Question:
Shouldn't people be truthful?
I'm a little concerned about some of the things I'm reading on this site about people trying to deceive doctors and insurance companies so they can have WLS. Putting quarters in your bra and pockets to increase your weight or stooping to make yourself seem shorter...or planning to gain weight to reach the required BMI to have WEIGHT LOSE surgery. What's going on? I would do cartwheels if I were only 100lbs over my ideal weight....which I think most would agree "ideal" weights are sometimes unrealistic. I realize some people may not be that much overweight and still have co-morbid conditions, but then there is no reason to lie about your BMI. Does anyone think the increase in people getting this surgery is leading more insurance companies to exclude it? — Sarahlicious (posted on February 7, 2003)
February 7, 2003
No. I think it is just the opposite. More people are having this surgery
because more and more insurance companies are paying for it. It is
becoming more acceptable to have the surgery. Not such a stigma as in the
past.
— susan P.
February 7, 2003
I didn't deceive my doctors to get WLS, but I was *only* 100lbs over. I got
the surgery BEFORE I went any higher. I feel for people that have much more
than 100lbs to lose. My problems (and weight) are just as much a problem
for me, as someone else's problems are for them. It's not fair to say
*only* 100lbs over. It may not be as much as other people, but it's a lot
for ME. Insurance companies don't want to pay for much of anything. Some of
them don't cover birth control pills, but they cover a pregnancy. It
doesn't make sense.
— Diana L.
February 7, 2003
I think that Sarah's point about being honest is a good one. Not only will
deception cloud the reputation of this surgery but insurance fraud is a
very serious matter if you are caught. I understand the desperation of
people who are just at or under the 40 BMI mark (as I was). I was afraid
that I would just be under (my weight fluctuated between 7-10 lbs
presurgery with no rhyme or reason) and I *briefly* (for about one second)
considered the quarters/ankle weights to make absolutely sure I was at 40
but decided against it.
Good thing I did because the nurse wound up moving my ankles on the scale
and also giving me an inoffice EKG and I would not have time to have gotten
rid of any "extras".
Also, I qualified (just at 40) so the paranoia was for nothing. I do,
however, understand the desperation. I would caution those way out range
who want to eat their way into range but if you are at 38 or 39 and just
need a few extra pounds to get to 40, find them the natural way. I agree
with Sarah that pennies and ankle weights are dishonest and not only could
cause insurance companies to tighten the reigns, but if you are caught,
fraud is one of the most serious things you can be involved in. Please
don't do it.
— susanje
February 7, 2003
I think it is great that people are getting their insurances to pay for
this surgery no matter what they have to do to get it. All these years
people pay and pay and pay to have insurance.....it's about time we get a
little back in return.
— DRutherford
February 7, 2003
My opinion is neatral here but I do know Dr.s that will make you shorter
also to make your BMI higher so it isn't just people wanting the surgery!
— cathywalden
February 7, 2003
Good questions. I am about 75-100 overweight still, I've lost 160 in 9
months. I would not have WLS at this weight, no way, no how. Think of it
as Karma for those who deceive their physicians, they are the ones who have
to live with the consequences! Hopefully, those who lie to get surgery
have happy outcomes but you never know. I know I've been to post-op
meetings where there are people who look fine to me that are wanting
surgery, they're not even that overweight! Everyone has their reasons but
in my humble opinion, it's not a good idea to lie to get what you want.
Oh, and my ideal weight is around 130lbs which I will never weigh and will
not try to get to!
— jenn2002
February 7, 2003
I work for an insurance company and this year they will stop covering WLS.
I think it is due to several different things (I don't agree with them not
covering the surgery) but we have had many cases of fraud against patients
(not the doctors) where they did things to get the surgery approved and
then bragged about it on a PUBLIC WEBSITE and people who did not have
insurance or their insurance did not pay for WLS called and reported them.
We then reversed the approval and took back the money and they are now
responsible to $50,000 + in medical bills. We have now started (even though
we will discontinue coverage this year) advising surgeons that they may
need to change some of their office pratices to insure that their patients
are not "pulling one over" on them.
— Sharon H.
February 7, 2003
I have a real problem with people doing things to make theri BMI appear
higher, just to get approved. I also think the surgery is becoming more
popular for several reasons.1. More media coverage of high profile cases
leading people do look into it for themselves. 2. People are learning
surgery is not just for the super obese. 3. As more people have surgery,
word of mouth spreads the positive effects. 4. Obesity as an epidemic has
caused more interest in the surgery. My insurance company had a limit of
surgery for those with a BMI over 40. My husband has a BMI of 38.5. We
appealed the denial and it was reversed, and the criteria was also changed
so that those with a BMI between 35-40 with co-morbids "and so forth'
could qualify. (I like those 3 little words - it leaves the door open for
other conditions that may not me co-morbids but impact the need for
surgery!) I think being honest with your surgeon from the beginning is
very important. I also wonder how well people do who lie to get the
surgery, after they have the procedure. It seems their energy may be so
focused on getting approval they don't do that well afterwords. I think
insurance companies are excluing it because of cost.
