So I complete all I have to to get the surgery and I am SO excited that they are finely going to submit to the insurance. So I give it about three weeks and then get a call from the doctors. My husbands work has decided to to cover the gastric bypass since the first of the year. Now I called about a year ago and they assured me that they covered it and it was no problem. So here I am, in tears and nothing to do. They told me that I can file an appeal and see how that works, but I am just crushed.
I called my husbands work and this snotty lady told me they will NEVER cover it again so tuff. I was SO upset. He called and spoke to them and they told him the same thing. He then called the terminal manager and that guy feels bad and says he thinks it's wrong and he will look into it, but I don't hold up much hope for it.
I sat here all evening crying and just feeling like S@#T. Has anyone else had this problem? Has the insurance said ok since you started the process before it was terminated, we'll cut you a break?
I don't hold high hopes and at this point, I don't even want to get my hopes up. I can't afford the $20,000 to pay out of pocket. I just feel stuck and sad, and mad. I hate this feeling.
Lindy sweety am so sorry! Unfortunately I can't help you with this because I come from a totally different health care system.. Just a thought though, is there an option to upgrade the type of insurance your husband has to cover the surgery? Can you get your own insurance that would cover it? Perhaps since THEY changed what is covered and what's not, maybe when you appeal and they find the date on your papers at the begining of the process prior to that of changing the coverage, they would do it? I really don't know but either way never give up! Surgey or no surgery you're going to do it!! Good luck to you either way..
P.S. I think a couple of ladies here had their surgeries in mexico, which is cheaper I guess.. maybe you could look into that if you can afford it or perhaps see if you can save for it
Sorry Lindy. I worked in benefits years ago and on the advice of our insurer, we also stopped covering the surgeries. The reasons were because the complications, if they occur, can be hugely costly for the employer to cover the ongoing expenses and complications that could result (just read some of the stories here and you'll see). Many employers are considering the long term liabilities that could come up for lifetime care after the surgery. Also, there have started to be studies out there questioning the long-term effectiveness in terms of people regaining the weight. Basically unless the lifestyle changes are adhered to, it comes back. So those were the decisions. I'm sorry you got stuck in the middle of this and had your hopes dashed, but yes, I have seen this happen, and no, there won't be anything to do in this case as the employer has last call on it if they are self-insured, which it sounds like they are. And that means, they pay for everything out of their own pockets for your medical care, which starts at 25,000-30,000 per surgery. However, in place of this, our plans offered excellent lifestyle modifications that mirrored the post-surgery lifestyle that we covered for people. I know this isn't the same, but in the end, you will still get there, maybe without just the initial kick-start surgery would have given you. But you are not alone...many employers are cutting this, I even read that WalMart stopped approving them bc they could prove people would work there just to get the surgery, and then quit or not come back to work after surgery. Why don't you call and see if they offer any other types of support like weight loss tools, health club reimbursements, or support groups. There might be something else you could start. Hang in there!
oh lindy. this is awful. you put it on hold for so long in an effort to do it yourself. and then you've jumped through whatever hoops you had to, and now this.
i think hrbabe has it pretty much on target. another alternative is to go out and get health insurance on your own, with a company that'll cover the surgery, but that's also expensive, and not really practical.
keep us posted... maybe something will happen- like a new job!
Oh that blows !!!!! how horrible of them and the place where your DH works... shame on them.
Can you get intouch with a lawyer that specializes in this just to see if there is anything you can do. I would definitly appeal it. If its a flat out no then have them reimburse you for all the expenses you put out getting ready for the surgery.
I'm so sorry honey..... but I believe there is something BETTER waiting for you.
I'm so sorry this is happening to you! Not as drastic as you... but last year, my insurance covered surgery with a $125 co-pay. This year, it is a $5,000 co-pay. I did a lapband, which only costs $10,000 at my hospital to begin with! But still, having them kick in half was better than nothing.
What type of surgery were you thinking about? You might want to look into getting a lapband. I know there are pros and cons to all types of surgery, but with the lower price, you might be able to afford it. At our hospital, they had a financing program that I could use to pay for the entire cost and then have a monthly bill. It made it much more feasible.
First, contact your benefits department at your husbands work to find out about the appeal process. Do NOT give up if this is what you really really want to do. My friend at work went through the process knowing our insurance would not cover it, but went through an appeals process several times and finally got it approved. So have patience.
Insurance Problems
Appeal!!!
