glenc Posted May 29, 2007 Report Share Posted May 29, 2007 I just read up on my insurance web page and it states that no weigh loss assistance is covered. Including surgery's, medication, counseling. NOTHING. Is there a way to force them to cover the surgery? Thank you in advance glen Link to comment Share on other sites More sharing options...
Clynn Posted May 29, 2007 Report Share Posted May 29, 2007 If your policy does not cover it you are probably stuck. You can try and recruit the help of obesity advocacy groups and your doctor. From what I've heard from other people who have gone through that process it will take some time, probably years. It's a big mess of back and forth which is why most people on this forum skip all of that and go to Dr Ortiz. Link to comment Share on other sites More sharing options...
glenc Posted May 29, 2007 Author Report Share Posted May 29, 2007 It's a big mess of back and forth which is why most people on this forum skip all of that and go to Dr Ortiz. My problem is I REALLY can not afford to pay for this out of pocket. Even if I was some how able to be financed. I just do not understand why insurance companies will not cover these treatments. I seems it would save them money in the long run due to other obesity related problems. Link to comment Share on other sites More sharing options...
Clynn Posted May 29, 2007 Report Share Posted May 29, 2007 Yeah, I know the frustration. I have a medical savings account where money is taken from my paycheck every week and then when I spend money on medical things I get reimbursed from that account tax- free. They've reimbursed me for pills, doctor visits, glasses, they'll even reimburse me for over the counter stuff like Nyquil though I have never tried. But when I tried to get reimbursed for a fill I've gotten grief about how that's not "medically necessary" and therefore not covered. Luckily my doctor is 100% behind me on this and has given me a note saying that it is medically necessary. Still waiting to hear if they will accept my claim this time. The momentum of the industry is that weight problems are personal problems rather than medical ones. I've been on Lipitor in the past and got that paid for no questions asked but the things which will get me away from all that badness is not covered. Link to comment Share on other sites More sharing options...
OCLili Posted May 30, 2007 Report Share Posted May 30, 2007 Wow, this is such a touchy subject for me. Our insurance (Cigna) doesn't cover the Lap-Band procedure at all. I've heard of people getting an "advocate" and fighting them to get the surgery coverred. Unfortunately...there's no way I would risk fighting them on it--just to have them drop us like hot potatoes. My hubby (who's having surgery 7/18) is a Cancer survivor, has diabetes and HBP....yeah, you would think that it saves the Insurance Co. money to have surgery and get him off all meds/dr. visits/etc., but...who knows what the deal is with our system. Hubby applied with our ins. for the RNY bypass (which is coverred by Cigna) and was denied once--we appealed and they denied our appeal....followed through with their requirements just to apply again and find out that--Hello--we had "exhausted" our avenues with 2 denials. ??? What a mess. Thank God for Dr. Ortiz. I don't know what we would've done without his help. You're right, it is difficult coming up with the money...but it is soooo worth it. Good luck in your journey...I wish you the best. Link to comment Share on other sites More sharing options...
glenc Posted May 30, 2007 Author Report Share Posted May 30, 2007 Wow, this is such a touchy subject for me. Our insurance (Cigna) doesn't cover the Lap-Band procedure at all. I've heard of people getting an "advocate" and fighting them to get the surgery coverred. Unfortunately...there's no way I would risk fighting them on it--just to have them drop us like hot potatoes. My hubby (who's having surgery 7/18) is a Cancer survivor, has diabetes and HBP....yeah, you would think that it saves the Insurance Co. money to have surgery and get him off all meds/dr. visits/etc., but...who knows what the deal is with our system. Hubby applied with our ins. for the RNY bypass (which is coverred by Cigna) and was denied once--we appealed and they denied our appeal....followed through with their requirements just to apply again and find out that--Hello--we had "exhausted" our avenues with 2 denials. ??? What a mess. Thank God for Dr. Ortiz. I don't know what we would've done without his help. You're right, it is difficult coming up with the money...but it is soooo worth it. Good luck in your journey...I wish you the best. I understand your fear. I on the other hand can not be dropped. I am insured through my work. They have to cover me even if I fight them over something Link to comment Share on other sites More sharing options...
