Gary Smithey

Aspiring evangelist, did you say "money whores?" The typical profits for health insurance companies have ranged from 2.2 to 4.4% in 2 of the last 3 years. Tupperware's stock has been reported as a better investment. But you know that they companies are, well I won't say it again. If anyone believes that the health insurance companies are making killer profits, this will be your lucky day. Beg, borrow or steal to get something in your brokerage account and buy some of their stock!! This is America! You can get rich getting in on this hugely profitable industry (tongue in cheek). As to the procedures, of course they are two different procedures with different codes being used. My dr. said he wanted me to wait and lose 50lbs before I had the hernia repair.

And also, thank you so much for the Phillipians quote!

go to unjury.com // Chocolate and Vanilla are good / Strawberry, too artificial tasting / they also have other things // These folks are great taste wise, but not cheap!

Having been banded on 10/3, taking the pills is not an option for me anymore. I picked up a large bottle of liquid Omega 3 from a health food store and take a spoonful once or twice a day. ($47, wow!) I have seen Centrum Silver in liquid at CVS but $9.99 worth lasted only 15 days. So I'm chewing a combination Vitamin tablet but may go back to the Silver if I can find a better deal or I run out of the other bottle of large, chewable pills any time soon. I'm taking Lipitor without cutting it now (20mg.). So, so far that's not been an issue. Before I was cutting it in half, but at just under 2 months I'm not very restricted so it goes down easily.

That was a quick update. It's getting close to midnight and I'm due in the Med Ctr. in Houston at 6AM for mine. Might as well grin and bear it at this point I guess. Thanks to all who post and share your information with others about your journey!

I'm a health insurance agent in Texas. I would be shocked if any individual plan covered weight loss surgery. But it appears that any group plan that wishes to allow it, can choose to do so and pay for it. It's possible that some states might require them to, but I would be surprised if that's so. If providing competitive benefits is what the company is trying to do, it would only make sense to provide weight loss surgery. As to do it now and submit it later plan, WOW! That's a true leap of faith. In my own case a very experienced local drs. staff told me two years in a row that they called and checked and that my policy didn't cover it (and I have Blue Cross). I accepted their "expertise" as being unimpeachable and let it go. Not long after the 2nd turn down by the drs. office, who stated I just didn't have the benefit, I had to discuss something in my plan with Blue Cross of California (now Anthem) and I asked them, not thinking I'd get a positive response, if they would cover it. YES, they said, if it was a medical necessity. (This was in the same year, just two months after the 2nd turn down). I did what they asked, I jumped all the hurdles, and surgery is 10/3. So don't even trust your drs. office to get it all right. Call them yourself and ask them lots of questions. You are the one who will gain if like, me, you get a different answer. 3rd time was a charm. And if your company doesn't have it this year, they just might add it next year. Talk to your head of HR if you can and ask if they are considering adding it in the future to their plan.

Spivak is a legend. Having a chance to go with him I think is a great option. His seminar was very straight forward. He said, I'm going to tell you how it really is, and not try to sell you. He gave us a very sobering presentation about the challenges. He said he does 60% lap band and 40% Gastric Bypass today. (and I assume he will the Sleeve) I had a one on one consultation with him as everyone did where we discussed how to deal with a hernia I have. He asked questions and listened with great patience. And, he has never lost a patient doing either GB or Lap Band and was first to do Lap Band in Texas. His staff is highly recommended by his patients. I have spoken to many of them. Please go with whom you want to, but cast no dispersions on Dr. Spivak unless you have a good reason. And Steve, I didn't see an ego at all. He did seem confident, but want him to be confident. Cocky? Not even close in my one meeting with him.

