Insurance... :( UHC

NatashaZ · 07-08-2008, 08:54 AM

Hello everyone... well, I went ahead and called my insurance to see if this would be covered. They said no. So does that mean there is absolutely no chance that they will pay for it? It sounds like a silly question but I am 23 years old and have only had insurance twice before, when I was 16 and then 21, for about 5 months each time. I have no idea how this works.

I read about people appealing and getting approved, does that mean they were told that it wasn't covered? Or was it always covered by their plan, but they needed to qualify first?? I am sooooo confused.

brandymom1234 · 07-08-2008, 09:04 AM

You can appeal it...be sure that you have documentation of diet history, letters from you PCP and your surgeon as well as all your co-morbs.

Good luck, I hope they cover you.

NatashaZ · 07-08-2008, 09:19 AM

Thanks BrandyMom. The only issue is, because of my lack of insurance, I barely ever went to the doctor. The two things that I do have medical records of are 2 surgeries I had that, while they were not caused by my weight, being heavy put me at much greater risk for complications (one surgery was spinal). I know both of my surgeons would write letters for me if I asked, saying that I can avoid a world of trouble in the future if I lose the weight in my 20s.

I moved to OH from NY 2 years ago and my family doc in NY, whom I didn't see much, would also be willing to send over a record of my weight, as would my pediatrician. I just never really discussed WLS with any of them and am unsure if my inability to lose weight on my own will be enough of a diet history. I never went on a medically supervised diet.

:(

I was scared when they said no that it went it was completely excluded from my employers plan? Insurance is so confusing!!

Bizzy Bee · 07-08-2008, 09:19 AM

I had UHC and it had a written exclusion that it would NOT cover WLS. I ended up having to save money and self pay in Mexico. I now have BCBS and same thing. Written exclusion. It really sucks. Insurance companies would rather pay for all the meds and care for a morbidly obese patient than help them get out of the cycle and have a healthier life.

afw · 07-08-2008, 11:07 AM

If your employer's health care plan specifically excludes WLS, you're out of luck - no appeal will help, they will not pay. Sorry, I know that's rotten news. Self-pay is your only option. The good news with that is, you probably won't need to worry about all that six-month supervised diet or that five-year weight history. Good luck to you!! I hope things work out for you.

NatashaZ · 07-08-2008, 11:30 AM

Thanks AFW, but the bad news is I can't afford it, and my credit is not positive enough for me to finance. While it is nice to think about being able to save a little each month towards a Lap Band, the truth is I have already severely cut my spending just to pay the rent. I no longer drive, I don't eat out, I turned off my cable... even with all these changes, I am still struggling paycheck to paycheck, and don't foresee myself saving anything at all.

mdargen · 07-09-2008, 04:54 PM

I was just told by my doctor's office that my UHC policy will not cover the surgery. It was written in as an exclusion. I am now looking into financing it. It is so frustrating.

Good luck!