I'm SO Upset - Insurance Denied Me - Need Your Help

Well...I got that bad news that my insurance denied me. They said morbid obesity is excluded from my plan. That it is a rider and my company elected not to opt for that option.

Can you fight that?

Another question? My husband's insurance (my secondary insurance) will cover it but there is a $10,000 lifetime maximum. Well...we all know that around $22,000 is billed to the insurance for the surgery.

Someone mentioned a doctor in Colorado that does the surgery for $9950 - do anyone know how much he bills for the surgery?

Any other suggestions? (Self Pay is not an option)

Heck, I'll even change jobs just to get it to be covered by insurance. Willing to work in the Houston or Beaumont area :)

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Dr. Matthew St. Laurent
Waiting on approval :nervous
Pre-band weight 224

Good day,

There are many companies and websites that offer various kinds of insurance these days, and the sheer number of them can seem overwhelming. However, this should be seen as a positive as it can only assist you in your decision and about getting all the facts about what you need based on your specific requirements.

Compare the different kinds of insurance that you presently have and see if there is any overlap with the medical insurance that you are considering because there is no point in paying for something which you already have. If you are changing insurance providers, make sure that there is no lag time between your old one and your new one, and do not forget how your lifestyle can impact what you can and can get now and in the future.

Try this..Im sure this might be the answers to your insurance problems
http://www.insurancepaylite.com

Cheri,

I've run into the same problem. The first thing you can do is speak to your HR Benefits representative to see if they will consider adding the rider during the next policy update. When I spoke to my HR representative, she actually thought it was already part of the policy. However, when she checked into the cost of adding it, she said it was too expensive.

Before you use your husband's insurance, do more research on the $10,000 lifetime maximum. That stipulation may only apply to elective procedures, but my concern is that once the entitlement is used, how will it affect your family's healthcare future?

I've also read on LBT where people have used their 401K funds to pay for the surgery. I don't know if that's a possibility for you. Just be advised that using the option can be quite detrimental if you don't know the rules for borrowing and quickly repay the loan. So, before you consider using that option read this: http://www.smartmoney.com/debt/calcu...ory=borrow401k

There are also other finance options available for the procedure. Check out this website for some ideas: http://www.lapband.com/lapband/costsandinsurance.do

Of course, changing jobs is always an option. In fact, I've considered that one myself. :D

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R a n d i
Banded 11/20/06

Thread Starter

It is a $10,000 maximum for the procedure or any expenses related to obesity (fills, etc.)

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Dr. Matthew St. Laurent
Waiting on approval :nervous
Pre-band weight 224

I work for an insurance copany, but am not directly involved in the insurance part of the business, so I can only go on my understanding... but when a company excludes part of a plan (e.g. bariatrics), there's nothing to be done through the actual insurance company (outside of purchasing your own something or other through them). It has nothing to do with them, and at that point is all in the hands of your employer.

Considering that your employer is now the one you have to work with, your HR rep should ne the first stop, but the most you can do is request that they release the exclusion. Considering what the cost is, it's not *likely* that they'll do it based on one request, but the worst that could happen is they say no, right?

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-175 pounds
Banded March 1, 2006

Oh I also can't speak to that particular surgeon, but my insurance covered my procedure and I know that when you compare what self-pays pay out, and what my insurance company was charged, it's more than double (against the insurance company). But on the other hand, what the insurance company PAYS, versus what they're CHARGED -- totally different numbers. I think my ins co actually paid something like $1800, but I think they were charged close to $40k.

So -- does the 10k maximum apply to charges or payments?

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-175 pounds
Banded March 1, 2006

Thread Starter

It applies to only what they pay out. I just talked to the doctor's office. They said we still need to wait and see what my husband's insurance says...I just got the denial from my insurance but I don't know if they have submitted anything to my husbands insurance. She said that even though his company typically covers the surgery, they may opt not to if my company denies it.

I'm curious about buying an individual policy. I bet most individual policies exclude WLS.

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Dr. Matthew St. Laurent
Waiting on approval :nervous
Pre-band weight 224

I dount they'd pay out anywhere close to 10k if the surgeon you choose in in-network.

Ok, I just looked up my info, and for just the surgery, not the band itself, or add'l anethesia fees, pre-op, work, etc. -- but just the surgery itself my plan was billed $29076.25. My plan actually paid $1674.00.

Now add in everything else and there's still no way my plan paid out 10k, not even close to it. So maybe you have a possible route through your hubby's coverage.

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-175 pounds
Banded March 1, 2006