Insurance Company Shut Me Down - ThinnerTimes

JustAnotherVictim1 · 02-14-2006, 03:29 PM

Hey everyone, I have been trying to get the ball rolling for this surgery, but today I talked to both my Insurance company and the actual employer, and I have been told that they do not cover bariatric surgery (one lady said they cover nothing to do with weight reduction) and they dont cover fertility surgery.

When I asked, they said it just isn't included on my contract. I asked them "What if it was considered *LIFE THREATENING* by a doctor, and she said they still would not cover it (Worst Case Scenario ordeal).

I then called the employer and the lady told me she actually had it done 7 years ago before the company switched insurance companies (just last year or the year before), and she knows for a fact they wont cover obesity surgery no matter.

My mother and father are divorced, and I am a dependant on my fathers insurance (is obligated to). One option is we will be going to my lawyer to figure out what we can do legally. Like I said in my other post, my Mother's lawyer hates my father with a passion and can't believe my Mom married him. But anyways, based on incomes, my Father (who disowned me basically) is liable for 80% of anything medically that insurance will not cover. Then obviously excludes an expensive surgery, right?

Another option that my Mother brought up is she was thinking maybe Welfare helps. (she thinks one of her friends that had it done got support through the state to get his done). We are very low income, so we think that this could be an option as well.

Does anybody have any input of either of these two options? Also, please share any ideas you mean have or have done yourself!

Thanks!!

Bypassingme619 · 02-14-2006, 05:35 PM

I say use all your options. I mean something has to give. Attend all you educational seminars, start going to support groups, pretty much get your self really involved. I would seek some legal help if you can afford it jump on it, never hurts to have some legal advice on your side. I really hope something comes through for you. Keep us posted.

cnvh · 02-14-2006, 05:56 PM

Welfare, at least in our state, is generally the "payor of last resort"-- in other words, if you have other insurance coverage, you cannot get medical assistance through welfare. Again though, this could be a state-to-state thing.

Call your local county assistance office and ask; it can't hurt, and at least you'll know!

Alleusion · 02-14-2006, 06:08 PM

My sister (being on medicaid) says that California will pay for the lap-band. That may vary from state to state.

JustAnotherVictim1 · 02-14-2006, 07:26 PM

Quote:

Originally Posted by cnvh

Welfare, at least in our state, is generally the "payor of last resort"-- in other words, if you have other insurance coverage, you cannot get medical assistance through welfare. Again though, this could be a state-to-state thing.

Call your local county assistance office and ask; it can't hurt, and at least you'll know!

Yeah, my mom has to go to a meeting for something to do with the state anyways, so she said she would ask for me.

coptergirl · 02-14-2006, 08:57 PM

I am so sorry you are going through this right now - I have been rooting you on!!! The contract your dads company has with the insurance company is generally negotiated yearly before open enrollment when new pricing and plans are chosen. The company and/or its brokers can ask that things be stricken from the blanket contract or added in. Sometimes it is a cost thing, and sometimes it is simply ignorance. When is open enrollment? Call HR and ask them if this is something that can be added into the contract as allowed, or if the insurance company is the one not allowing, complain to the HR department so that they opt for a different plan/company come open enrollment...

gaspassbaby! · 02-14-2006, 09:08 PM

Yes...it must vary from state to state about the welfare thing.

I'm on disability with medicare aka welfare and mine came through easily enough but I was also told that you have to have complications associated with mo (morbid obesity).

Someone mentioned that California state medical (welfare) only covers the lap band.....and Washington State won't cover it! Perfect example of how it varies from one state to another!

JustAnotherVictim1 · 02-14-2006, 09:09 PM

Quote:

Originally Posted by gaspassbaby!

Yes...it must vary from state to state about the welfare thing.

I'm on disability with medicare aka welfare and mine came through easily enough but I was also told that you have to have complications associated with mo (morbid obesity).

Someone mentioned that California state medical (welfare) only covers the lap band.....and Washington State won't cover it! Perfect example of how it varies from one state to another!

Yeah. Understandable.

To Coptergirl, as far as I have been told it is the insurance company due to expenses and "The insurance companies experience"?

How would I go about complaining to HR? lol

coptergirl · 02-14-2006, 09:20 PM

Quote:

Originally Posted by JustAnotherVictim1

Yeah. Understandable.

To Coptergirl, as far as I have been told it is the insurance company due to expenses and "The insurance companies experience"?

How would I go about complaining to HR? lol

Tell them exactly what is happening. The truth of the matter is this: You are MO (we all are - or have been, so you are in terrific company). You may be young and not have any full blown co-morbidities yet, but you will. The insurance company will have to fork over more money on you then. Then as you have complications they will have to fork over eben more dough. These days that isn't really an argument because of all of the insurance choices out there, but its worth a try. You will die eventualy if you can't get the weight off, and even with Xenical or Merdian you'll only loose 5-10% unless you completely beat the odds. Tell them you are not happy woth their service.
I am in HR and every year, we tale a survey of our employees to see how they feel about the benefits offered. Once a year we look at pricing for our plan and others and we choose. Your dads company should do the same for the simple fact of cost effectiveness and smart business.

Another option is to go private insurance which is a lot more expensive to dad, but you could shop around for companies that do cover the surgery. Also check into the welfare thing - you never know. Try everything you can!!

JustAnotherVictim1 · 02-14-2006, 09:22 PM

Quote:

Originally Posted by coptergirl

Tell them exactly what is happening. The truth of the matter is this: You are MO (we all are - or have been, so you are in terrific company). You may be young and not have any full blown co-morbidities yet, but you will. The insurance company will have to fork over more money on you then. Then as you have complications they will have to fork over eben more dough. These days that isn't really an argument because of all of the insurance choices out there, but its worth a try. You will die eventualy if you can't get the weight off, and even with Xenical or Merdian you'll only loose 5-10% unless you completely beat the odds. Tell them you are not happy woth their service.
I am in HR and every year, we tale a survey of our employees to see how they feel about the benefits offered. Once a year we look at pricing for our plan and others and we choose. Your dads company should do the same for the simple fact of cost effectiveness and smart business.

Another option is to go private insurance which is a lot more expensive to dad, but you could shop around for companies that do cover the surgery. Also check into the welfare thing - you never know. Try everything you can!!

The private insurance would be a lot more expensive to my dad? Gotta remember, I don't see my Dad...so is it really something I could do, or would it have to be something he would have to (which I know he won't, I never see him)

Would I tell HR about how my conditions will just get worse and worse, or the insurance company?