Re: REPOST insurance question - please help!~

February 15, 2006

Lil,

Where are you located? I am located in the Charlotte NC area and I am

scheduled for WLS March 2 and I have UHC for insurance. They are paying 100% of

my surgery and I have a $100.00 co-pay for the hospital. My Dr's insurance

consultant told me at my inital eval visit that they normally don't have any

problem getting UHC to pay and sure enough they are paying mine, no problem.

Don't know if this is of any help to you but keep the faith.

Marvin

heather wrote:

Lil needs help guys!!! Anybody self pay???

>

> Hi all!

>

> So my insurance is changing soon over to United Health

Care...which

> has a written exclusion policy for weight loss surgery and

> apparently ANY treatment of obesity, be it surgical or not!

> (WHAT?!?! how is that legal?!) I certainly can't afford the surgery

> on my own, but my parents are so incredibly generous and supportive

> and told me that they'd help me pay for the surgery if it came to

> that. So I talked to the nice people at NWWLS and they said they

> actually won't do the surgery if your insurance won't cover it

> because if anything goes wrong, I'd get nailed with even MORE bills

> and the surgery is already about 36,000. It totally makes sense,

but

> kinda a bummer and another kink in my plan. SOOOOO (the woman

> in charge of insurance and stuff at NWWLS center) suggested that I

> find another plan on my own. Some that she mentioned were BC/BS,

> Tufts, and Harvard Pilgrim. It looks like Tufts doesn't insure just

> individuals...only if you're with a company...but BC/BS and Harvard

> Pilgrim looked like they have a few plans for individuals. Ok, so

my

> question is, does anyone have any advice for me as to what to do?

> Which company/plan to go with?? Anyone else here ever do anything

> like this? please help if you can!

>

> Thanks!!

>

> ~Lil~

>

We are a very active support group.

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Robyn@...

February 15, 2006

i was self pay lil

im in missouri

i had to apy everything up front

it cost me $28,000.00...out my own pocket

i have health ins thru my employer

they exclude everything having to do with WLS too,

they think its cosmetic

i AM in the process as wes peak of suing them to get my money back

and to assure that they WILL pay for my recon surgery!!

todd

lap rny

09/08/05

375/250/190

> >

> > Hi all!

> >

> > So my insurance is changing soon over to United Health

> Care...which

> > has a written exclusion policy for weight loss surgery and

> > apparently ANY treatment of obesity, be it surgical or not!

> > (WHAT?!?! how is that legal?!) I certainly can't afford the

surgery

> > on my own, but my parents are so incredibly generous and

supportive

> > and told me that they'd help me pay for the surgery if it came

to

> > that. So I talked to the nice people at NWWLS and they said they

> > actually won't do the surgery if your insurance won't cover it

> > because if anything goes wrong, I'd get nailed with even MORE

bills

> > and the surgery is already about 36,000. It totally makes sense,

> but

> > kinda a bummer and another kink in my plan. SOOOOO (the

woman

> > in charge of insurance and stuff at NWWLS center) suggested that

I

> > find another plan on my own. Some that she mentioned were BC/BS,

> > Tufts, and Harvard Pilgrim. It looks like Tufts doesn't insure

just

> > individuals...only if you're with a company...but BC/BS and

Harvard

> > Pilgrim looked like they have a few plans for individuals. Ok,

so

> my

> > question is, does anyone have any advice for me as to what to

do?

> > Which company/plan to go with?? Anyone else here ever do

anything

> > like this? please help if you can!

> >

> > Thanks!!

> >

> > ~Lil~

> >

>

February 15, 2006

Marvin,

Thank you for answering her post!! It was very sweet of you!!

Hugs!

> >

> > Hi all!

> >

> > So my insurance is changing soon over to United Health

> Care...which

> > has a written exclusion policy for weight loss surgery and

> > apparently ANY treatment of obesity, be it surgical or not!

> > (WHAT?!?! how is that legal?!) I certainly can't afford the

surgery

> > on my own, but my parents are so incredibly generous and

supportive

> > and told me that they'd help me pay for the surgery if it came to

> > that. So I talked to the nice people at NWWLS and they said they

> > actually won't do the surgery if your insurance won't cover it

> > because if anything goes wrong, I'd get nailed with even MORE

bills

> > and the surgery is already about 36,000. It totally makes sense,

> but

> > kinda a bummer and another kink in my plan. SOOOOO (the

woman

> > in charge of insurance and stuff at NWWLS center) suggested that

I

> > find another plan on my own. Some that she mentioned were BC/BS,

> > Tufts, and Harvard Pilgrim. It looks like Tufts doesn't insure

just

> > individuals...only if you're with a company...but BC/BS and

Harvard

> > Pilgrim looked like they have a few plans for individuals. Ok, so

> my

> > question is, does anyone have any advice for me as to what to do?

