Fath, Hope and Prayers

[lash44 313]

My Quest for weight loss surgery started approx. over two years ago, it’s been a series of lows and highs from my stand point. First my primary care physician suggested I should consider bariatric surgery because of my body weight, diabetes, elevated cholesterol, high uric acid levels, high blood pressure, and sleep problems. At the time my insurance carrier was Blue Cross Blue Shield who covers bariatric surgery, but my employer did not put weight loss surgery in their group plain needless to say I did not qualify. A few months later I was laid off. My hope to lose 100 pounds was fading fast.

In late May of 2010 I was covered under my wife group plain with Aetna, an insurance plan which accepts the surgical procedure with a six month regiment to be eligible. Finally I was on my way to weight loss gratification.

In June my wife employer changed insurance companies and as you know the new carrier (Cigna) did not cover the surgery. Another big letdown, yet I tried making my case on an existing condition clause, but was advised by the state insurance commission and insurance companies that it was up to the insurance company who had the final decision. After numerous phones calls, emails, and letters to any and all who would listen; my faith in the system was vanishing very fast.

In mid September, my life took a turn when I received a phone call from a case worker at Cigna and she stated she was reviewing my case and look like I would be covered under the plan. In October Cigna approved my case, but the surgeon was not in the network which meant I had to pay a 3700 dollar deductible, which I had to started saving for. All over again my life had taken a spin in the wrong direction.

Once more, that angel of a case worker notified me that the surgeon would be put in the network and I could go forward with the operation.

I am now scheduled for the surgery within thirty days.

My prayers have been answered.

[AutumnLily 77]

It was a long and bumpy road to get where you are wanting to be. I think it will have been worth the extra mileage! Congratulations.

[ThatDudesMom 13]

I am so happy for you! With that determination, you will surely be successful.

I still don't know why any insurance company would want to deny coverage for things related to obesity. I have BCBS and it is basically the only major insurance company in Kansas that does cover the surgery (or anything else weight loss related).

Good luck!

[myrori 55]

Well you certianly have been through more hoops than most of us. Congratulations on your perseverance! Prayers for your upcoming surgery!

[LynetteT 0]

What a wonderful blessing

[klus263 9]

I am glad you have not given up. My surgeon was not in the network but the hospital was. Most insurances if you have no network providers within a certain mile radius, will pay the provider as in network. My doctor filled out a form and agreed to a negotiated rate so I ended up with a 10% copay instead of 30%. I did have to have them reprocess the claim as they did pay it out of network first time. I am so grateful that my company is pushing their employees to be proactive in our healthcare and covers weight loss surgery. I never would have been able to do this without insurance coverage.

[Eloray 3]

Wow! What a miracle for you.