Insurance sucks

angela1der · 06-09-2008, 10:26 AM

Just got off the phone with my insurance company and I am feeling down in the dumps now. They told me that under no circumstance would they ever cover wls of any kind. It is considered a medical exclusion and no amount of appealing would get them to change their mind. I called my dr's office to cancel my consultation but the receptionist wouldn't let me, she said that sometimes insurance companies change their tune when they're on the phone with the doctor. I am hoping. I asked her how much the surgery cost in case I decided to finance it and she said 20k. Ekk, thats more than my car and its more than a year at my college. So I don't know what to do if my doc can't get this covered. I guess I will have to wait until I graduate and start working for a different company. Kind of a bummer, but oh well. Should I call an obesity lawyer? Could they help me? Or should I wait until after my doc makes a few calls? I go in thursday to see him and I am praying and keeping my fingers crossed that all will go well. Thanks everyone, you all have been really awesome on here and I hope to join many of you on the other side of the surgery soon.

It's_Christine · 06-09-2008, 10:32 AM

As far as I know if the provider of your insurance has excluded wls they will continue to have the right to refuse payment. I don't see how a lawyer can change that contract. Are you sure your consultation with the physician will be covered? I would not take the word of the receptionist since she does not know your policy limits. The good news is not every policy is the same so this does not exclude covered wls from your future.

edieparks · 06-09-2008, 10:44 AM

I figured I spent about $7 extra a day feeding my addiction. $7 x 7 days x 4 weeks = $200 a month for a payment.

I was self pay and worth every penny.

edie

MTBiker · 06-09-2008, 11:34 AM

My previous employer's health insurance also didn't cover any weight loss. This is often due to the contract between the insurance co and the employer company, so your anger perhaps should be directed at the employer. I also filed an appeal, though not with a lawyer, and was summarily dismissed. My only break was that my company was aquired, and the new owner company health plan does allow for LAP-BAND®. If you don't have a career invested in your current employer, it may be worth it to change jobs.

laurenwhite82 · 06-09-2008, 01:18 PM

I began looking into LAP-BAND® while I was in grad school and I was on student insurance. My policy excluded WLS. I spoke to my dr about it there and she said when the surgery is flat out excluded, it is really hard to get companies to change their mind. You basically would have to by dying in the hospital for them to make an exception. You mentioned you are a student. I do not know if this is your situation, but many insurance plans sold through universities/colleges, geared toward students, have these kinds of exclusions because they know they will not be paying out long term for your healthcare. Generally speaking, you will only be covered by them for 2-5 years. They are frankly not very concerned with your health in the sense that once you are not covered by them, they are not forking over money to treat any health issues, obesity related or otherwise. They figure that very little is going to happen to you within the time you are covered by them. This is why the rates are somewhat affordable, usually the benefits arent so great. I knew I would be getting a job the next year, so I just waited it out. I now have Cigna and it is covered under my plan. Will you graduate soon?? Good luck to you!

angela1der · 06-09-2008, 07:40 PM

I have insurance through my school and thru my employer, i work for a pharmacy. They paid 100% of my sleep apnea, machine and everything but not for wls. I will try and figure it out, kind of sucky since i probably will be with them for a little while longer. I applied for a federal job for after i graduate but they want a master's degree and i don't have one yet, thats another 3 years from now. Phooey!