— koogy
February 7, 2003
Sarah, I agree with you about honesty. I am glad some of the insurance
compasnies are paying for the surgery but those that deceive and practice
fraud are the reason our insurance rates are so high. People on fixed
incomes can barely afford it. Some people cheat and everyone pays the
price. It is not a GREAT THING. The same with doctors and malpractice
insurance. Some surgeries have been cancelled lately because doctors have
walked out . If people would stop frivously suing doctors, their ins.
rates wouldn't go up but some people look for anything to sue over and we
all pay the price. It is a sad day in America when people state that they
think it is GREAT that people are lying to get this surgery. Just my 2c
— Delores S.
February 7, 2003
I'm glad the poster from the insurance company chimed in. I'm alway amazed
when I see people posting (often with their full names) who encourage or
defend insurance fraud. At the very least, you gotta think about the
likelihood that someone's going to see your post and report it. At the
most, you gotta think about the effect of encouraging fraud in a world that
still doesn't believe in this surgery and doesn't understand why we don't
just push ourselves "away from the table" instead of seeking WLS.
It's going to be hard enough to get insurance companies keep paying for
this surgery, as we get heavier as a society, and as society starts to
realize how expensive this surgery is when the popularity increases.
People are going to do what they're going to do, but it saddens me to see
some of the responses justifying fraud. I strongly suspect there's also a
higher chance of long-term failure with the surgery when some of those same
folks think the pouch rules *also* don't apply to them. :)
— Suzy C.
February 8, 2003
I have to comment to this one. I have suffered for over 7 years to lose
weight. Try everything from the extreme and unsafe to a carefully monitored
diet by my doctor. People have to understand that this surgery is to treat
a medical condition for the men and women who need the assistance of modern
medicine to save the life of this person. Why anyone would want to have
major surgery (excluding cosmetic) to reroute you intestines, staple or cut
in half your stomach or to permantly have a device in your system is beyond
belief. I also think magazines that promote an unhealthy (starved) image to
our young girls and boys has something to do with it. I hope that once the
"fame" of this surgery dies down people without serious weight
problems will understand that this surgery is nothing to take lightly.
Insurance fraud is nothing to joke about and insurance companies should go
after people who do it. I would rather that than to have yet another
increase to my insurance benefits like last year.
— Deborah M.
February 8, 2003
Hi Sarah, I am going to add my 2 cents here and fully expect to be slammed
myself. I am a nurse and work in a hospital. I see patients
"frauding" all kinds of things. And you know who eventually pays
for it?? YOU AND ME! Now I think WLS is the best thing in the world and am
so blessed to have been able to get it and I was well over 100 lbs over
weight. My insurance company paid almost all of it but I of course have to
pay the premiums and what was not covered. What makes me mad is that
medicaid will pay 100% of this for people and some of them are NOT 100 lbs
over. We pay for medicaid. So essentually we are paying for some of these
people to have free surgery while we are having to pay for our own. I am
sure I am going to be slammed bad, but seeing the abuse of insurance and
medicaid use in the hospital and seeing what my family has to pay to get
medical insurance makes me irrate. SO to LIE about your BMI, or your weight
or even your need for WLS doesn't make me thrilled. I am one tax paying
person that is tired of paying for everyone to have the freebies while
those of us who work hard have to pay out the wazoo for our healthcare.
These people who fraud are the reason for the high cost of healthcare and
one reason why some people who absolutly NEED this surgery can't get it.
They are jumping through hoops because of the liars.
OK theres my 2 cents. Slam me.
— Gina D.
February 8, 2003
GINA you go girl. You spoke what the rest of us honest people are thinking.
— Delores S.
February 8, 2003
Gina, I am in both boats. I don't have to lie about my weight problems
(5'4" 328lbs BMI 56.3), but I have worked as a nurse in a doctor's
office and hospital. I've seen patients lie to get pain meds, procedures,
etc.. It's sickening. I'm also on Medicaid and praying they'll cover my
surgery. I will say that at "just" 100 lbs overweight I didn't
consider surgery, but didn't know it was an option. Not sure I would have
done it at that. Especially since I didn't have many co-morbids at the
time. Now, I can't perform ADLs, so surgery, for me, is lifesaving.
