Obesity Action Coalition - Can I appeal?

[Alycat]

Hi everyone. I am at the very end of getting all my clearance appointments completed and am hoping to get sleeved by February. My insurance has a specific exclusion for Bariatric services but I was wondering if anyone has ever gone through the Bariatric Action Coalition for support or possibly tried fighting their insurance company and gotten any success? It's so expensive to self pay and either way I'm going to do it but if there is any way to appeal my insurance company's decision I would like to try. I've been preparing for almost a year now getting all my medical clearance and just want to finally get this done. Please let me know if any of you out there had any success appealing your insurance company's decision. I'd love any advice! Thank you!

[Kindle]

I don't think it's a matter of denial. You simply have a policy that excludes WLS. It would be like asking your car insurance company to cover your damages if you ran into a tree if you only had liability insurance. But your best bet is to contact Bariatric Action Coalition to see if they even take on cases like yours.

My insurance didn't cover WLS, either. I had my sleeve done 3 years ago by Dr. Ariel Ortiz at Obesity Control Center. International Center of Excellence and accredited surgeon. Pain free, easy recovery with zero complications. Down 100 pounds and loving life. Worth every penny.

[Christie13]

Yup. When it comes to insurance, if it is an exclusion, there isn't anything you can do about it. I know a lot of people get sleeved in Mexico for the same reason. There are a ton of people on here that have gone to Mexico to reach out for recommendations and advice if you choose to go that route. It is much cheaper than in the US. I was fortunate enough that my plan from my job covered it. Good luck.

[Shirl]

I moved from California (where my insurance covered my Sleeve Gastrectomy) to Texas where I'm paying more for my insurance policy and it doesn't even cover anything Bariatric related! I had to pay out of pocket to see a Bariatric surgeon for aftercare once I got here. Luckily for me I haven't had any complications related to my surgery.

It really makes no sense to me why insurances are allowed to have exclude Bariatric surgery or aftercare.

I would think Obesity Action Coalition is trying to work with states legislators and insurance companies to include WLS as an option to combat metabolic diseases related to obesity.

I hope they can help you some way some how!

[BelleKreyol]

Yes I agree. And exclusion means it's not covered at all. I am not sure anyone could help with that. You do have a few options otherwise. Change to an insurance plan that covers WLS or self-pay. I was in a very similar situation earlier this year. I had an international insurance plan that did not have wls covered. It took me a few months to just save the funds to self-pay for surgery in Mexico. Other folks also get their surgery financed through secured or unsecured loans. Others use their credit cards. If you're scared you'll spend the money, you can send wire transfers to your surgeon in tranches. That way it's not sitting on your account. Even if you were covered, depending on your insurance plan you may have had a hefty copay.

I do hope you find a solution and can get the surgery.

Belle

[jerzeygirl]

I actually know someone who had a "scholarship" or some grant from OAC. He had a lapband and I'd be happy to put you in touch with him. PM me and I'll see what I can do to hook you up so he can share the information. I do believe that there is an option on the Obesity Action Coalition. Good luck!