Calling all Losers!! - ThinnerTimes

Omega · 05-17-2007, 09:04 AM

HELP!,

I no sooner got started on my journey last week and yesterday got a bad call. My insurance EXCLUDES WLS...

Never in a million years did I expect to hear that. I thought a rejection, maybe and I would be on my way. So I need guidence. What have you done, how did you get around this, is there someone I can talk to to change this???

More bad news is that I called the HR lady where I work and she said they only offer 2 plans, 1 PPO and 1 HMO that are exactly the same only the prices are different.

I am in deperate need of good news, I could not have imagined how upset this has made me. I even took off today so I would not come off the wrong way at work, and since I contract to other companies I really can't take that chance.

Thanks for listening,
J

LisaM · 05-17-2007, 09:07 AM

I don't have any words of wisdom for you, other than possibly saving up to pay for it, or having it in another country, where you can have it much cheaper. I am NOT recommending that, but it has come up a few times. So far, no major horror stories that I'm aware of. The other option is a different job with better insurance. A lot of state, local and federal government health insurers pay for WLS.

Baron Patrick · 05-17-2007, 09:23 AM

I was told the same thing by my insurance co. (or as I affectionally call - "THEM"). What THEM didn't tell me was that it IS covered only if it's a MEDICAL NECESSITY simply because I didn't ask enough questions at first.

You need to ask specific questions or you won't get any straight answers. Check with your HR, read the book you get every year that lists the coverages. THEM also told me they only covered lapBand (lie, lie, lie - they cover both). Don't take "no" for an answer. I'd go ahead and get started anyway, you have a lot of things to do before you can get the surgery anyway. Does your doctor support wls? If not, you need to get a doctor who does (I changed docs twice). Have you tried other diets, drugs, and stuff? Are they documented? Have you had the proverbial "six month medically supervised diet"? If not, get started on that like right now. You need to get all this documentation together.

Get your pre-op done before asking for wls, and be sure your doctor writes a letter of medical necessity when your info is submitted for your wls referral. If they still say no, there is an appeal and grievance process. Trust me, I've gone through everything one can go through to get the surgery!

Keep us posted, we DO care!

Omega · 05-17-2007, 09:46 AM

I will get started on this, but have 2 more questions...

1. has anyone bought their own insurance to get around this?

2. has anyone tried to pull out 401K money to pay for the operation?

THANKS AGAIN!!!
J

Baron Patrick · 05-17-2007, 09:54 AM

I will get started on this, but have 2 more questions...

1. has anyone bought their own insurance to get around this?

I think I've heard a very few looking into this. If I remember, they found it's almost as expensive as having the surgery.

2. has anyone tried to pull out 401K money to pay for the operation?

You might, if you can prove to the IRS it's a medical necessity and not something like a implants. I would Check with the IRS to be sure.

THANKS AGAIN!!!

SDeRossett · 05-17-2007, 10:34 AM

Ask what company handles your IRA and call them direct. You can usually withdraw $$ from it but there is a penalty for early withdrawl. If you do - make sure you have them take out the federal taxes right away and you may also want to put away the $$ for state and local taxes that you will have to pay at the end of the year. Hope this helps. Keep fighting!!! We're pulling for ya!

Sharon

JenBear7 · 05-17-2007, 03:24 PM

If I were in your shoes... I would ask for a copy of the specific exclusion. My insurance specifically excludes the surgery also.. however, I was approved because part of the small print was... Unless deemed medically necessary...

Cant hurt to see for yourself.. and give them another call right?

paige52 · 05-17-2007, 04:44 PM

Go with a doctor that uses a county facility...here in the US anyway... because they are obligated to charge you the same as they would charge an insurance company.

My hospital bill alone was 92 thousand dollars... just for the hosptial, that didn't cover doctors or tests or anethestia....but my insurance only had to pay 8 thousand. Same thing happend when my son had surgery... insurance wasn't going to pay so the hospital billed me for 17K. I went to them and said my insurance, had they paid, would have only paid 2K, why do I have to pay more... finally I ended up with the hospital administrator who allowed me to pay what the insurance would have paid!

My long story point... if you end up paying for it, try to avoid going out of country simply because of possible post-op complications.

Fight like heck with your insurance company because the fine print frequently tells you something they don't want you to know. I have a freind that works for an insurance company that told me they decline all WLS the first time around, regardless of co-morbid issues... eventually the persistant ones get approved.

Hang tough... and I will keep you in my thoughts.

mauldinmama · 05-17-2007, 04:47 PM

my insurance had a wls exclusion as well BUT with certain exclusions...health reasons as well as certain bmi qualifications....I would call back and go from there!

Omega · 05-18-2007, 06:59 AM

I have been very down since I started this thread, but you all have really helped me find my way again!

Funny, I can do anything in my career, anything I never have doubts and beat any challenge that come before me... but for the life of me when something happens in my personal life I fail miserably to keep a positive out look.

So, again thank you for your support! (wow, now I feel like a commercial

)

J