I have October 3 as my surgery date. I got a big lump in my throat making the call to set it up. Never having spent a night in the hospital, breaking a bone, etc., surgery is all new to me. My wife's class has a H.S. reunion, so I wanted to go with her toward the end of the month. And then Friday, the 3rd was better for her work schedule, so I took that date. Dr. Spivak, in Houston will do it. He doesn't require much in the way of dieting pre-op, I understand other than not to gain weight. I'm thinking I'll start a low fat diet (his ofc. said low fat or S. Beach might be good if I wanted to). Start giving up the sodas, red meat, Pasta and breads as it get closer. (He does ask to give up red meat and pasta for 5 days "for my comfort") Any suggestions on pre op diets?

I'm so sorry for your loss, Waikiki! I lost my dad 20 years ago and I still miss him. We are never wanting them to live on in pain, but we miss what they were to us and we miss seeing them so much. Our pain is mostly for ourselves as we know he is in a better place. As a local pastor in the UMC for 10 years, with 2 small congregations, I can tell you cremations are here to stay. Some have nothing against them to begin with, some do it for financial reasons alone. But the advice to have a Memorial Service is just right. All you need are some pictures of him. Invite her to come but don't let her response bother you in any way. Don't focus on her, focus on him. Ask the Chaplain to do "Celebration of Life" kind of service with good things remembered. Some scripture and a brief message, or whatever you want would complete the planning. These type services are very important to end properly and remember and memorialize our loved ones. Email me at ges01@comcast.net if you'd like to discuss this. God's blessings on you and on the wonderful memories he is leaving you all.

Becca, that was neat that we got to experience a fill. I have 3 drs. visits of the 6 behind me with no. 4 coming up in 6 days. It would be possible, for me to have surgery in 90 days if all goes well. I am looking forward to the loss, but dreading just a bit going through the process. At 60, I've never spent the night in the hospital other than at birth and I know this should be day surgery, and go pretty easy, still it's just a slight bit unsettling. Seeing your video just makes it all seem kind of routine, though I know it's not. But it is comforting to see how smoothly the process went. I would have thought he would have let the local have some time, but guess that's not needed. Keep it up and I do hope we will see more posts from you soon.

I don't think I misspoke pointing out there are two kinds of plans. If you have the option to add it, do so. Your post did not make it clear which kind of plan you had. Many people that own their own business are on "individual plans" so it's not a lock that business owners all have group coverage.

Oops! Back at the top of this series of messages, the lady says she has Cigna and it does not cover weight loss surgery. Cigna doesn't have individual plans in Texas so I never see them do "individual health" cases. It would appear in Florida, Cigna has both group and individual coverage. Just like maternity, the best way to get this covered would be to get a job with a company large enough to have group insurance and specifically, have a plan that covers weight loss surgery. Many group plans don't cover weight loss surgery. It is an additional cost (and benefit to the employee) and not every company sees the value of doing it.

Cigna is a group insurer. Of course group insurance can cover weight loss surgery. I know I'm counting on them approving my case soon. The original question was posed by a woman who was looking for "individual" not group coverage. In group insurance, risk is based on the total group. 50% or more of the true cost of the employee's insurance is usually covered by the employer. A generous package of benefits is usually included. It is a form of pay to the employees. Individual plans are much different, with the client having to qualify for the plan (get approved by the underwriting dept.), and pay the monthly premiums all by themselves. My point is that it is highly unlikely that any state will have a major medical policy sold to individuals (individual health insurance) that will have a rider for weight loss surgery. If you find one, post their name here. For this same reason pregnant women, without group insurance, can't call up companies after they are pregnant and get them to cover the cost of their pregnancies. It would cost the companies a lot of money and they are not interested in taking on clients or making provisions that guarantee them a loss.

I know nothing of Florida insurance laws but just think about it. Who wants a new client that costs them money, in any business. If that was true, individual plans would let a pregnant woman sign up for $100t to $200 a month (you make up the amount) and cover a $10,000 pregnancy. Pregnant women, diabetics, those over a certain weight, etc. are consisitantly denied by all the big name major med companies in Texas. What company could stay in business taking on clients that drain their profits? So the idea that one could sign up for a "weight loss surgery rider" on an individual plan, seems unlikely to me in all 50 states, but I don't know all their laws. Insurance companies do not exist to be charitable or to solve your problems. They run a business and their CEO will get fired if he doesn't generate a reasonable return to stockholders. No different than a football coach or corporate leader.

