Written by Walter Lindstrom of PRIA Appeals
Kelley and I are, first and foremost, parents. It’s our main job in life. We have two amazing children and we are so proud of the people they are becoming. Like most parents, we would do anything to help them be safe, happy and healthy!
So when we hear about an insurer denying coverage for bariatric surgery for teenagers, it hits us especially hard. With a denial, the insurer is essentially telling the parents, “No, we are not going to pay for this chance to improve your daughter’s health,” and that doesn’t sit well with us.
We just got a 15-year-old girl approved for a bariatric procedure being performed under a research study protocol by a world-renowned surgeon. I wanted to share parts of the email I received from the mom, because her words speak to all parents who struggle with helping their child deal with morbid obesity and the difficult journey towards weight loss surgery.
What this mom expressed is what any parent would feel when trying to get weight loss surgery for their teen: desperation, hopelessness, and anger at the situation created by their insurer, plus an understandable reluctance to seek help. Fortunately, they did ask us for help, and as a result they did not have to pay out-of-pocket and worry about possible complications that can cost hundreds of thousands of dollars.
If this mom’s words to me after we secured her daughter’s approval help to empower even one other parent to fight an insurer who is saying “No” to their child, this blog post will be worth it! It may also help answer some questions you may be having, such as:
- If my insurer won’t cover bariatric surgery, should I pay out of pocket for it?
- Is it worth hiring a patient advocate to appeal my insurance denial for bariatric surgery?
We hope her words can help you in your journey:
“…When the insurance company said she did not need bariatric surgery, our first reaction was outrage. How could they say she did not need the procedure when three of her doctors and we, as her parents, all believed that she needed the procedure? Our second response was to remove the obstacle to our daughter’s well-being. Even though we pay for insurance to protect the health of our family, if their decision was to not pay for the procedure, we would find a way to pay for it ourselves. They were not going to stop us.
When the suggestion was made that we contact you before paying out of pocket, we were very hesitant because we thought it would be a waste of time and money, and as we were going to pay out of pocket regardless of the outcome, this was money that we needed. Making the call was the best decision we could have made. Our conversation provided me with information that we did not know and gave us an opportunity to step back for a minute and let someone try to help. We realized that delaying the decision to pay out-of-pocket was not a sign that we loved our daughter any less or did not prioritize her well-being.
The letter of appeal that Walter wrote was exceptional. Although I had a vested interest in the outcome, I could not imagine anyone reading the letter and denying the appeal. The time the insurance company took to review the appeal was torturous. Our plans for the timing of the procedure were ruined, and not being in control of this “thing” that was affecting our child was almost maddening. Kelley handled my anxiety and numerous e-mails by letting me know that I was still in control and could move ahead while reminding me of some of the adversities of that decision.
We can not thank you enough. Our best to you and your family and we will send you an update in a few months. Thank you.”
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If you have been denied insurance coverage for a necessary medical treatment or procedure, PRIA Appeals can help!