> > Which company/plan to go with?? Anyone else here ever do anything

> > like this? please help if you can!

> >

> > Thanks!!

> >

> > ~Lil~

> >

>

> We are a very active support group.

> If the email becomes overwhelming,

> please change your setting to NO EMAIL!

> Please contact Group Creator

> Robyn@...

>

February 15, 2006

WOW Todd good for you!!!! I knew you swere self pay but I didn't know

you were going after them for the cost. WAY to go I'm so glad you are

fighting this!! Let us know how things go.

BIG HUGS!!

> > >

> > > Hi all!

> > >

> > > So my insurance is changing soon over to United Health

> > Care...which

> > > has a written exclusion policy for weight loss surgery and

> > > apparently ANY treatment of obesity, be it surgical or not!

> > > (WHAT?!?! how is that legal?!) I certainly can't afford the

> surgery

> > > on my own, but my parents are so incredibly generous and

> supportive

> > > and told me that they'd help me pay for the surgery if it came

> to

> > > that. So I talked to the nice people at NWWLS and they said

they

> > > actually won't do the surgery if your insurance won't cover it

> > > because if anything goes wrong, I'd get nailed with even MORE

> bills

> > > and the surgery is already about 36,000. It totally makes

sense,

> > but

> > > kinda a bummer and another kink in my plan. SOOOOO (the

> woman

> > > in charge of insurance and stuff at NWWLS center) suggested

that

> I

> > > find another plan on my own. Some that she mentioned were

BC/BS,

> > > Tufts, and Harvard Pilgrim. It looks like Tufts doesn't insure

> just

> > > individuals...only if you're with a company...but BC/BS and

> Harvard

> > > Pilgrim looked like they have a few plans for individuals. Ok,

> so

> > my

> > > question is, does anyone have any advice for me as to what to

> do?

> > > Which company/plan to go with?? Anyone else here ever do

> anything

> > > like this? please help if you can!

> > >

> > > Thanks!!

> > >

> > > ~Lil~

> > >

> >

>

February 15, 2006

yep i will.....

my lawyer says that even though they dont think it needed and was

excluded..that i might..might, still have a chance

they leave it up to a judge.

hope fully it will get filed in the county i live in..cause i work

on all the judges cars lol...and they like me a bunch !!!!LOL

yep...i'll keep you posted....

:-)

todd

> > > >

> > > > Hi all!

> > > >

> > > > So my insurance is changing soon over to United Health

> > > Care...which

> > > > has a written exclusion policy for weight loss surgery and

> > > > apparently ANY treatment of obesity, be it surgical or not!

> > > > (WHAT?!?! how is that legal?!) I certainly can't afford the

> > surgery

> > > > on my own, but my parents are so incredibly generous and

> > supportive

> > > > and told me that they'd help me pay for the surgery if it

came

> > to

> > > > that. So I talked to the nice people at NWWLS and they said

> they

> > > > actually won't do the surgery if your insurance won't cover

it

> > > > because if anything goes wrong, I'd get nailed with even

MORE

> > bills

> > > > and the surgery is already about 36,000. It totally makes

> sense,

> > > but

> > > > kinda a bummer and another kink in my plan. SOOOOO

(the

> > woman

> > > > in charge of insurance and stuff at NWWLS center) suggested

> that

> > I

> > > > find another plan on my own. Some that she mentioned were

> BC/BS,

> > > > Tufts, and Harvard Pilgrim. It looks like Tufts doesn't

insure

> > just

> > > > individuals...only if you're with a company...but BC/BS and

> > Harvard

> > > > Pilgrim looked like they have a few plans for individuals.

Ok,

> > so

> > > my

> > > > question is, does anyone have any advice for me as to what

to

> > do?

> > > > Which company/plan to go with?? Anyone else here ever do

> > anything

> > > > like this? please help if you can!

> > > >

> > > > Thanks!!

> > > >

> > > > ~Lil~

> > > >

> > >

> >

>

February 15, 2006

Lil,

I am still pre-op, but have read and heard alot about insurance. I

know that my insurance (Mutual of Omaha) is going to NOT be easy, but

as I have gone through Obesityhelp.com, and searched through

insurance companies, i see that BCBS is pretty simple and usually

give approval after the first attempt. That might be an option. If

all else fails for me, I will be switching over to hubby's insurance

which costs more, but i KNOW they will cover it. Good luck!!

