Question:
Written exclusion, I feel hopeless!!!

Well, I got another ABSOLUTELY NOT from my insurance carrier. I have been in tears all day. I guess my only recourse now is to get a job that has insurance that provides this surgery. I can do this with all my spare time with 3 kids at home, and myself a full-time college student. Will it ever get better????    — Andrea S. (posted on April 11, 2002)

April 10, 2002
Hi Andrea, I know exactly how you feel. I went through the same thing. I wrote a detailed letter to the Human Resources Director of my employer explaining all the reason why I needed the WLS. Since our policy is self-funded through my employer, they actually make the final decision. My employer had our policy rewritten to cover WLS as long as detailed criteria is met. I'm approved. My surgery is scheduled for April 29. Find out if your policy is self-funded. If so, appeal to the employer. My prayers are with you. I know how disheartening those denials can be.
   — Tammy W.

April 11, 2002
Maybe you could get a loan or self pay. Sometimes a Dr will let you pay off installments. Good Luck
   — Robert L.

April 11, 2002
Some attorneys will put pressure on Insurance Companies because of the discriminatory practice of excluding WLS in their plans. Don't forget, morbid obesity is different then obesity, and if your physician is saying for example, thatyou are diabetic, have arthritis, etc secondary to excessive weight, and a history of failed attempts at weight loss is provided to the insurance company, it seems their refusal to pay is putting your health and possibly your life at risk. I found this address. I am not sure where you live but these folks may be a good start off point to get you where you need and want to go. Obesity Law and Advocacy Center 7710 Hazard Center Drive, Suite E, PMB No. 443, San Diego, CA 92108 (619) 656-5251 - (619) 656-5254 Fax Best of luck to you. Ann ([email protected])
   — Ann B.

April 11, 2002
Also think about if you own a home on taking out a home equity loan. You can write off the intrest on the loan and also now deduct the cost of your surgery on next years tax return. Just a suggestion hope you find a way to have the surgery!
   — Tawny F.

April 11, 2002
Hi Andred...First rule in dealing with insurance is to not give up! I went through 6 months of games and 2 denials before getting it reversed. Find out the nature of the exclusions and specifically why you were denied. You'll need this info as you proceed. Tammy had some really good suggestions as did others here. Find out what the exclusion is and then begin your appeal. Walter Lindstrom at Obesity Law is a terrific recourse and it might cost you $300-450 to appeal it. Go to his site and ask for information telling them the situation. They will email you a form to fill in with more detail and then will email back whether or not they think they can help and their rates. Then you decide if you want to try this route. Is your surgeon working with your insurance. If so talk to them and see what they think is next. Hollar if I can help you but don't give up yet!
   — AJC750

April 11, 2002
My daughter's insurance wouldn't cover hers either. She just signed up with a plan that is called care entree. It is not an insurance but some kind of discount card. She will be paying less than $7000 dollars for her complete surgery. If you want more information email her at [email protected] I'll be praying for you.
   — Brenda T.

April 11, 2002
I too join some of the previous posters in recommend Walter Lindstrom, especially if you have any major co-morbidities. I fought with insurance for 4 months and 2 denials, hired Walter, and for a $350 fee he submitted a legal brief appeal, and within 3 days I was approved and on my way to a thinner, more healthy me.
   — Dell H.