My last @%$!^# effort.. EPIC FAIL.

[three sixty six 1]

:cursing::cursing:RANT.:cursing:

The process so far has been, well.. annoying.

I've gotten a policy exclusion from my "oh so excellent" health care coverage provided by my employer.

I've appealed. Denied.

I've appealed to HR in my firm. Denied. They won't add the WLS rider.

Now on to the doctor. I wrote him a letter, asking for a discounted price of the surgery that would be equal to the write-off from my insurance company. Basically I asked to pay what my insurance company would pay (which after a phone call to the insurance co is 1/6 of what he's charging!). I know how much he gets. I know that if he gets 1/6 of what he charges from an insurance company, he can't bill me for the rest, so basically he has to settle for the 1/6.

Today I get a denial from the doctor.

I didn't have anything better to do with that $17,500 anyway.

Another part of my anger right now is that what REALLY bothers me is how I see people on here every damn day complaining about a couple of hundred (or hell, even a couple thousand) dollar co-pay. With BMIs in the high 30's, low 40's, mind you. Mine's over 50! Not to be a complete bitch, but I need this surgery more than someone who weighs 225. Sorry, but I haven't weighed that since high school. I would have a harder time w/o this surgery than you! I even met a woman in my doctor's office who looked skinny to me. Literally. Miniskirt and everything. She was "broke" but was on state healthcare (on welfare), and was complaining that she had to pay the $500 program fee out of pocket. Waah, wahh. Get off welfare, lady! Your designer shoes cost half the fee! That wacked sense of entitlement bothers me.

ARGHH I AM SO MAD.

Oh, and I just know that some people are going to tell me that this surgery is worth $1 million, and I should spend the $$ (and I will) and not complain (that, I refuse to do).

I'm just in a right state. Thanks for letting me vent.

[fluffycat 1]

go to mexico and save $10,000

[NicoleW8ing 0]

I had the exact same situation. EXACT. THE THE F**KING TEE! I am approved now. 5 Month struggle to do so, but I got it.

First off, it sounds like you're being denied because your BMI is over 50, is this correct?

My policy had an exclusion for BMI over 50 as well.

I am going to PM you now. I am approved. It was a struggle, but I was.

I am a full time student, full time employee, and I sure as hell don't have the funds to pay for this surgery myself. My premium health insurance didn't want to cover it for some stupid exclusion, but I got around it. Alright... sorry for rant, PMing you now.

Edited April 15, 2008 by NicoleW8ing

[Ang1982 4]

Another part of my anger right now is that what REALLY bothers me is how I see people on here every damn day complaining about a couple of hundred (or hell, even a couple thousand) dollar co-pay. With BMIs in the high 30's, low 40's, mind you. Mine's over 50! Not to be a complete bitch, but I need this surgery more than someone who weighs 225. Sorry, but I haven't weighed that since high school. I would have a harder time w/o this surgery than you!

Sorry I don't mean to be a bitch but to say that someone needs the surgery less than you if they only weigh 225 lbs sounds like you have some entitlement issues as well. You don't know those people, you don't know if they have co-morbidities and you don't know their life and their situations (health wise or financially) and that doesn't really give you the right to say that you deserve and would put it to better use than they would.

I know you are frustrated and I am sorry to hear that your insurance has the exclusion policy. I know forking out the money sucks (I'm self pay too) but in the end it will all be worth it. Like fluffycat said there are alternative places to go to to pay less money like Mexico or to Dr.Kirschenbaum in Denver ($9000-something with him) as long as you get your aftercare lined up where you live why not consider something like that.

I wish you the best of luck in your journey and I hope you are able to get things figured out so you can get the surgery underway. Hang in there, it will all be worth it in the end.

[MrsFlipFlops 2]

I remember back in the day when you HAD to be 100 pounds overweight to get the Lap Band. It did shock me a little to see people with less to lose shell out cold hard cash to get the surgery. It's funny because I can't wait to just be overweight... heck, at this stage I'm excited to just be obese rather than morbidly obese! Good luck three sixty six. I'm sorry it's been so difficult for you. I know how frustrating times can be when your goals are so close but so far.

[brandyII 9]

three sixty six,

I understand your anger, I've even heard of people wearing ankle weights to make it the weight. Can I ask you why you've chosen the lap band over gastric bypass? I got the lap band last August and still struggling with it. My daughter is a few years younger than you is scheduled to get the gastric bypass in May. Just curious, brandyII.

[anonemouse 1]

Sorry I don't mean to be a bitch but to say that someone needs the surgery less than you if they only weigh 225 lbs sounds like you have some entitlement issues as well. You don't know those people, you don't know if they have co-morbidities and you don't know their life and their situations (health wise or financially) and that doesn't really give you the right to say that you deserve and would put it to better use than they would.

I know you are frustrated and I am sorry to hear that your insurance has the exclusion policy. I know forking out the money sucks (I'm self pay too) but in the end it will all be worth it. Like fluffycat said there are alternative places to go to to pay less money like Mexico or to Dr.Kirschenbaum in Denver ($9000-something with him) as long as you get your aftercare lined up where you live why not consider something like that.

