Question:
PLEASE HELP! What can I do to pay for my surgery?
We have insurance, but ours is an exclusion policy. Our debt ratio is too high to get financing, and my family is not able to help. Vocatioal Rehab in Idaho does not offer assistance for wls. I think I have exhausted every idea/option and I'm desperate. Thank you. marie — sm S. (posted on January 5, 2003)
January 5, 2003
My insurance also has an exclusion. BUT some exclusions can evidently be
over ridden by letters of medical necessity sent from the surgeon, PCP etc.
The surgeons office doesnt think I will have any problem at all with my
approval. See what you can find out before you give up.
— Bethy413
January 5, 2003
I am in the same situatuation. Poor credit after a bitter divorce.
Someone told me to call 888-737-3679 to find out about a loan with a
cosigner. My insurance also has wls as an exclusion. I refuse to give up.
Keep trying. Do you own your home? How about an equity loan? Good luck.
— susan P.
January 5, 2003
I, too am in the same boat. Sometimes a good letter from a doctor will get
them to drop the exclusion, but usually not. Bariatric Treatment Centers
has a lot of experience... They only do RNY's and have a lot of experience
dealing with this, and even have a lawyer draft a letter as a last resort
on their fourth try to get it approved. (My friend is still waiting...)
They are only located in a few cities across the country, however. I
unfortunately have no insurance at all at this time! My neighbor, who is a
nurse, has told me that most surgeons try to get this paid for or as much
as possible by the insurance company, realizing what a health benefit the
surgery is. The surgery itself is only about a thrid of what the hospital,
tests, anethesia, and all adds up to. If you can find a surgeon who cares
enough in your area to find a way to get the other things covered as much
as possible and work with you on HIS fee, it might be possible to work out
some arrangement. Another option, if your BMI is high enough and you have
a few co-morbidities is to check out www.millergoodmanfoundation.org as
they provide assistance. Finally, I have heard there are some really good
doctors in Mexico. I, myself would be scared to do such a thing but I have
seen some great feedback on this site and they are not nearly as expensive.
Good luck to you!
— shanmarie M.
January 6, 2003
Marie, do you own your own home? Have you refinanced lately to take out
some of the equity? If you already have equity in your home and don't want
to or have already refinanced, you can get an equity loan perhaps? If not,
then I would start looking around for a different job, even if you have to
take a pay cut, one with insurance that does cover the WLS.
— Cindy R.
January 6, 2003
I have seen so many people post on these message boards that you should not
let exclusion clauses or "no" answers stop you. Appeal, appeal,
appeal. There are some very good letter templates found on this web site.
They quote from the Americans with Disabilities Act and other laws and
appear to do a good job of letting them know that you are serious and
informed. Try for approval, have your appeal letters ready....
Now, having said that, I have to confess that it took me two different jobs
and four different insurance companies before I was approved (I did not
actually change jobs for the insurance, it was just a happy coincidence).
One final possible suggestion. I live in Texas and we have something called
the Texas Workforce Commission. I have heard of some people getting the
entire surgery paid for by them (due to the morbid obesity keeping you from
being able to work). Might you have something similar in Idaho, or was the
Vocational Rehab the only option?
— Steve O.
January 6, 2003
Hi Marie. I'm from Idaho too (just much more northern & rurual).
Idaho really sucks as far as available insurance that doesn't have the
exclusion. I did find one individual policy last spring through BC of
Idaho that paid for it if it was medically necessary. If you are in good
health you might try applying for coverage on that policy. The worst they
could say is no. (which for me they did). Also check out the section on
here where is shows Idaho surgeons and which insurances they accepted from
people. Then I'd do some searching to find out which employers offer that
insurance. Being in Boise there has to be some companies. Another
possible option is, if you can get on it, Medicaid. The last I heard IF
you can get on Medicaid and you prove medical necessity the state will pay
for it. I know they're a pain in the butt to work with but if you could
somehow qualify it would be worth it. The next thing is, if you can come
up with PART of the money to contact the surgeons in your area. I found
one in Spokane (about the same distance as Coeur d' Alene from me) who was
willing to have nothing down on his surgeons fee or the anethesiast he
works with and then you have to work out things with the hospital. Sacred
Heart Hospital wanted 10,000 down and then you have 2 years to pay off the
balance and the surgeon & anesthesiast were willing to work on small
payments. I'm just letting you know what they wanted in my area spring of
last year, maybe your hospital won't require as much down in advance. Its
still (at least to me) a really large amount of money to come up with all
at once but it's a start. Hope something here helps. shelly
— Shelly S.
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