Need Help with insurance and bypass surgery.

babs

babs

Member
I don't know what anyone will think of me, but at this point in my life i have to ask advise anywhere i can get it. I have gotten good anvise from this site, and i've seen others get help.
My problem is I NEED gastric bypass surgery and my husband's insurence says it is an exclusion in the policy, Even though i've proven beyond medical nessisity, they say no.
Does anyone have any suggestions. I know there are some law students on here, maybe Doctors or Lawyers or someone that's been through the same thing.
I'm at the point of not walking because of knees, and the knee dr. says he's not doing nothing till the bypass surgery to get the weight off. So i'm so deeply in trouble.
any suggestions will be taken..
thanks.
 
lovethesea

lovethesea

Active Member
isn't there a new procedure called the Lap Band ? (I think) Is that maybe less costly?
Not sure if thats any new info for you. I know here in ST. Louis there are many ads for these procedures, but I am not aware of the cost involved.
 
nyyankeees

nyyankeees

Member
My mom and uncle both had this surgery, the got alot of info and help from a site called obesityhelp.com. My mom and uncle both got denied by their insurance to start with but they wrote appeal letters and also their Dr's did too, have you done this already? I know it cost alot of money for the surgey but is there anyway you could finance it personally? a loan, remortgage, etc...? that might sound crazy but how much is your life worth to you? Hope this helps.
 
nemo lover

nemo lover

Member
Also check into government help. I am not going through the same thing but similar. My daughter has been diagnosed with developmental delays, and I have no insurance. I have applied for private insurance and was denyied, I appied for medicade I was denyied, I appied for fl.kidcare and my oldest daughter was accepted but the younger daughter with the medical needs was denied. Its very stressfull just don't give up and keep trying.
 
offshore80

offshore80

Member
A friend of mines wife was 300+ lbs and was denied at first. But after about a 6 month ordeal with Dr's and specialist recommendations CIGNA finally approved it and she has done real well over the past 8 months. She’s down to 170. I hope it works out for you.
 
A

andretti

Guest
My dad was in the EXACT situation about two years ago. It was actually his orothopediac surgeon who went to bat for him. His doctor had proven that his knees were bad because of the excess weight he had been carrying all of his life and without the gastric bypass, the kness and other parts of the body would become much worse. So basically the insurance company forked over the $$$$ for the surgery so that it would save them big $$$$$ later on down the line. You could try that approach. Either a little now or a lot later.
He lost over 150 lbs in less than two years.
 
babs

babs

Member
thanks everyone, i haven't been on here in awhile so i am just readin replies.
I have apealed the insurance. and when i call they all but told me that there is no way to fight an exclusion. even though i am now having more knee problems and major back problems.
i don't know what else to do.
i have heard of lap band, haven't researched it to the extent of bypass. Ins. won't cover it either.
Yes, i am member of obesietyhelp.com, but i got to depressed reading others success stories. i am happy for them but i want to live too.
i will keep post on ins. i am fixin to fight them one more time.
thanks for all help or suggestions.
 
nemo lover

nemo lover

Member
Heres an idea maybe you should call you insurance comission, they'll look over your policy, and if theres a loop hole they'll find it and they will help anyway if they can.
Insurance is a pita!! Also have you talked to the government? If it is medically nessisty they might be able to help since your insurance can't.
I have still not recieved insurance for my daughter ethier. Medicade says "I make to much money." Florida kid care says "My older child is eligable for a buy in program, with a 120.00 payment. But, my younger daughter is not because she is to young for the buy in program," and my income is to high for c.m.s.(Childrens Medical Services)which is the only program for children with special needs in florida. I have apealed my denial at all of the above. And am still awaiting a decision. The biggiest problem I am having is getting help to get her diagnosed, once I have her diagnosed thier are other programs to help. But I am having the hardest time ever. Even my doctors are on my side trying to help as much as possible. They have given her a pre-diagnosed condition "developmental delays, high roof pallet in her mouth, and some type of posture. But nothing more can be said or done with out more testing. But that was enough for private insurance to say "no".It is very fustrating I know, sometimes I feel like screaming, and cursing people, but none of this will help so I try to keep my calm. Thats all we can do. Do give up and keep trying.
 
babs

babs

Member
i am not understanding the goverment thing. what and how would i ask gov. to help?
I will try anything. I hope your daughter is better and that you're getting the help you need, I know the ins. deal is tough. i am in Missouri and it's harder everyday.thanks to our new Govenor whose making too many stupid cuts.
what is insurance commission too...
thanks
my email is bbritt43@peoplepc.com
 
You must log in or register to reply here.
Top