Question:
Should I self pay and fight for approval later?

It is official, my insurance has denied my surgery. I am eager to have this done and am considering going ahead and doing a self pay while I go through the appeal process for reimbursement. Is this stupid? Will self pay lessen my chances of payment or will it help demonstrate my desparate need?Also, if I have complications will insurance pay for those or will those charges be denied as being part of the surgery? All advice , suggestions , experience welcome, Thank you.    — [Anonymous] (posted on July 10, 2001)

July 10, 2001
I am self-pay also and I asked my surgeon this very question and he told me in his experience the insurance company would be less likely to pay if I self-paid then fought them. He had one instance where he thought a patient had a decent shot at an appeal but the patient didn't want to put the surgery off and self paid and the insurance company completely disregarded the case. I think if you have a good shot at getting approved to exhaust that option first then self-pay only if you have to. Self pay's also have the added worry that if there is a complication, the surgery could end up costing them twice as much as what they thought. Some insurance companies will not pay for the actual surgery but if there are complications, they will pay for the added cost. That is what mine finally agreed to. Good luck!!
   — Elizabeth C.

July 10, 2001
I told the doctor I would self pay since my policy has an exclusion for weight loss surgery. I was sure getting CIGNA to pay was a lost cause. Sure enough, CIGNA denied my request. Still, my doctor's office filled an appeal, and today CIGNA agreed that weight was the cause of most of my health difficulties. Will they approve me? I don't know, but since I have a late surgery date (8-28-01) I have a little time to let the system work. At least now, I have a little hope CIGNA will come through.
   — blank first name B.

July 10, 2001
Are you absolutely sure the fight is over with your insurance company? What was the basis for denial? An exclusion is not a valid reason if you are morbidly obese. I can send you the letter I used to be approved without having to file an appeal. The insurance companies want you to give up and believe it's a lost cause. If you qualify for the surgery, it's not a lost cause.
   — Lisa B.

July 17, 2001
hi.. please please dont give up. sometimes thats what they are wanting/hoping for.. Im sorry I dont know whats its like...but i do know that its easier to pay, but lol get mid-evil on there ass...good luck.. i hope it works out for yea...
   — sherry F.