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07-08-2009, 02:43 PM
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#1 (permalink)
| | Newbie
Join Date: Jul 2009 Location: WI/ MO
Posts: 3
Weight Statistics
5' 4"
Height:
313 lb Start Weight:
313 lb Current Weight:
313 lb Lb Left to Lose:
Body Mass Index53.7204589844 BMI Start:
53.7204589844 BMI Current:
|  Insurance won't cover me..
 Help. I have been dealing with weight my entire life. I was reffered by my Dr. to look into Gastric Bypass. I went to a surgeon got approved then was denied by my insurance. I have anthem Blue cross of WI. They do not cover anything regarding to weight loss. I have been looking for an insurance to cover my surgery for 2 years now, and am coming up unsucessful. Please help me. I need this surgery and cannot get insurance through my work. So it needs to be an individual plan. Thank you in advance for your replys!! | 
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07-08-2009, 03:50 PM
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#2 (permalink)
| | Cub Reporter
Join Date: May 2009 Location: Indiana
Posts: 55
Weight Statistics Now Start Date:
September 04, 2009 Surgery Date:
5' 7"
Height:
286 lb Start Weight:
285 lb Current Weight:
140 lb Goal Weight:
1 lb Weight Loss:
145 lb Lb Left to Lose:
0.34965034965 % % Lost:
year Goal Date:
Body Mass Index44.7890398753 BMI Start:
44.6324348407 BMI Current:
21.924704834 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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There are so many out there that WANT to help you with your weight. You need to keep researching them. I have Anthem BCBS of Georgia and they were wonderful. The guidelines are pretty much the same as the surgery guidelines. Keep your faith in this as hard as it is sometimes and I think you will overcome it all!! Good luck with this and may God bless.
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07-08-2009, 03:57 PM
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#3 (permalink)
| | Whipper Snapper
Join Date: May 2009 Location: California
Posts: 35
Weight Statistics May 7, 2009 Surgery Date:
5' 4"
Height:
323 lb Start Weight:
215 lb Current Weight:
165 lb Goal Weight:
108 lb Weight Loss:
50 lb Lb Left to Lose:
33.4365325077 % % Lost:
Body Mass Index55.4367675781 BMI Start:
36.9006347656 BMI Current:
28.3190917969 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I have Blue Cross of CA ~ PPO. I have private insurance (not provided through work) they approved me within 4 days?
Try submitting again? Besides your weight, are there other health issues (diabetes, high blood pressure, etc?)
Keep trying ~ I hope someone here has the answer you need.
Good luck.
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07-08-2009, 04:16 PM
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#4 (permalink)
| | Seasoned Veteran
Join Date: May 2008 Location: Just north of Iowa, not far from I-35. 2nd star on the right and straight on 'til morning!
Posts: 8,641
Weight Statistics December 13, 2007 (pre-op liquid diet started) Start Date:
December 27, 2007 Surgery Date:
5' 9"
Height:
280 lb Start Weight:
172 lb Current Weight:
184 lb Goal Weight:
108 lb Weight Loss:
-12 lb Lb Left to Lose:
38.5714285714 % % Lost:
Originally - 12/08. Actually - 8/08. Goal Date:
Body Mass Index41.3442554085 BMI Start:
25.3971854652 BMI Current:
27.1690821256 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Have you clicked on the insurance ad right below your post?
CT
__________________ da perfesser
*******************
Dare to live your dream!!
If you want to be healthy for life, do for life the things that get you healthy!! Living healthy takes work. Dying fat is easy!! "That which we persist in doing becomes easier, not that the nature of the task has changed, but that our capacity to do has increased." - HJ Grant
"Do, or do not. There is no try!" - Yoda
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07-08-2009, 05:17 PM
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#5 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: NY
Posts: 10,174
Weight Statistics 4/19/2007 Surgery Date:
5' 9"
Height:
260 lb Start Weight:
152 lb Current Weight:
165 lb Goal Weight:
108 lb Weight Loss:
-13 lb Lb Left to Lose:
41.5384615385 % % Lost:
Body Mass Index38.3910943079 BMI Start:
22.4440243646 BMI Current:
24.36357908 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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its going to be the specifics of the policy not the brand of insurance itself...
if you are purchasing insurance privately, you can ask for this to be added to your rider. it will cost you, but it can be done. if the brand you carry doesnt offer this as part of their offerings, then you may have to switch. you cannot appeal that. it will make no sense resubmitting if they do not provide for it.
it's less complicated when you are purchasing your own insurance as opposed to just going with what you are given from a job. let us know which way you go and how things work out.
