Insurance company in the Spokane area that I can afford that will pay for the surgery. Right now I have Community health plan (Basic Health) and have been refused 2 appeals. I am now starting on the 3rd time around. I think my doctor (GP) thinks I am nuts to try again. But he is not heavy. I'm over 400 pounds and still managing to work. But don't know how much longer I can keep going. The insurance company just considers this cosmetic surgery, and doesn't even care that It means my life. Just so they don't have to pay for it. Does anyone have any good ideas?

First try to find out if Community Health has ever covered WLS and what their criteria is and then address each of those items in your appeal letter along with Dr. letters addressing each of the criteria (co-morbitities). You may also want to find out what the criteria is for medicaid. The next thing is to try to find a surgeon who will accept Community Health. I understand in Washington State there are very few, if any, surgeons who will take medicare, medicaid, and maybe basic health. However, do not give up. Call surgeon offices to ask them if they will make an exception for you. Some surgeons will set aside a few exceptions each year. They loose money on medicare, medicaid ect. Tell them it is life and death. Good luck. M

I know of a Doctor that will take Medicaid and or Medicare but He is bellevue, Washington I know this may not help but Let me know if you need his Number and or Address.

hi Yvonne, I actually work in the customer service dept for CHPW. I hate to tell you that there is no criteria for the surgery because it simply is not a covered benefit. I can only imagine the frustration. I will try to find out if there's any way to even get it considered for you but don't get your hopes up cause I know this insurance isn't very giving when it comes to certain procedures such as WLS. Have you checked with Molina? Is it offered in your area? Their number is 800-869-7165, you could check their benefits cause i know they have BHP as an HMO. Have you tried to see if you qualify for DSHS? I know they in some cases cover gastroplasty. Anyways, I'll see what I can find out to help your case. GOod luck!