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How One Patient Finally Got Her Gastric Bypass Claims Paid
The following article was written by a reader who wanted to share her
experiences in getting her health insurance policy to cover weight loss
surgery. For privacy reasons, her name is not included.
For tips on dealing with health insurance companies, see "The
Cost of Gastric Bypass Surgery."
"I have to be honest, trying to get my insurance company to cover
my gastric bypass surgery was almost impossible..."
Now optional bodily alterations such as plastic surgery and weight
loss related operations are grey area for insurance companies. These
companies never want to pay even if it is something life threatening.
When I first approached my company to open a claim it was almost embarrassing.
I had to explain why I wanted the surgery and went through a barrage
of questions and inquisitions that ultimately ended with my claim being
declined. I had even shopped around to other insurance companies and
all were the same thing, they required solid beyond a reasonable doubt
that your life was threatened if you did not have this operation.
This also proposed a Catch-22. No doctor would perform the surgery
without myself being covered, they wouldnt take cash and no one would
cover me for this operation at first. Now life is all a shell game when
it comes to medical insurance. Before my gastric bypass I had developed
a small heart condition which was a direct result of my weight.
So now I really needed this operation, I had begun to try and loose
weight on a regular cardiovascular workout but my doctor had insisted
that I have this operation as soon as I could. The fear was other ailments
such as diabetes and perhaps even the loss of my legs would follow.
My doctor had filed a report and written a referral that I should have
the operation. Having this was like a smoking gun when I next approached
my insurance company. Now that I was able to prove that the gastric
bypass operation was indeed a life threatening need I had a chance of
opening a claim and having the operation covered by my insurance.
Which they did pass my request in the end and I was admitted and prepped
for surgery three days later. It was bad enough I was under the knife
but I was relieved I didnt have to worry about the money for this operation.
When I came to a day later, my insurance company had found something
in my request and was now refusing to pay for the operation. So I had
to fight this situation while in the midst of my recovery in the hospital
which was adding up for each day I was in there. Let me tell you, undo
stress is not good for when youre recovering from this form of surgery.
Stomach ulcers are not good in this case.
In the end with some legal action, my insurance company made good on
paying for the operation, even though they took their time doing so.
To read first-person accounts from people who have experienced
gastric bypass surgery, click
here.
Note: The information given here should
not be taken as medical advice. Be sure to talk to your doctor
about any concerns you may have about gastric bypass surgery.
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