Thanks to all who have responded to my newbie questions. I did talk to the pysch lady yesterday. She lives a couple of miles away. We could end up doing this over the phone! Or at Starbucks. I do want to say it's not fair to use the name OldMe at age 36. Based on your weight loss so far maybe HYLYMOTIVATED / or WALKSONWATER would be more appropriate given the numbers you are putting up. Gee is it great to hear that someone can lose the way you are doing it. Makes me less happy with my excuses. I do see a personal trainer twice a week and get an hour there with 1 or more sharing her attention. It has helped a lot but I do nothing in between and I'm trying to get more active but so far I'm leaning on the "forced" workouts. To all of you, fight the good fight! Keep it up.

Maitai, in Texas, individual health plans (these are different than group plans) do not offer such riders. Group insurance plans may or may not opt for such coverage. Group insurance is given as a "benefit." It is another way to pay employees to work for them. So, if a company has the weight loss option in their plan, they are trying to give a very good benefit to their employees. Many plans don't have the option because they don't want to spend more on their employees, short sighted as that may be. In the individual plans in Texas, weight loss surgery is excluded, and some other things are as well. There is no rider I have ever heard of to add weight loss to an individual plan. The individual health market exists to make money for the company's stockholders and limit risk to those they deem insurable. If you and your "health conditions" fit their idea of reasonable risk, they cover you. They may rate you up in cost or eliminate coverage with a waiver. Everyone else not fitting the model gets declined.

Any follow up on how the Blue Cross process is going. I'm on a group BC of California plan and they tell me nothing. Dr. Spivak's office says 6 drs. visits discussing only weight (no other instruction to me) and one pysch visit and they will submit. Know anything about the psych visit?

That may be the problem. If you don't have group insurance, it's inconceivable to me, a licensed agent in Texas, that any company would sell you a policy so they could lose money. Insurance companies measure risk and avoid them! Groups may have have coverage, individual plans don't have maternity. Why would they do weight surgery? Their goal when they sign up a client is the same as AT&T, or your dentist. They plan to make money on you. They won't offer you a plan that starts out to lose money.

Like MPope, I'm a newbie, 3 visits in the can to the dr., 3 more to go. Leslie, playing with your child will so wonderful. Do whatever it takes. Terri, I am so happy to hear you are headed toward a far better outcome! At 60, w/ HBP and Cholesterol and back issues, and 5-10, 320, I certainly need to help myself to a better lifestyle. I have a personal trainer and work out with my wife with the trainer twice a week. My flexibility, wind and back have all improved dramatically. Now I need to get some weight as well. Lighter and stronger would really rock!

Where is this surgery happening? I'm 3 dr. visits out of 6 with Blue Cross toward getting approved. Let's certainly hope they approve me. And I do have the psych visit as well to do. So, I'm about 3 months away from talking to BCross. The reality it could happen is beginning to set in. Oh, I'm 320 headed toward 180.

OK Miss Laura. I'm about 3 drs. visits into the required 6 before I can apply to Blue Cross for approval. Your nos. before and your goal look very similar to mine. At 321 now, my GP says he wants me to get to 180. So, you can see how similar out paths could be. Knowing what you do now, does reaching that goal seem likely to you? I know very little about all this at this point.

I'll bite. Hi Alan, how's it going across the pond. How's the weight loss coming? Are you struggling with the diet, the fills, etc. ?

