Question:
question about insurance company

if i called my insurance company and they said they have an exclusion for gastric bypass, then what? can you fight that? and for anyone whom took out a loan, self paid ect how did you do it? bc i certainly dont have 30,000 lying around...what did you pay monthly if you paid for it yourself? can anyone help me? because i desperately want this surgery.    — sweetiefacek (posted on June 16, 2009)

June 16, 2009
Ask your surgeons office about payment plans. Contact your bank and ask them for options. You need to beware of some of these companies that specialize in financing medical procedures. Some states allow banks to open a line of credit on their equity which can be used to pay for surgery. Also, check out the insurance, cash pay, and financing forum under "Weight Loss Related" forums. Hope this helps.
   — Jung

June 16, 2009
I have that situation right now and am gettng my self armed to the teeth with information and filing an apeal as soon as the denial letter arrives. I working with the doctors office and will let you know how I make out. Never give up the fight. Never settle for less than you desreve and you desreve the best.
   — abuddingrose

June 17, 2009
Is there some kind of clause for "medically necessary?" I mean, I was denied adn told that my insurance policy doesn't cover it and then I called the insurance company again and they said yes for the 100th time we do cover it if it is considered "medically necessary." I am fighting for VSG and that's why I am having a hard time but hopefully by next week I will have an answer to my appeal for VSG. But I would just file an appeal and keep my fingers crossed!
   — Papoose79

June 17, 2009
Insurance companies are notorious for giving out contradictory information. They longer they put you off or keep you confused, the longer they don't have to pay a claim. Call again and ask for a copy of your plan's Medical Policy for weight loss surgery. That document spells out the criteria for eligibility to have WLS. If they say they don't have it, ask for a supervisor because it has to be provided. My BCBS PPO plan has a website and I found mine there. I copied it and printed it out to make sure my surgeon's insurance coordinator had the same information. Also, you can check your insurance handbook from your employer if you were given one. If not, check with the HR dept to make sure your employer doesn't have their own exclusion on the policy. This is an option and some employers choose to not have it because it reduces the overall cost of the policy. Good luck to you, I hope it all works out and you do have coverage. It can still be a challenge so be prepared to fight for it.
   — Arkin10

June 17, 2009
I have to fight insurance for everything. Medi-Cal is now even covering this procedure. I would look into and have the doctor submit for the auth...once you get a denial then you can work with that.
   — gttackett