Question:
I'm planning to self-pay; any chance of insurance payback later?

My insurance specifically excludes treatment for obesity, including complications of any treatment. My BMI is 36, so it would hard to make a case for morbid obesity, though I do have diabetes (lots of medication needed), high BP, and high cholesterol. I'm planning to self-pay (about $23K for LAP band; just got the home equity loan). Does it seem likely that after I have the surgery and see great improvement in my co-morbidities that I could talk insurance into paying me back? Maybe just a pipe dream!    — sjwilde (posted on February 15, 2003)

February 15, 2003
I think you've answered your own question. It's a pipe dream. I had the same one and I was super morbidly obese. I lost the weight and all the comorbidities so I've cost the insurance company nothing since my surgery, but they don't care. You'd think they would at least send a card or something, but nada.
   — Traci H.

February 15, 2003
Hi, I work for and insurance company. ((No hate mail please ... lol)) And unfortunately, if there is an exclusion and you go ahead and pay for the services chances are, No, you will not be reimbursed for the charges.<p>In my own opinion, I think that you making the effort, coming up with the money and your doctor stating medical necessity should be enough to get the surgery approved. As we all know, this doesn't work! If you have a self-funded plan (a third party administrator-not exactly an insurance company) they tend to complicate things even more.<p>Good luck to you! Mary
   — Merry I.

February 15, 2003
Personally I think your better approach would be to submit for pre-approval based on 35BMI and co-morbidities. If denied then start the appeals process but also proceed with the self-pay process. If you are able to win the appeal(s), then the bills would be paid either to you because you could show proof of payment or sent to doctor's and they would reimburse you. If you don't apply first and then fight after the fact I think it could work against you. Chris
   — zoedogcbr

February 15, 2003
Thanks for your responses. My surgeon's office did put in an initial query and it got turned down immediately. I've pretty well accepted that I'll be paying for this myself but just wondered if there were any avenues I wasn't aware of. One thing that helps a little: most of it will be tax-deductible, so I'll get a chunk of the money back. Also, I'm going to talk to the hospital about a discount since they'd be giving a big discount to my insurer if it were covered. Hopefully cash on the barrelhead will count for something!
   — sjwilde

February 15, 2003
Actually I would hire Walter Linstrom in Calf. and have him fight the battle for you, That's what he does, he only costs about $300 bucks. too.
   — Tracy H.

February 17, 2003
Hi... Dont waste your hard earned money here in the states! You can have a DS, or lap band in Brazil for a fraction of the cost! I had a DS for $8000 + airfare and hotel! It is a wonderful place and a gifted surgeon! Email me and I can fill you in on all of the details! Check out our group... [email protected] Good luck to you! Jackie
   — Jacklyn C.

February 17, 2003
Go ahead and urn it into your insurance company anyway! I have United Health Care and they denied me 3 times. Someone told me to turn it in anyway, so I did and they have paid almost $5,000.00 already. I still have about $12,000.00 in bills still out, so I am hoping they may pay some more. But if they don't, that's okay because they have already paid for more than they said they would.
   — Colleen S.

February 17, 2003
Let me clarify on that a bit. UHC is my primary insurance and I have Health Star as a secondary. Health Star approved it after the 3 denials from UHC. With UHC being my primary, I found out AFTER my surgery (when the bills were sent to Health Star)that they had to go through UHC first. My friend told me to go ahead and send everything through UHC and let them deny the charges, then Health Star would pick it up. Much to my suprise, UHC has actually paid for some things. Whoo hoo!
   — Colleen S.