As to being declined by individual health insurance companies, I have some experience in this area. First as a person who applied with Blue Cross over the phone 5 years ago for coverage. I was told when I answered yes to the "do you have a CPAP device" question, that I was an automatic decline. Later, when I was back on a group plan (my wife's), I began to write health insurance as a profession. I had to study and pass state certification exams in order to get a license. That license has to be renewed every two years and 30 hours of CEU's that meet the state's criteria are required for renewal. If I do not follow the state's laws on insurance I can of course lose my license. I say the following not to confront any of the previous comments, but to give a better understanding of how health insurance really works. I can only speak to Texas health insurance and speak most authoritatively of the individual plans. Group insurance takes you no matter what your health situation is under their "open enrollment" provisions. So you can get in if you have a job that offers it or if you are a spouse of an employee. But you only get what the policy states it covers. Your imagination is always bigger than the policy, but the insurance company tends to follow the policy pretty closely and you have ZERO chance of getting something paid for that's not written into it. (KNOW YOUR POLICY!) Getting in a group only means you are a member of the plan, with the features that the state law required and with the features the officers of the company decided they could afford. It may lack some things you assume it will have. State law controls almost every part of your insurance. And your state does not subsidize the insurance companies. No tax dollars go to Blue Cross. So the state allows Blue Cross to try and earn a profit, like other businesses (this is true in most states - Blue Cross in Texas is actually a non profit). So, the group plans will take persons with health conditions that the individual plans won't. Remember that group insurance is offered as a "benefit", a part of your pay. If they want your skills, they won't think twice about adding another person to their group. In individual insurance, you provide your own "benefits". The individual plans treat each individual application with the companies asking themselves if they can make a profit on the applicant. They know that some of the applicants will lose hundreds of thousands of dollars for the company, but they won't knowingly take those whose risk profiles are too high. They decline them. And they add ("rate up" or "rider") various health conditions (smoking, obesity, asthma,etc.) and decline many others (diabetics, cancer victims, morbid obesity, etc.) Yes, N.J. and N.Y. are "guaranteed issue" states. In 32 other states, Texas being one of them, they are designated as "risk pool" states, where if you are turned down, you can apply to the state risk pool, and in most cases you will be accepted at a higher rate (about double the cost). How does N.J. deal with the unprofitability of clients with bad health entering their plans? By passing their true health costs on to others. If you think your health insurance costs are high now, try paying for someone else's coverage also. It's certainly not a perfect systems, but someone has to pay for the coverage. Groups can add or pass on adding certain features (maternity, obesity surgery, etc.) based on their state's laws. Groups of a certain size in Texas (less than 25) can decline to carry maternity, and coverage such as obesity surgery is strictly an option, your company chooses off a list of upgrades over the basic plans as it shops for your plan each year. Each additional feature they add, causes some employees delight and more employees to tell the management the plan is once again just "too expensive." And some to drop coverage altogether. So, back to an earlier posed question, "How can California deny individual insurance to a person who has had a CPAP device or obesity surgery?" Simple, your state law permits it. If you think that's wrong, lobby your state legislature. They make many changes each year to their health insurance laws. If it makes sense, nothing should be easier than to get your state to make the changes needed. But don't forget, passing on the cost of your health issues in our system to someone else is not a given. Insurance seeks as an industry, to "share risk" so that many pay an affordable amount, and a few can have unaffordable treatments. The state sees it's part as working with those for whom the companies feel they cannot. This brief explanation may not make your like the insurance industry any more than you already do, but that is the basis of why it does what it does. I believe we may see some federal intervention in the future, but I don't expect it to lay off all the current industry workers and replace them. Instead I see the government working with the the private sector more as it does with Medicare supplements now. But that's just my opinion. Seen as a part of the American free enterprise system and without state and federal assistance, the insurance companies run a model that they can measure (using acutarial knowledge, etc.) and cost management (underwriting criteria) in a fashion that will help them pay back their stockholders, just like the companies most of us work for. Learning what your choices are, what you policy says and staying as healthy as you can is our responsibility, until such time as the system is changed.