— gyverbabe
February 8, 2003
Hello everyone! I want to start off by saying that this is a rather
interesting question, and I thought I would put in my own 2 cents, for what
it is worth. *Lol* I think that advising someone to "cheat" to
get their BMI high up enough to have surgery is just another example of the
moral fiber of the world coming apart. Now, I understand that people with a
lower BMI should have as much access to this surgery as someone like
myself, who has a BMI of 81.5+. But to go in to your doctor and to cheat
and lie just to get the surgery is just not fair to others who need it just
as badly, if not more so, than the person cheating. Yes, it might be a
novel, or cute idea. But in the long run, it ends up making the surgery
lists longer, the patients more despondent, and the insurance companies
wary of covering this for the people who really need it. There are a lot of
people out here who are depending on this surgery to save them from an
early grave, and to do something for oneself that could affect more than
just oneself is very selfish, at best. And one last thought. My grandfather
had a saying. If you don't want to get caught doing something...don't put
it down in writing. Let's just hope anyone who bragged about it on here did
not get spotted by their doctors. That might just be a little bit
embarassing. Anyways, have a great day, all. And God bless.
— Lisa S.
February 8, 2003
Oh, and I forgot. Gina, you rock! You said what is part of the problem in a
succinct manner. My mother used to be a nurse, and she would talk about how
some people would fake injury, just to get pain meds, and it was all paid
for by Medicaid. It used to infuriate her. I think your opinion was quite
valid.
— Lisa S.
February 8, 2003
"ONLY 100 lbs" Wow, to me that was a lot of weight. I have just
lost down to 99 lbs. at 15 months post-op. This surgery has saved my life.
I was the epitome of miserable. I had a huge list of co-morbs and I felt
like my organs were suffocating and felt like I was on the brink of death.
A friend of mine was almost 200 lbs. over her ideal, but called herself a
'healthy fatty' because she felt great with no co-morbidities. And I was
stressed over whether I would qualify with a BMI of 38 point something. I
purposely gained a few pounds to be absolutely positive that I would
qualify. I was doing this as a fight for my life. Would my friend be a
better candidate for the surgery, having no problems? And I not qualify
with my extensive list? All because of some numbers used as guidelines. I
think that they should always look at the WHOLE person and thier medical
history. I also have been obese my entire life. What about those who are
MO, but have only been for a short time? Many things should be taken into
consideration for qualifying each individual. I don't think that the BMI
can tell the whole story. This surgery has been the very best thing that I
have ever done for myself and my health. I never considered doing the
pennies in the pocket thing, or the weight belt or whatever. I had the
same suggestions 2 years ago when I was waiting for my surgery and was
stressing over qualifying. I had issues with the dishonesty. But putting
on a few lbs. during my last supper syndrome was no problem, I would have
done it anyway. And also, everything is relative. You said you would do
cartwheels if you were only 100 over. Well I used to think the same thing
about people who said they wanted to lose 10 or 20 lbs. But now I want to
lose that much and it is just as difficult to lose at this weight as it is
at a higher weight. When you are 50 lbs. over what your body is used to,
your clothes don't fit, you're tired all the time, blah blah blah and can
be just as miserable. Now I can't say I know what it is like to be super
MO, and I truly have sympathy for those who are. I cannot even imagine. I
felt I was at the end of my rope at ONLY 100 over. And I also feel that we
shouldn't judge others when we haven't walked a mile in their shoes, or try
to walk to the corner in their shoes, without huffing and puffing and
gasping. IF you know what I mean. I pray that your journey will be a
successful and exciting one. Enjoy! Lap RNY 11/09/01 245/146/maybe 10
more:~)
— Cheri M.
February 8, 2003
If you have cancer or diabetes or heart disease, etc. you have that
disease. You don't have a little cancer or a little heart disease, you
have it, period. So, to say that someone is "only" 100 lbs
overweight is not right. I'm very sorry when I hear about those who are
super M.O., but at 100 lbs overweight, I had enough health problems that it
didn't matter if I just barely qualified. I know that my health problems
were related to the weight now because after losing 102 lbs, all my issues
are resolved except for the arthritis. So, I'm not commenting on the
insurance fraud issue, but as to being "only" 100 pounds
overweight, don't pass judgement on others. I know of MANY super morbidly
obese people who wish that they could have had the surgery at
"only" 100 pounds overweight because they wouldn't have gotten
many of the conditions that have caused them so much pain and suffering
over the years.
— cjabates
February 8, 2003
To add one more thing, state governments need to get involved and require
insurance companies to cover this surgery when it is medically necessary.
In Virginia, there already is this law. Of course the insurance companies
will fight it, and probably raise their rates, but having insurance is
better than self pay any day. I pay $821.10 per month for insurance for my
family, and I've complained about the cost, but when my son was in the
Neonatal ICU after his birth and the bill was $37,000, I was VERY grateful
to have that insurance. You never know what is going to happen or what
surprises will crop up in life.