I wish you the best of luck in your journey and I hope you are able to get things figured out so you can get the surgery underway. Hang in there, it will all be worth it in the end.

Well said.

[juliegeraci 7]

This is elective surgery so yes, there are insurance companies that will not cover it. If you really want the surgery you will make it happen. Mexico is an option. Wish I had more sympathy but this is coming from a person who spend almost $4k out of pocket my first 18 months on fills. If you want it bad enough you will make it happen. Good luck.

[Fanny Adams 7]

Sorry I don't mean to be a bitch but to say that someone needs the surgery less than you if they only weigh 225 lbs sounds like you have some entitlement issues as well. You don't know those people, you don't know if they have co-morbidities and you don't know their life and their situations (health wise or financially) and that doesn't really give you the right to say that you deserve and would put it to better use than they would.

I know you are frustrated and I am sorry to hear that your insurance has the exclusion policy. I know forking out the money sucks (I'm self pay too) but in the end it will all be worth it. Like fluffycat said there are alternative places to go to to pay less money like Mexico or to Dr.Kirschenbaum in Denver ($9000-something with him) as long as you get your aftercare lined up where you live why not consider something like that.

I wish you the best of luck in your journey and I hope you are able to get things figured out so you can get the surgery underway. Hang in there, it will all be worth it in the end.

Quoted For Truth!

[three sixty six 1]

With everyone quoting the same response, it looks as though I've hit a nerve.

I'm not directing my comments at anyone in particular. I should have been clearer. My anger about those with much lower BMIs stems from the postings I've seen and the people I've met who are only recently obese; that is, those who have not struggled all their lives.

Regardless of your reactions to my comments, I'm sticking by them. I guess I *do* have entitlement issues, Ang. Thanks for pointing that out!

[gingerbug 3]

put your anger into researching other doctors. My doctor in houston only charges 12,000 for self pay and that covers a year of fills. Maybe there is a doc like this near you? Perhaps you can get the procedure with a doc that does a self pay that is lower and get your fills locally. Mexico, maybe? Lots of people go there with great success. Be solutions-driven instead of anger-driven.

[luluc 6]

With everyone quoting the same response, it looks as though I've hit a nerve.

I'm not directing my comments at anyone in particular. I should have been clearer. My anger about those with much lower BMIs stems from the postings I've seen and the people I've met who are only recently obese; that is, those who have not struggled all their lives.

Regardless of your reactions to my comments, I'm sticking by them. I guess I *do* have entitlement issues, Ang. Thanks for pointing that out!

Yeah - you did hit a bit of a nerve, at least w/me - but am going to acknowlege this is likely coming from a place of anger & frustration. I say that because 225 "Could" put someone in the Mobidly Obese category - someone like me who is 5'1. At 200lbs I was MO, my insurance covered WLS - but I did not meet their requirements. I wanted this - so self pay was my only option.

To say that you are more deserving (and that's what I'm interpreting) is pretty selfish & uncaring to those who wanted to "Prevent" the onset of MO, by getting surgery sooner rather than later. I WISH I did!!! For what it's worth, I have never regretted dropping 15k to essentially save me from future health issues.

I wish you well -

[Daisalana 33]

Well, I understand the need to vent. My insurance wouldn't cover it, and despite the confidence I have in certain Mexico doctors, my family wouldn't back me on it.

But like Ang, I see an entitlement issue with you saying you feel you deserve it more than others. I was 300+lbs in high school, and the only time I was 225lb was maybe in 4th grade. Does that mean I deserved the surgery more than you?

It's not our place to decide who is more 'deserving' of the surgery, and because someone else was approved, that did not result in you being denied, so the rant against people who were approved when you were not, is a bit misguided.

Hope you get things worked out, and if you can convince anyone who would be concerned, to go to Mexico.. for self-pay I think that's the way to go.

[want_so_bad 0]

who are you to know that while someone's bmi is lower they have not struggled with weight issues all their lives? my bmi was never as high as yours and yet i have struggled with weight all my life. to assume your weight issues are more pressing and important than someone else's isnt right. and who are you to harbor such anger against those with lower bmi's that self pay for their surgery? i had a lower bmi to start and self paid. who are you to judge that i didnt need this amazing life altering surgery just as much as you? after reading your post i got this mental image of you jumping up and down screaming like a two year old about how its not fair that sally who-body got it and you didnt. grow up. life is unfair. if you have such problems, self pay and stop bitching about it. countless of us others did it. turn that no good anger at the world around and use it for researching ways to get this surgery if it means that much to you. you have gotten several great ideas suggested here already.

[MacMadame 81]

I'm not directing my comments at anyone in particular.

That doesn't make it okay. It's still judgmental.

Btw, being overly focused on other people isn't the kind of attitude that will serve you well in the long run, especially when it comes to weight loss. After all, there will always be someone thinner than you, who loses weight faster, who loses weight with less effort, etc. You can't focus on that and how "unfair" it is without getting side-tracked from your own situation and your own efforts.