Molly

Still Pre-op

> >

> > Hi all!

> >

> > So my insurance is changing soon over to United Health

> Care...which

> > has a written exclusion policy for weight loss surgery and

> > apparently ANY treatment of obesity, be it surgical or not!

> > (WHAT?!?! how is that legal?!) I certainly can't afford the

surgery

> > on my own, but my parents are so incredibly generous and

supportive

> > and told me that they'd help me pay for the surgery if it came to

> > that. So I talked to the nice people at NWWLS and they said they

> > actually won't do the surgery if your insurance won't cover it

> > because if anything goes wrong, I'd get nailed with even MORE

bills

> > and the surgery is already about 36,000. It totally makes sense,

> but

> > kinda a bummer and another kink in my plan. SOOOOO (the

woman

> > in charge of insurance and stuff at NWWLS center) suggested that

I

> > find another plan on my own. Some that she mentioned were BC/BS,

> > Tufts, and Harvard Pilgrim. It looks like Tufts doesn't insure

just

> > individuals...only if you're with a company...but BC/BS and

Harvard

> > Pilgrim looked like they have a few plans for individuals. Ok, so

> my

> > question is, does anyone have any advice for me as to what to do?

> > Which company/plan to go with?? Anyone else here ever do anything

> > like this? please help if you can!

> >

> > Thanks!!

> >

> > ~Lil~

> >

>

February 15, 2006

Thank you all sooo much for the replies! And thanks for re-

posting for me! I'm 24 and have about 150 lbs to lose and am

otherwise in good health. I live in MA. the policies we have to

chose from at my work (3 different options from UHC) all have

written exclusion policies for WLS...I may try with them first

anyway, but will probably have to get insurance elsewhere. I

absolutely love the surgeon and program I am with right now, so I

don't really want to change surgeons...and since my parents won't be

paying for my WLS, maybe that means they'll help me pay for

reconstruction surgery in the end! hehehe Anyways, if anyone has

more to add on this topic, PLEAS feel free to do so!

<3

~Lil~

> > >

> > > Hi all!

> > >

> > > So my insurance is changing soon over to United Health

> > Care...which

> > > has a written exclusion policy for weight loss surgery and

> > > apparently ANY treatment of obesity, be it surgical or not!

> > > (WHAT?!?! how is that legal?!) I certainly can't afford the

> surgery

> > > on my own, but my parents are so incredibly generous and

> supportive

> > > and told me that they'd help me pay for the surgery if it came

to

> > > that. So I talked to the nice people at NWWLS and they said

they

> > > actually won't do the surgery if your insurance won't cover it

> > > because if anything goes wrong, I'd get nailed with even MORE

> bills

> > > and the surgery is already about 36,000. It totally makes

sense,

> > but

> > > kinda a bummer and another kink in my plan. SOOOOO (the

> woman

> > > in charge of insurance and stuff at NWWLS center) suggested

that

> I

> > > find another plan on my own. Some that she mentioned were

BC/BS,

> > > Tufts, and Harvard Pilgrim. It looks like Tufts doesn't insure

> just

> > > individuals...only if you're with a company...but BC/BS and

> Harvard

> > > Pilgrim looked like they have a few plans for individuals. Ok,

so

> > my

> > > question is, does anyone have any advice for me as to what to

do?

> > > Which company/plan to go with?? Anyone else here ever do

anything

> > > like this? please help if you can!

> > >

> > > Thanks!!

> > >

> > > ~Lil~

> > >

> >

>

February 16, 2006

Hi Lil --

If you decide to get an inusrnace policy on your own, be sure to read the

small print. You need to make sure they cover bariatric surgery, and note if

there is a waiting period on the policy that is required prior to using the

insurance to cover bariatric surgery. In CA, one can purchase a BC policy for

individuals, but there tends to be a 90 or 180 day (depending on the policy)

waiting period in which you must be enrolled, pay your premiums, and then you

can start the process to get authorization. You need to also find out what the

criteria for Bariatric surgery is with the policy you purchase. Some plans

require a 6 or 12 month medically supervised (by a physician or dietician/nurse)

diet and have all records submitted to them before they will consider

authorizing surgery.

If you have 1 12 month supervised diet required (Like BC/BS of IL, as an

example) it may be a good idea to get that started now, prior to paying premiums

for a policy you cannot use. If you have a 180 day waiting period as well, get

your diet started now, then purchase the policy later...there are so many

details of insurance coverage...and every state has their own criteria for them

to consider the surgery as medically necessary...just be sure to read and ask

the questions, so you know what you are facing prior to spending any more money.

regards,

Jbbb