JustJuraLV
Member
- Joined
- Nov 30, 2016
- Messages
- 10
@Larra @DianaCox
I am currently insured through a private health insurance, Clark County Teachers Health Trust, for licensed employees of our school district in Las Vegas, NV. We have no other choices for health insurance. I have been out on disability since Nov. 8th, 2016 and paying for my health insurance through COBRA. Before the end of 2016 I looked into buying my own health insurance privately through a big name carrier like United, BCBS, etc., but found that I couldnt purchase anything that would cover me and the surgery I need (hernia repair with component separation/mesh placement). I was told that the National Market was taken away. I had my DS back in 2002 and have had several other surgeries and procedures since then, however, anything related to bariatric surgery is considered an exclusion. This is what I was sent regarding my last surgery was in Dec. 2015 by Dr. K in CA. It was initially just for a feeding tube placement, but he ended up having to go in and found I had a severe blockage and hernia that had to be repaired as well.
"Please be aware that bariatric surgery is not a covered benefit under the Teachers Health Trust PPO Benefit Plan, and any complications incurred as a result of that non-covered surgery are also excluded. Please refer to your Summary Plan Document, Non-Covered Expense # 4, which indicates that the following is a non-covered expense: Expenses for bariatric surgery, including treatment of the complications resulting from bariatric surgery. Any and all future expenses for any complications directly related to your previous bariatric surgery are also not covered."
Now I'm in currently in another situation where I have a hernia that is causing an obstruction and Dr. K said my colon appears to be redundant and needs to be looked at.
Do I have a chance fighting this with an appeal (I know my health insurance will deny procedure)?
Jura in Las Vegas
I am currently insured through a private health insurance, Clark County Teachers Health Trust, for licensed employees of our school district in Las Vegas, NV. We have no other choices for health insurance. I have been out on disability since Nov. 8th, 2016 and paying for my health insurance through COBRA. Before the end of 2016 I looked into buying my own health insurance privately through a big name carrier like United, BCBS, etc., but found that I couldnt purchase anything that would cover me and the surgery I need (hernia repair with component separation/mesh placement). I was told that the National Market was taken away. I had my DS back in 2002 and have had several other surgeries and procedures since then, however, anything related to bariatric surgery is considered an exclusion. This is what I was sent regarding my last surgery was in Dec. 2015 by Dr. K in CA. It was initially just for a feeding tube placement, but he ended up having to go in and found I had a severe blockage and hernia that had to be repaired as well.
"Please be aware that bariatric surgery is not a covered benefit under the Teachers Health Trust PPO Benefit Plan, and any complications incurred as a result of that non-covered surgery are also excluded. Please refer to your Summary Plan Document, Non-Covered Expense # 4, which indicates that the following is a non-covered expense: Expenses for bariatric surgery, including treatment of the complications resulting from bariatric surgery. Any and all future expenses for any complications directly related to your previous bariatric surgery are also not covered."
Now I'm in currently in another situation where I have a hernia that is causing an obstruction and Dr. K said my colon appears to be redundant and needs to be looked at.
Do I have a chance fighting this with an appeal (I know my health insurance will deny procedure)?
Jura in Las Vegas