Question:
Is there a way to get your insurance to pay for the surgery if it's an exclusion ?
I'am desparate to have this surgery. It is an exclusion on my insurance benefits. Is there a way to force my insurance to pay for this surgery for me? Someone told me that there are ways to deal with exclusions in order to get the surgery. I'am looking for any answer's or help for this. — Claudia P. (posted on April 9, 2004)
April 9, 2004
Claudia,
I wish. Here's my experience.
I was denied by two insurance companies - both through my husband's
employer (long story, but suffice it to say we went through an insurance
carrier change mid-stream). Both policies had air-tight legal exclusions
to WLS. We still tried. Did all of the pre-ops, went through the program
with a local bariatric surgeon, etc. Got to the point of submitting to
insurance - the silly company would pay for all of the pre-ops and stuff,
just not surgery! So, after going through this with both companies,
decided to write a letter asking my husband's employer if they would change
the insurance product that they purchase to allow WLS. They basically told
me to take a flying leap. At that point in time, we consulted with Walter
Lindstrom - who is an attorney who specializes in this sort of thing. He
pretty much told me there was no hope- he'd been trying for years to have
success with the insurance carriers that I was dealing with, and that I
should save my pennies and self-pay. So, I did!
I ended up going to Spain and Dr. Aniceto Baltasar (www.bodybybaltasar.com)
for my surgery. For everything - travel and surgery - I paid $15,800.00.
You might want to consider contacting the two attorneys that I know of who
do specifically work in regard to this issue. The web sites are:
www.obesitylawyer.com and www.obesitylaw.com
You might also be interested in the out of country WLS Yahoo group - it
can be found at http://groups.yahoo.com/group/OSSG-OutofCountryWLS
Hope that helps!
Blessings,
dina
— Dina McBride
April 9, 2004
Claudia, I too had no luck with 2 different insurance companies. I ended
up going to Ensenada, Mexico for my surgery and am SOOOOOO glad I did. I
had better care than my sister who had her surgery in December in a
Northern Virginia hospital (rated the best in the state??? my arss!) Read
my profile if you want to know more about my trip to Meico. Good luck to
you! Shawna - Dr. Aguirre - 5/2/03 445/245/180
— SMG I.
April 10, 2004
My ins. has an exclusion. I am now self pay, going to Little Rock, Dr.
Gibbs. Total cost $15,000. I have borrowed the money through
Capitalone.com, cosmetic fee plan. It is the only way that I could come up
with the money.
— bubbleboo K.
April 11, 2004
No. If your policy specifically states it will not cover WLS, don't waste
your time or money. Find other coverage or pay for it on your own. You
say this is your husbands policy....do you work? You can find a job that
has ins that covers it. If working is a hardship for you...work long
enough to get the coverage and take it out on cobra.
— RebeccaP
April 11, 2004
Hmmm, wherever I got that husbands policy stuff is beyond me....sorry. LOL
— RebeccaP
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