Question:
Am I at the end of the road?

I haven't had my surgical consult yet but have called my two insurance providers, United Health Care & BC/BS, in regards to having the surgery. I have PPO plans for both and have found that in both policies, there is an exclusion regarding WLS...basically wouldn't be covered! I am so frustrated because many doctors have said that I'm a definite candidate for the procedures. What do I do now?! should I just wait until I meet with my surgeon?! anyone go through the same thing? what did you do? HELP ME!!!!!! PLEASE!!!    — Ryan F. (posted on January 9, 2002)

January 9, 2002
Ryan, I too have United Health Care. They refused to pay because of the exclusion. I ended up paying out of pocket. The total cost was $15,000 I couldn't believe the discount the hospitol gave for prepay (I guess so they didn't have to deal with insurance.) Anyway, the way I looked at it was that was the price of a car. And my health was at least that important...Just my 2 cents....Bill
   — bandmancwc

January 9, 2002
My sisters insurance company told her the same thing I even got into an fight with them about it. So we decided to go see the DR anyway and they sent in the needed papers and guess what she got approval. Then she decided to switch DRs. and the 2nd Dr office called and they said it wasnt covered so I called the insurance co and they must have talked to the wrong person but anyhow she has approval for the second DR. So dont allways believe what they say let them send in the paper work. I think they try to get out of paying if they can let you believe it isnt a covered procedure.
   — JOYCE C.

January 9, 2002
Don't go by anything they tell you over the phone. Call both insurance companies back. If they tell you they don't cover it, ask them to send that to you in writing. My insurance company told me on the phone that they didn't cover it. I told them I wanted to see it in writing. They sent me the page out of the book and it DOES cover the surgery for the 'morbidly obese'. Well, DUH!
   — [Anonymous]

January 9, 2002
Ryan, I have Blue Cross PPO and it is covered. They normally do not cover obesity surgery but there is an exclusion under "Medical Care That Is Not Covered" that says that treatments for morbid obesity are covered. I know because I had to call on it today. They approved me for surgery and when I went to the nutritionist and for my preops, they didn't pay up. So, a few weeks ago I called and let them know that I was approved for surgery and that I had to see the nutr. and go for pre-op testing in order to have the surgery. That was all of 2 minutes. They paid. Today, I checked on the BC website to see if my EOB for the surgery was up and I noticed that they didn't pay anything out and that they were going to make it my "responsibility." I pulled out my benefits book, called BC and read to the rep the part where it says that MO is an exclusion of the "not covered" section. She said that they probably didn't look for my approval or authorization. She gave me a case/approval number and said not to worry cause they were going to take care of it. Good luck! If you have any more questions don't hesitate to email or IM me.
   — tmrivas

January 9, 2002
I was denied by BC/BS BlueChoice and ended up self-paying. I was denied twice due to an exclusion. I contacted Walter Lindstrom for legal assistance but he said that BC/BS was notorious for denial and didn't feel I had much of a chance. It has placed quite a financial burden on my family but I am so thrilled with my surgery results!
   — Brenda H.

January 9, 2002
I have United Health Care Select POS, and I called them and they said they would cover WLS if it was needed medically. I am just curious as to what exclusion you are talking about? Please email me! [email protected]
   — Sopha W.