Flipped out Angry :(

luv2bingo07 · December 2, 2004

Hello all,

I hope this is not good bye to this wonderful site, but I called my insurance today and found out that any surgery or treatment for obesity is a strict exclusion!.

I didn't know whether or not to punch a whole in the wall or my company presidents face! I cannot believe that we were all told several months ago that our insurance policy had been changed or revised and that there are soooooo many freakin exclusions in it that SHOULD NOT be there!

I do not know what to do now. :cry I was so excited to become a bandster with everyone, but it looks like it may not happen and I can go find a nice high bridge. Just overdramatizing. Don't worry, I know that won't solve anything. I am just beside myself with anger and being so upset I could punch someone. Really, I am in no way a violent person, but this was a horrible end to a lousy day anyway.

My credit absolutely sucks and so a loan is seriously out of the question. I have no rich relatives either. LOL

So, needless to say, any help, advice, encouragement, etc. would be sooo appreciated.

So sorry for venting like this.

Judy

Penni60 · December 2, 2004

Judy: If I am not mistaken all or MOST anyway will tell you that. They don't wanna pay for the procedure period. You have to prove co-morbidities and have your doc write them a letter. Alexandra on here can best direct you what to do next. Don't give up hope just yet. I will say a prayer for you that the new year brings you everything you desire.

OK well maybe not what you desire, but how about this weight loss and becoming healthier. IS that doable?

Alexandra · December 2, 2004

Hi Judy,

I know exactly how you feel. When I first started looking into this, my insurance carrier explicity excluded the band itself, under any circumstances. I was so ticked and was ready to find a high bridge too.

But all is not lost. A lot depends on what state you're in and what the regulations are. Is your company self-insured? Is the plan a standard one from carriers? Read your exclusions carefully--lots of them say treatment for obesity is excluded except with a diagnosis of morbid obesity. Some of them say surgery is excluded unless this, unless that, etc., etc.

So don't give up, just keep researching. Find out who wrote the policy and whether your company has any ability to change its provisions. Find out who regulates health coverage in your state (department of health? department of insurance?), and contact them and find out what your appeal options are.

There is widespread medical agreement that morbid obesity is a disease that requires treatment. And surgical treatment is a widely accepted option. You may ened up wanting legal assistance before you're done, but even if you can't afford surgery you'd likely be able to afford that.

There is always another step to take before jumping off that bridge!! Don't give up!

luv2bingo07 · December 2, 2004

Thank you so much Alexandra and Penni for your replies.

I live in Oregon and the company I work for has Regence Life and Health BC/BS insurance.

This is what the Exclusion says in my benefits booklet:

Treatment For Obesity Or Weight Control

Surgery or treatment (including any later complications), even if you or your enrolled dependent has other medical conditions related to or caused by obesity. Specifically excluded are: gastric stapling or bypass procedures, weight loss programs, counseling, hypnosis, biofeedback, neurolinguistic programming, guided imagery, and other forms of relaxation training as well as subliminal suggestion used to modify eating behavior.

That's all it says. Nothing about gastric banding specifically, but it pretty much seems to cover any and all obesity surgeries.

My health is getting really bad and I know truly for a fact that it can get better with help. I am a smoker and it is either help with weight loss and then quit smoking or nothing. I quit smoking for about 4 months once, gained almost 30 pounds and started smoking again because of stress.

Yes, please pray for me and I believe something will happen with this for the better! :-)

Hugs to you both,

Judy

leatha_g · December 2, 2004

Judy,

I can sympathize with you regarding the smoking. I too was a smoker. However, I sort of got the idea of regaining my health in the back of my mind and I actually quit smoking 8 months before my banding. I knew that this was one thing I absolutely DID have to do even if I was unable to be banded. My lung capacity was so bad I just had no choice. I really enjoyed smoking and believe me, the first year I missed it alot. This second year has been so much easier and today I am GLAD I quit instead of resenting that I had to.

The best part about that is that when I actually did get to have surgery, that was one less thing that I had to be concerned with. Anesthesia is tough on you anyway, but being a smoker makes it much harder.

Of course this is your journey and you'll do what is best for you. I wish you the very best.