__________________  KenyaR.  Lap RNY 4/19/07 | |
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07-08-2009, 05:23 PM
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#6 (permalink)
| | WLS Guru
Join Date: Mar 2009 Location: New Hampshire
Posts: 481
Weight Statistics July 3,2008 Start Date:
March 18,2009 Surgery Date:
5' 11"
Height:
514 lb Start Weight:
256 lb Current Weight:
220 lb Goal Weight:
258 lb Weight Loss:
36 lb Lb Left to Lose:
50.1945525292 % % Lost:
Body Mass Index71.6806189248 BMI Start:
35.7008530054 BMI Current:
30.6804205515 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Have your Doctor appeal it to the insurance company. Your Doctor can appeal to a higher person than the one in the cubical that denied you.
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07-08-2009, 05:51 PM
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#7 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: NY
Posts: 10,174
Weight Statistics 4/19/2007 Surgery Date:
5' 9"
Height:
260 lb Start Weight:
152 lb Current Weight:
165 lb Goal Weight:
108 lb Weight Loss:
-13 lb Lb Left to Lose:
41.5384615385 % % Lost:
Body Mass Index38.3910943079 BMI Start:
22.4440243646 BMI Current:
24.36357908 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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*you only appeal if it is a covered service that is being denied to you.
i could be interpreting your original post wrong if so i apologize. but before you do ANYTHING, see if this is a service covered by your specific policy and being denied, vs something they do not cover for anyone.
__________________ KenyaR. Lap RNY 4/19/07 | |
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07-08-2009, 09:02 PM
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#8 (permalink)
| | Seasoned Veteran
Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 9,445
Weight Statistics September 19th 2007 Start Date:
September 19th 2007 June 18,2012 Surgery Date:
5' 10"
Height:
363 lb Start Weight:
226 lb Current Weight:
170 lb Goal Weight:
137 lb Weight Loss:
56 lb Lb Left to Lose:
37.741046832 % % Lost:
When I get there again Goal Date:
Body Mass Index52.0793877551 BMI Start:
32.4240816327 BMI Current:
24.3897959184 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Im sorry honey Kenya is right. What your employer has is BSBS. However they didnt purchase the rider that was offered to them or mabye not offered. They simply purchased a plan that didnt carry the rider.
Unfortunally unless Craigs book has a way to do it ........ and appeal to your insurance company will not help because its a non covered benefit. You dont find many of these any more. Im gonna take that you dont work for a large company? That probally has alot to do with it. They try to get insurance at the best cost for the company and it hurts some in the long run.
Self insurance is very high but you can get it. You need to make sure exactly what it covers before purchasing it.
Good luck with all this. It should be mandated that everyone should be able to get it even if it meant paying the rider for your own use if necessary.
__________________ Remember Tough times never last Tough people do... This Ribbon is for our Lady Lisa and all the women that fight this ugly disease. RIP Jerry my friend
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07-09-2009, 08:10 AM
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#9 (permalink)
| | Seasoned Veteran
Join Date: Sep 2008 Location: Mississippi
Posts: 5,198
Weight Statistics 3/18/2008 (dieted all my life) Start Date:
9/30/2008 Surgery Date:
5' 8"
Height:
292 lb Start Weight:
192 lb Current Weight:
189 lb Goal Weight:
100 lb Weight Loss:
3 lb Lb Left to Lose:
34.2465753425 % % Lost:
2 years Goal Date:
Body Mass Index44.3935986159 BMI Start:
29.1903114187 BMI Current:
28.7342128028 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I wish you luck finding an insurance that will cover your surgery. I was blessed that mine did. If it had not I would not have been able to do it. Don't give up. You deserve this surgery and should not be denied. You would think that any insurance would cover it. Heck in the long run they save money. Your health would be so much improved.. I will pray that you find a way. I had though that if I got denied that I would some how get a loan and pay cash for it. They offer a good discount for cash where I had it done and many even offer a finance plan. I save that much on food and medicine cost to pay the payment I am sure. ((hugs)) dixie
__________________   Love to Share , Health to Spare, and Friends that Care!
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07-09-2009, 09:16 AM
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#10 (permalink)
| | Newbie
Join Date: May 2009 Location: WI
Posts: 3
Weight Statistics 04-02-09 Surgery Date:
5' 7"
Height:
256 lb Start Weight:
153 lb Current Weight:
160 lb Goal Weight:
103 lb Weight Loss:
-7 lb Lb Left to Lose:
40.234375 % % Lost:
Body Mass Index40.0908888394 BMI Start:
23.9605702829 BMI Current:
25.0568055246 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I live in WI and I looked into getting Ins other than through my work but there is no plan out there that will cover any weight loss surgery, they will deny you for it.
I ended up doing a self pay for $21k that included the surgery, the hospt stay, after care for one year and it came with bliss ins which will pay for any major complication for two months. I had to use my work ins to pay for all pre testing as that was not included and also I use it for my blood test every three moths.
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