amethystlady

hi, i've come to the end of my rope, i'll be 50 next february and have been fat since i would say the 2nd grade. for the last 10-15 years as i've gotten older, several health concerns have arisen. as doctor's been telling us for years. i've been hospitalized at least 3 times for congestive heart failure and the last time 3 years ago, after a weight gain of over 100 pounds, they found out i had severe sleep apnea. while in the hospital, lasiks was intravenous given to me and with a low salt, low calorie diet, i was able to lose over 100 pounds. back to the sleep apnea, the hospitals tried the c-pap machine, but i wasn't able to withstand the air forces, so for my benefit (but my detriment (sp?) ) i was place with a trach. i've learned to live with this damn thing and i won't it out, but alas to get it out an additional 100 lbs have to be lost. but that was 2004, after going from 418lbs in the hospital to 300lbs when i was released 3 months later after being in an after care facility, today, i'm back at 352. i know....it's a shame and i'm ashamed. i now feel my life is going from bad to worse and if i don't do something now, it'll be too late. the last time i saw my pulmonary doctor, he asked if i've considered weight loss surgery. i wasn't sure then, but now with all of the shows on tlc (the learning channel) and my mother, i'm really ready. while talking with the pulmonary doctor he says that my bcbs insurance would take care of it. all i would have to do is get another doctor including himself and the paperwork and other things that's included and i could get the surgery. now, the bad part, i called blue cross and blue shields today and they state there's a provision that stops me for getting the surgery. my employee booklet is at home and i'll have to look that up. but what i wanted to ask after all this history and sob story i've given, can this be fought? thank you all for your help. i've been reading the threads and i have hope, maybe there's something i can do or have doctors do so i can get this surgery. it can't be thought of as cosmetic surgery, it's life and death, my life.

well, i went home and found my bcbs benefit book and found out what the customer service rep. told me was true. #20 states...the plan covers and will not pay services intended to treat obesity, such as gastric bypasses and balloons, stomach stapling and jaw wiring. i just knew that couldn't be true. but it's in black and white. so, is that that? can i appeal? am i able to appeal? or do i just give up the idea of getting this procedure through my insurance carrier. i'm hoping with my medical problems that i explained in my introduction earlier today, and maybe with the help of a concerned doctor/doctors i might be able to get it. what do you all think. is this iron clad or can i protest with an appeal. if i can't, i can't. thanks for listening.

i have bcbs of texas and in my employee handbook it states they will not cover any type of wls. i've heard from so many people from this forum and others stating it's a good chance when they say no, it's no; i've also been told to go to my human resource dept. and speak with someone over benefits and see if the non-coverage can be overridden because of my health concerns (of course with all my physicians paperwork); was told to continue to have a letters of neccesity sent by my physician (s)to bcbs and if denied, appeal, appeal, appeal. and lastly, get a obesity advocy (sp) lawyer if necessary. i've read of a few on this forum and another who care and will help for almost next to nothing. so, knowing all of this, i will continue to see my pcp, let her know what i'm planning, have all the steps needed before i get lapband documented if and when i do get o.k'd. i will continue to fight.

thanks everyone for your input and encouragement. i will not give up. we will be changing our insurance providers soon and i will look at them all and see if wls is covered, i'll they do i'll get rid of bcbs. i will continue to see my pcp so evertyhing is documented, so on and so forth. thanks again. i really enjoy this forum!

hi, it's me again. i'm going to fight and get my surgery even though i'm not covered. i read on the thread about this attorney walter (sorry, i've forgotten his last name) and his team who i may ask for assistance if my doctor's letters won't help. what i'd like to know if anyone on the forum can recommend a surgeon/surgeons here in houston, texas who does this type of surgery and the hospital/hospitals they work. as you can see this is weighing heavy on my heart and i think it maybe a possiblity of a ray of hope that if i do what needs to be done, i might be able to get the procedure. thank you

thank you all for your helpful comments. i really do appreciate that there's others who know exactly what i'm going through. i am so happy i join this informative forum, what a blessing. on my next day off i'll get an appointment and see my primary care physician at kelsey seybold main campus here in houston. so, when i see her what is it should i say? i know i'll let her know i'm interested in getting the lap-band procedure, do i tell her that bcbs doesn't cover it but i still want to go through the steps so i'll have it under my belt when and if i have to appeal? would she know the steps? i think i know them and if i get stumped i'll have friends here who can assist me. i really think i'm going to appeal. i know it will take time, but maybe by this time next year in my 50th year of life, i'll finally can take control of my weight and health. that's what's important. thank you all, margaret