— cjabates
February 8, 2003
Original poster here...I realize that I have adapted to my weight very well
over the years and can probably handle my extra pounds better than someone
who put theirs on more quickly no matter what the difference in numbers is.
I have a friend who is pregnant and she tells me she doesn't understand
how I manage because she feels so weighed down with her extra 30 lbs. At
least I know when I get pregnant I'll know all the tricks to getting my
shoes on!
— Sarahlicious
February 12, 2003
I agree with you totally!!!! I do see in the future insurance companies
buckling down on this surgery due to people just wanting to get it, just to
get it, as opposed to people like myself who was 240 lbs OVERWEIGHT. I
just hope that this doesnt effect the people who really need this surgery.
It really bothers me to see people who are barely over 200 lbs getting the
surgery, because there are people out there who are extremely overweight
and fighting with their insurance companies. This surgery needs to be for
HEALTH, not a TREND. Whew...thanks for letting me vent. lol
— Shavonne P.
February 12, 2003
I liked this question till I got to the part of "Just" 100 lbs
overweight. I am looking at having this surgery myself as I am
"JUST" 110 lbs overweight with sleep apnea diabetic and high
blood pressure. I certainly hope that I get approved so I don't continue
going in the up direction but in the down direction instead. I realize that
I need this added tool in order to do so. It sounded to me like you were
saying those that were as overweight as I am not seek the surgery at all.
Maybe I was wrong in reading it this way but please give us ones that are
"JUST" 100 lbs overweight and need the surgery a break as
well.It's inportant to us too!
Barbara
— Barbara T.
February 12, 2003
I think that I can give an interesting point to this one. Ofcourse I do
not condone any type of insurance fraud. I have a child with severe
dissabilities and have had to fight until the end to get him the services
he needs from my insurance company. As an end result I had to temporarily
give up custody of my son in order to get him the services he needs. (He
needed residential care at over 150,000 per year) I still haven't given up
hope and I testify to congress in order to try to have bills passed to make
changes. Please pray for me that my son will be able to return home to me
soon. It was the absolute hardest thing I have ever had to do in my life;
however, he is doing very well and I would do it again if I had to. I think
that insurance industry needs to be overhauled in all aspects which I'm
sure fraud has had a hand in.
That said....I was "ONLY 100lbs" overweight when I first
attempted to have surgery. I had been fighting with insurance and
commissioners for so long that I decided to self-pay because my insurance
company was to rigid to get approved and I didn't have the fight in me
anymore. I had my surgery scheduled for 10/18/02 and I had second thoughts
because other than achy joints, depression and mild asthma I didn't have so
called co-morbs. I decided that I could lose the weight after all I wasn't
super MO and I didn't need as much as they did. Well, since then I
developed a cold and had the worst astham exaserbation that I've ever had
which had a lot ot deal with my weight. You see, I've only been MO for
over a year; however, my weight has steadily climbed over the last 9 years.
I am now basically house bound because I can't walk to my car in the cold
weather without going into an asthma attack. I can't play with my
children, my son with special needs comes home on the weekends but I have
to have someone take me to get him on cold days. I'm only 29 years old and
my youngest child is 2!! My children shouldn't have to spend their
childhood with a mother like this if it is preventable. Since being
homebound I have gained 20 lbs due to inactivity and depression. So,
usually people who are 100lbs overweight don't stay that way. I am now
120lbs overweight and am scheduled for surgery March 20th. I wish now that
I had my surgery in October. I look at it as if "why delay the
inevitable if you don't have to" Again, don't fraud the insurance
companies because all people suffer because of that in some way or another.
God bless to all.
Please don't send negative comments regarding my decision to seek the best
optimal care for my son. I did this with much deliberation and years of
trying to receive care for him. I posted this with a heavy heart in hope
that it will help people understand how fraud and deception can hurt even
our countries most precious comodities. CHILDREN!!!!
— denisel
February 13, 2003
Wow what a thought. I must be naive, because I can't imagine people making
putting themselves at a higher risk. This suregry is not for the faint of
heart nor is it for the person that just wants to look good. So, I am
300lbs...I still look good! If there were no such thing as WLS, I would
have to go anyhow.
I think the insurance companies will buckle down on the requirements. I
don't belive they will stop approvals. Too many lawsuits for those of us
who really need the surgery will arise.
As far as being "just" 100 lbs over weight I don't think she
meant to claim that it was a good thing or a reason not to have WLS. I
believe that is one of the requirements for some medical facilities and
insurance apporvals. That is really not the point.
Just like every thing else, there will be capped placed on the WLS, and
then that should weed out the "others". However, being obese
causes mental issues...therefore psychs et al...will be in on it too. LOL
— Laaliyyah M.
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