Question:
Insurance won't pay, no $ for self pay... now what?
Hi there. Just a quick question. I have Blue Cross (POS) insurance in Georgia and I have been told twice that the surgery is excluded in my benefits. I even asked would it be excluded if the surgery was medically necessary and was told it is still excluded. I am 5'6", 260 pounds, with a BMI of 42, and hypertension, weight related depression (both of which I am currently being medicated for) and now the fun joint pain that is associated with being this heavy. I have tried just about every diet known to man, only to rebound the weight, plus some. I have applied with financial companies to see if I can get a loan to pay for the surgery, but have been turned down due to past financial issues, including filing bankruptcy. I am at my wits end. I am 31 years old with 3 very active children. I know that this disease (morbid obesity) is killing me, and I can't stand the thought of dying while my sons are so young. I want to be there for them, but not just FOR them, but WITH them. We live in the mountains of North Georgia, and my kids lOVE to hike and go camping. They have to do it with their father, because I can't make it up a hill, much less a mountain. I know that you guys probably get asked this question every day, but does anyone out there know of a company that would finance this surgery? We are not a wealthy family by any means, but we could afford to make monthly payments if we had to. Thank you all for your time, and I look forward to hearing from you! Michelle — Michelle Cope (posted on June 4, 2007)
June 4, 2007
Sorry for your problems, however, you and I are in the same boat. My
employer has this clause too. I have sent them materials in regards to
WLS, Lap Band, they were to have met with my doctor for a presentation
about the benefits, etc, of this surgery. I am still waiting, but rather
than let them hold "my life" in the balance. I have started
seekign other jobs, and fortunately the State of NC has BCBS and they do
cover this under their benefits.
while I like my present job and all that it has to offer, a Sistah has got
to make a power move if I value my life.
— MissSax1980
June 4, 2007
You may need to switch to the lap-band. Most Drs will take payments for
this and it is much less expensive then the open gastric bypass. You may
have to start making payments before the surgery and then when at least
half are pd they will do the surgery. Check with your Dr. Good Luck
— Lost4Ever
June 4, 2007
do you or your husband have a 401k you could make a loan on. it doesnt
require a credit check since it is your money. and the money is usually
withheld from each paycheck. hope this helps!
— addysmom
June 4, 2007
Hi Michelle. I am in a similar situation, as my insurance cap is $10,000
and the approximate cost of the LAP RNY at the clinic I am going to is
around $25,000. I will have to finance the balance. I have found three
companies online that finance medical procedures. All three will require
your doctor to participate in their program (which is no cost to them and
actually can benefit them as a finance option to all their patients). If
you do not have the credit to get financing on your own, find a family
member or close friend who would be willing to co-sign for you. Just make
sure you can honor your financial obligation before you risk someone else's
credit rating. Try these services:
http://www.capitalonehealthcarefinance.com/
http://www.abfcredit.com/Home.asp
http://www.creditmedical.com/
Just so you know, I have not yet reached the point where I need to secure
my part of the cost, so I cannot vouch for any of these services. Research
carefully and let us know how it works out for you!
— BykerGrrl
June 4, 2007
I have heard that doctors can deem the surgery medically necessary and it
is then covered even if there's an exclusion. You should speak to your
benefits administrator and have them check the specific policy because many
times when you call they don't look that closely. I wouldn't put yourself
in dire financial constraints to pay for surgery but making yourself a pest
to the insurance company is a good idea. If Medicaid can cover wls, your
insurance company should see it as a no brainer! Good luck.
— Sheri A.
June 4, 2007
i say keep runnimg up the tab for seeing a dr. for obsity and a
chiropractic for pain. then get your dr. to keep sending letters statig
that its medicaly neccary for you to have this surgery . its a matter of
life and death. then you should be able to contact your human resources and
fnd out what qualify you. dont give up
— yvettetas
June 4, 2007
my insurance would not pay. It was EXCLUDED..THERE WAS no fighting it. I
went to Dr Joya in puerta vallarta mexico...I had to have 1000 down payment
and payed the rest on a low interest credit card.. I have taken on some
extra work to pay for it. 75# later it has been well worth it and I am only
3 months out....good luck
— kerryf
June 5, 2007
Hi michelle
I am in the same boat. The HOSPITAL I work for won't pay, and our surgeons
actually do the surgery. But anyway my mother actually took out a home
equity loan on her house that I am paying off. Words cant express how much
I appreciated this of course. May be this could be a possibility,
— danosteve
June 5, 2007
There IS a way to FIGHT this exclusion!!!!! Research people! You have
access to the internet, USE it! Here is an excerpt from something I found
online and used it in my appeal for Wellcare. I found a case that was sent
to the NMR (national medical review) where the petitioner was denied
bariatric surgery after being offered coverage for medical management of
her obesity. She didn't want to participate in the required medically
supervised diet because of past failures. The petitioner won her case and
the insurance company HAD to pay for the surgery. In a nutshell, because
the insurance companies agree to pay for all your co-morbidities, they can
be sued for "exculding" this in their policy as obesity/morbid
obesity has been shown to be more costly in the long run than for the cost
of these surgeries. To only treat the co-morbidities is NOT curing the
actual disease! Obesity/morbid obesity has been declared a DISEASE by the
FDA and the NIH (national institute of health). Here's the link-- good
luck!
http://www.michigan.gov/cis/0,1607,7-154-10555_20594_20596-82522--,00.htm
— crystalsno
June 6, 2007
Buy a private help care plan long enough to get the surgery and cancel the
policy after you've gotten the surgery done. Private policys can be bought
for about $350.00 a month, make sure it covers the surgery. Good luck.
— NHDebbie
June 6, 2007
surgeryloans.com
— packleader
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