Karmelbaby1 Posted May 30, 2007 Report Share Posted May 30, 2007 I just read up on my insurance web page and it states that no weigh loss assistance is covered. Including surgery's, medication, counseling. NOTHING. Is there a way to force them to cover the surgery?Thank you in advance glen Glen, I doubt it. Who is your insurance with? If you don't mind me asking. Karmel Link to comment Share on other sites More sharing options...
glenc Posted May 30, 2007 Author Report Share Posted May 30, 2007 Glen,I doubt it. Who is your insurance with? If you don't mind me asking. Karmel I am in Oklahoma and my insurance company is Health Choice Link to comment Share on other sites More sharing options...
coloratura Posted June 16, 2007 Report Share Posted June 16, 2007 I just read up on my insurance web page and it states that no weigh loss assistance is covered. Including surgery's, medication, counseling. NOTHING. Is there a way to force them to cover the surgery?Thank you in advance glen I have the same problem with my insurance. In doing some research I found out that Insurance companies really don't care about the long term health benefits of weight loss. The fact is that most corporations change insurance carriers every one or two years, so long term health means nothing to the insurance company. They will not be the ones who reap the financial benefit of an obese person's health improvement. If they would just realize that if ALL insurance companies covered weight loss procedures, then ALL of them would reap the financial reward of healthier clients. Link to comment Share on other sites More sharing options...
sharrroc Posted July 12, 2007 Report Share Posted July 12, 2007 I have the same problem with my insurance. In doing some research I found out that Insurance companies really don't care about the long term health benefits of weight loss. The fact is that most corporations change insurance carriers every one or two years, so long term health means nothing to the insurance company. They will not be the ones who reap the financial benefit of an obese person's health improvement. If they would just realize that if ALL insurance companies covered weight loss procedures, then ALL of them would reap the financial reward of healthier clients. From my other support group let me tell you what they all have to say. If your Insurance does not cover gastric bypass surgry of any kind, well then tehre is a thing called incidental surgery, say if you have the appendix removed well then a lot of Dr.s will go ahead and do the gastric surgery and tag it on as an incidental surgery and walla people have had the surgery and their insurance company covered it because you were having surgery in that particluar area. When I had my hysterectomy back in 1986 not only did that get removed but so did my gallbladder and appendix and well it was all covered. I know that some Insurance Companies do not allow the LapBand procedure but do allow the roux-en-y so some times a Dr. will make up a reason after the patient is under anestshia that they would not be a candidate for the roux-en-y but then will turn around and do the lapband and the insurance provider covers it. Link to comment Share on other sites More sharing options...
Deb H. Posted July 13, 2007 Report Share Posted July 13, 2007 My insurance specifically excludes the procedure too, but I've decided not to wait out the beauracracy (sp?). My company touts all kinds of health and wellness activities, even has a gym on campus (who wants to exercise with the CEO?), but this they refuse to consider. I'm ready to make this change and will do whatever I have to do to cope with the long term care. My family Dr. is supportive, so hopefully, I'll be side-effect free or at least minimized. Onward and upward, I say! Deb =D> Link to comment Share on other sites More sharing options...
sugarm123@msn.com Posted July 13, 2007 Report Share Posted July 13, 2007 I just read up on my insurance web page and it states that no weigh loss assistance is covered. Including surgery's, medication, counseling. NOTHING. Is there a way to force them to cover the surgery?Thank you in advance glen There's a law firm that is sponsored by lap band and if they feel your insurance is being unjust they may be able to help you.....the helped me when my insurance said they would not approve my surgery. It took about a month and the insurance company paid for everything. Try emailing Obesitylaw.com. they were wonderful and it's free most of the time. They helped me for free. I was just banded Monday and doing okay...a;ittle hungry but surviving Link to comment Share on other sites More sharing options...
sugarm123@msn.com Posted July 13, 2007 Report Share Posted July 13, 2007 Wow, this is such a touchy subject for me. Our insurance (Cigna) doesn't cover the Lap-Band procedure at all. I've heard of people getting an "advocate" and fighting them to get the surgery coverred. Unfortunately...there's no way I would risk fighting them on it--just to have them drop us like hot potatoes. My hubby (who's having surgery 7/18) is a Cancer survivor, has diabetes and HBP....yeah, you would think that it saves the Insurance Co. money to have surgery and get him off all meds/dr. visits/etc., but...who knows what the deal is with our system. Hubby applied with our ins. for the RNY bypass (which is coverred by Cigna) and was denied once--we appealed and they denied our appeal....followed through with their requirements just to apply again and find out that--Hello--we had "exhausted" our avenues with 2 denials. ??? What a mess. Thank God for Dr. Ortiz. I don't know what we would've done without his help. You're right, it is difficult coming up with the money...but it is soooo worth it. Good luck in your journey...I wish you the best. Try obesitylaw.com they helped with my appeals with my insurance company...they were wonderful and sponsored bt the makers of Lap band so in most cases are free....mo harm in emailing them to see where you stand...In NY you have a time frame for the appeal process of 45 days...hope this helps Link to comment Share on other sites More sharing options...
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