Insurance question. - ThinnerTimes

AZPete · 09-27-2006, 10:48 PM

I have been denied by my health insurance. They tell me my employer has an exclusion on WLS. My question to everyone is, can I appeal, can I get my employer to allow me to pay a higher premium, can I get a personal health insurance plan etc. I have the money for the procedure, and have the date, however, I would rather have someone else pay for it if possible. Anyone with experience in this, I am open to suggestions. While the $26,000 hurts enough, its the thought of complications arising due to the procedure, then having my insurance deny those claims. Could be pricey. If I am misunderstanding that, please let me know. Are any/all complications due to the surgery cause for denial by my health insurance?

Makenzie and Logan's Mom · 09-28-2006, 09:31 AM

I had 2 procedures that were caused by the surgery after the fact and Atena did NOT cover either of them, totally out of pocket!

Ruca · 09-29-2006, 06:21 AM

I had to change jobs because GEICO cheap ass multi-billion dollar corporation excluded WLS from all their plans except Kaiser. Anyone that knows Kaiser knows it is like pulling teeth to get them to approve you.

It is open enrollment season, are there any other options for you, preferably a non Aetna based HMO? Seems like the United Healthcare families are best for approval. (United HC, Pacificare, etc all under UHC)

brittany · 09-30-2006, 07:27 PM

I had United Heath Care at a job about 2 years ago and I was denied! I appealed twice it was that the company I worked for had WLS as an exclusion. You can try to appeal but I don't know anyone who has won an appeal yet, I am not saying that there is not anyone who hasn't won one however I do not know of anyone! During this time I searched for personal insurance I even spoke with an insurance broker who said in my state (Texas) you wouldn’t find anyone for personal coverage the premium would be too high. Two years after that I changed jobs and found that we had United Health Care, I was disappointed! Then found out it wasn't an exclusion. The doctor’s office sent in my letter to the insurance company on 8/1 and I had my surgery on 9/7... no test no classes or anything.... I choose now to go to nutrition classes and I will go to an exercise class after I am 6 weeks post-op. But it all depends on your employer not the insurance company. Your employer probably only has one plan to offer unless you work for an extremely large company. Good luck to you I feel like I was sent to my current job because it was time for be to have WLS.

U2Rocks · 10-04-2006, 09:04 PM

Even if you can't get your employer's insurance to cover it, and if you don't want to find a job with insurance that covers, you may want to consider a financing option.

Capital One actually has a whole health care financing division. Yeah, it'd still be out of pocket, but at least it would possibly be in easily managed payments?

Good luck!

reborn · 10-04-2006, 10:39 PM

Look what you need to do is call your insurance company that you have now and ask them how much money it would cost you to buy insurance directly from them cause they will sell it to you its a lot more but I almost sure it wont cost you the 2600.00 I think you should try it. I lost my job and I still wanted my insurance cause believe it or not I only wanted this job cause I know this insurance had no problem with approvals, so then I lost my job and now I still have it but through COBRA and I investigated how much it would cost if I paid for it on my own it was double what I pay through COBRA. So shop around my insurance company is Blue Cross.
Good luck

AZPete · 10-06-2006, 11:47 AM

First off I would never leave my employer. I love where I work, the opportunities for advancement are plentifull, and I have gotten used to the six figure plus income. United Health Care is our insurance company, and they will not allow me to buy insurance on my own. I have the $26,000 set aside already, sucks, but it looks like I have no other choice.