Question:
Denied 3X due to exclsuion, need ideas, Mexico not an option. Anyone?
I have been denied 3 times because of an EXCLUSION. I have accepted that my BCBS will not cover this procedure even if it is medically necessary. The HR person where my husband works said for me to get on here and BEG you guys to help me figure out some way for me to get this surgery. I have tried to get my own personal insurance, but they say this is a pre-existing condition and they don't think it will be covered. (State Farm wants $408 per month $1000. ded. and wil pay maybe 50%) I called S.C. Residual Pool insurance market, they want $713. per month and they are not yet covering Gastric Bypass surgery, but will in "the near future". Vocational Rehab said they have had so many cut backs that they do not help with surgery now, My husband makes to much for me to get medicaid or whatever....we live in a doublewide and my father-in-law owns the land that it sits on so we can't mortgage our home. I just don't know where to turn...BTW hubby says NO to Mexico. Just thought maybe SOMEONE might have some leads for me. I appreciate all that have written to me saying not to give up, but when you have exhausted all your options what are you to do? I truly hope someone will have a brainstorm and help me out! — cindyedens (posted on March 18, 2003)
March 18, 2003
Hi Cindy, I know exactly how you feel. My insurance has a big fat
exclusion as well. I found a doctor in Arkansas that does the surgery
(open only) for about $15000. You have to pay up front, but that covers
everything. My really awesome parents are helping me out. My mom is
getting a home equity loan and I just have to make the payments. The doc
in Arkansas is named Dr. Ozment. The office is really great and they are
way helpful. I don't know if this was helpful, but I hope so. Feel free
to email me if you want any other info. Good luck!
— Dana M.
March 18, 2003
Hi! I'am really sorry to hear about your insurance. I have some GREAT info.
on my profile. There are 3 doctors in Little Rock with the starting price
at $11,600.00. Also about Dr.Aguirre in Ensenada, Mexico for $6,900.00. I
know your husband said NO but I've got to tell you "SHOW HIM MY
PROFILE" it is amazing how much this Dr. puts everything he's got into
doing this surgery, and this isn't a chicken truck ride down a dirt road.
Just research it a little before you close your mind to it. It might save
your life!
Anyway all the detailed info. on ALL of the Dr.'s are in my profile. I wish
you the best of luck on your journey!!
— latrishanickle
March 18, 2003
Dear Cindi,
I know that it is frustrating not being able to obtain the known solution
to your health problems because of insurance. I did want to post to let
you know, that there is a doctor who is offering a free operation (a Lap
Band). He is holding a drawing July 1, 2003. Here is the url:
http://www.belighter.com/index.html
I hope that everything works out for you. I just wanted to give you another
option.
Lisa
— Lisa H.
March 18, 2003
My answer.. get a job at a place that has better insurance. I have had a
GREAT time with Aetna. My husband works for Kinkos and I couldn't be any
happier with the benefits they offer. I had to pay only $250 for my
surgery.. the cost of my inpatient copay.
— SarahC
March 18, 2003
About a job at home depoit or other place that covers WLS?
— bob-haller
March 19, 2003
I work for the state of Indiana and they cover it. Is there any reason you
can't work full time somewhere that offers good benefits. Perhaps you can
post where you live and people can give you ideas. Of course if you succeed
in getting a job never mention or inquire about the surgery while on
probation.
— Candace F.
March 19, 2003
Cindy, just wanted to say you're not alone. There are tons of us out there
that can't get insurance that will cover WLS. Also, once you think you've
exhausted all your resources you may want to look them over again. We all
rule out choices that might help us, whether we intend to or not. What
about stocking up credit cards and using them for a big chunck, if not all.
How about a legal separation from your husband and trying to get state
medical without his income. There is changing jobs, moving to a new
location for a job or state medical through a state thats better at
covering it. Begging/borrowing money from your friends & family? Or a
loan cosigned by a friend, family member, your boss? Then there's the
option of saving up for years to finally have it, if you physically can
manage that wait. After you do all the "creative financing" and
if you just can't come up with 15-25,000 for a US performed WLS (cheapest)
you might reconsider Mexico or Spain. Some very fine surgeons are in those
countries too, only MUCH less expensive.
— Shelly S.
March 19, 2003
Cindy, I'm sorry you have to go through this. My only suggestion might be
to write your Congressman, explain medical necessity, go into the costs of
private insurance and the budget cuts of Vocational Rehab. Try to stick to
the long-term quality of life issues, cost-savings for the State and
Insurance company, etc., and maybe a little personal info. I really don't
know if it will do a thing except put you on his (her) Christmas card list,
but it's worth a shot. Good luck honey.
— Leslie F.
February 12, 2004
I was approved for RNY in two days by Blue Cross, however, I am only
interested in Lap Band. I am looking into obtaining a second policy with a
company that will cover lap band, otherwise I will have it done in Mexico
with Dr. Rumbaut. My boyfriend was very leary of the mexico option,
however, after much research we are both more comfortable with Dr. Rumbauts
credentials with regard to lap band as he is one of the foremost bariatric
surgeons in the world and has far more experience with the lap band
operation than any US doctor. He was actually involved in the training of
US docs when the procedure was first approved by the FDA. It sounds like
you don't have alot of options at this point and it may behoove you and
your husband to do some more research. Also, if I really want something,
particularly something that is going to be done to MY body, no one is going
to tell me know. My BF is a body builder who has never been fat a day in
his life, while he is 100% supportive of whatever decision I make, he has
no idea what it is like to be fat and his opinion has only so much
influence on my ultimate decision.
— A C.
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