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10-18-2007, 09:47 PM
| #1 (permalink) |
| Whipper Snapper Join Date: Sep 2007 Location: Miami
Posts: 18
Weight Statistics 12/01/06 Start Date:
12/8/06 Surgery Date:
5' 9" Height: 288 lb Start Weight:
158 lb Current Weight:
170 lb Goal Weight:
130 lb Weight Loss:
-12 lb Lb Left to Lose:
45.1388888889 % % Lost:
Body Mass Index 42.5255198488 BMI Start:
23.3299726948 BMI Current:
25.1018693552 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass  |  Legal help hi everyone.....my wls was last dec everything has gone great. Now a guy at work wants to have wls but AVMED wont cover it. I need options so my friend can reaearch. I have read here that folks where able to sue insurance companys to force them to pay..Any info will be appreciated thnx RayinMiami
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Yes, you can often get insurance cover for your Weight Loss Surgery. Our own Craig "Big-T" Thompson has been there and done that, and he's written an e-book about it.  |
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10-18-2007, 09:55 PM
| #2 (permalink) |
| Seasoned Veteran  Join Date: Jan 2007 Location: Hawaii
Posts: 3,437
Blog Entries: 8 Weight Statistics 07/23/2007 Start Date:
July 23, 2007 Surgery Date:
5' 2" Height: 230 lb Start Weight:
123 lb Current Weight:
125 lb Goal Weight:
107 lb Weight Loss:
-2 lb Lb Left to Lose:
46.5217391304 % % Lost:
June 23 2008 Goal Date:
Body Mass Index 42.0629552549 BMI Start:
22.4945369407 BMI Current:
22.860301769 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass  | I havent heard of anyone suing but I have heard of people appealing the decision of the insurance company many times over until the insurance changes their minds |
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10-19-2007, 12:45 AM
| #3 (permalink) |
| Super Moderator  | No, no one on this board has sued. However, there are many who have appealed successfully after the initial denial by the insurance co. What this means is that the surgery is covered by insurance, but the insurance co decided that the person who asked for the surgery didn't meet their criteria to approve surgery for one reason or another. In these cases, you can find out what the exact reason for the denial is, and fight over it, or back track and cover whatever issue that needs to be covered for approval. So, you need to find out the exact conditions of the contract between your work place and the insurance co. If the contract is an outright no, then it isn't covered, period, which means taking the insurance co to court won't be of any use because it's the work place's decision not to include the surgery to save money on the premiums. In this case, you need to work with the work place to include the surgey in the policy when the next contract revision comes around. Some people have had alternate or secondary contracts that covered the surgey and have had it done through that, if I remember correctly. MsVickie would know more and better. but in the meanwhile, hope this helps.
__________________ "In every job that must be done, there is an element of fun."   Just a li'le bit 'bout myself  |
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10-19-2007, 06:34 AM
| #4 (permalink) |
| Seasoned Veteran  Join Date: May 2007 Location: Upstate NY
Posts: 2,211
Weight Statistics April 11th 2007 Surgery Date:
5' 4" Height: 267 lb Start Weight:
153 lb Current Weight:
150 lb Goal Weight:
114 lb Weight Loss:
3 lb Lb Left to Lose:
42.6966292135 % % Lost:
Body Mass Index 45.8254394531 BMI Start:
26.2595214844 BMI Current:
25.7446289062 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Yeah I have not heard of anyone suing but like the others said, I have heard of people appealing and finally winning. Its tough battle but its worth it.
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10-19-2007, 09:09 AM
| #5 (permalink) |
| Seasoned Veteran  Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 3,500
Blog Entries: 1 Weight Statistics September 19th 2007 Start Date:
September 19th 2007 Surgery Date:
5' 10" Height: 363 lb Start Weight:
221 lb Current Weight:
165 lb Goal Weight:
142 lb Weight Loss:
56 lb Lb Left to Lose:
39.1184573003 % % Lost:
12/31/09 Goal Date:
Body Mass Index 52.0793877551 BMI Start:
31.7067346939 BMI Current:
23.6724489796 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | There have been alot who appealed to the insurance companys but I dont think I have come accross anyone that sued the insurance company on this board. I wish your friend the best of luck. |
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10-19-2007, 09:11 AM
| #6 (permalink) |
| Seasoned Veteran  Join Date: Jun 2007 Location: North Texas
Posts: 3,133
Blog Entries: 1 Weight Statistics I've lost/gained my whole life!!! Start Date:
Aug 1, 2007 Surgery Date:
5' 8" Height: 280 lb Start Weight:
148 lb Current Weight:
150 lb Goal Weight:
132 lb Weight Loss:
-2 lb Lb Left to Lose:
47.1428571429 % % Lost:
Summer 2008 Goal Date:
Body Mass Index 42.5692041522 BMI Start:
22.5008650519 BMI Current:
22.8049307958 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass  | This should be interesting to watch, as it could be a precedent for cases moving forward. Actually, I think it would be great if someone sued. Maybe then, the insurance companies would WAKE UP and see that paying ONE time is better than paying LIFETIME for co-morbidities that surface if the surgery is NOT done! Keep us posted! |
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10-19-2007, 09:40 AM
| #7 (permalink) | |
| Super Moderator | Quote:
This is because it isn't that the insurance companies don't cover weight loss surgery, they all have policies that include weight loss surgery, rather, it's whether the surgery is included or not in the package that the work places arrange with the insurance companies. So, there will be work places that decide to get the package that doesn't include the surgery, to keep the premium that they have to pay low. So, what you need to do, is to make a case of how much money the work place will save if they let their employees have the surgery, as the healthier you are, you will be taking less off time for illness, and be more productive, thus bringing in more money for the work place, rather than having you on sick leave all the time.
__________________ "In every job that must be done, there is an element of fun." Just a li'le bit 'bout myself | |
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10-19-2007, 09:46 AM
| #8 (permalink) |
| Seasoned Veteran  Join Date: Apr 2007 Location: Mount Vernon, NY
Posts: 7,278
Weight Statistics 4/1/07 Start Date:
4/19/07 Surgery Date:
5' 9" Height: 258 lb Start Weight:
146 lb Current Weight:
165 lb Goal Weight:
112 lb Weight Loss:
-19 lb Lb Left to Lose:
43.4108527132 % % Lost:
04/19/2008 Goal Date:
Body Mass Index 38.0957781979 BMI Start:
21.5580760344 BMI Current:
24.36357908 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass  | good point doc!
__________________ Anything worth having is worth working for Kenya R.  Lap RNY 4/19/07     |
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