Frustrated

Right now I am very frustrated. I contacted Voc Rehab for assistance. I was told because I am working I do not qualify for any assistance from this office. She further states that there is a new policy in regards to WLS. I asked her if she would mail me a copy of the policy and she advised that it is on the website. I have been unable to locate the policy, and am very upset with the cavalier attitudes regarding obesity. The County that I live in has a written exclusionary clause against WLS. However, it is listed under "Physical Appearance"! I am not getting a boob job, I am trying to save my life! IS THERE SOMEONE OUT HERE THAT CAN ASSIST ME WITH MY DILEMMA?!!??? I am at my wits end and am trying to remain positive, but it is waning......

Can you explain more about your situation? Voc rehab only provides assistance for vocational training, so they would not be able to help you with anything regarding weight loss surgery unless you became disabled as a result of the surgery. As for the county. do you work for the county or are you trying to get assistance from the county services? Do you have medical insurance? I am guessing that you don't and that is why you are looking for help, but it is not clear from your post. I will try and help you if I can with more information. Sherry

Thank you for responding. I work for Wake County and I have United Healthcare for my insurance carrier. Due to an exclusionary clause in the County's insurance policy, under "physical appearance" WLS is not covered. I have been on the OH's insurance site and saw where VR has helped some. I have requested information and had not been successful. Voc Rehab advised that they do not assist with WLS any more, due to a new policy, and in asking where on the site could I look for it, I was told that it is on there somewhere. I am in need of some assistance, other than seeking another job with perhaps the state, and using the State Health plan, I need this surgery done in order to continue to live. Thank you for any assistance that you can provide.

Thanks for the clarification. I am not sure that I can help in your sitation other than trying to get your surgery covered by appealing to the county or United Healthcare or looking at paying for it privately. A lot of people in your situation end up doing it that way, and you might have to consider it if you can't get it covered. The doctor that you met with can probably help you figure out where to apply or how to get financing for the surgery. It looks like that is the only option I can think of. Sorry and good luck! Sherry

Thanks again, unfortunately, if I could afford to pay for the surgery, I would go ahead and be done with it, but because I do not have a few $$$'s in the bank, that is not an option for me. The gentleman in benefits, has been a jewel as far a listening, and I have advised him that any information that I can get to prove my "case', I will bring it to him, however, when a person cannot look you in the eyes when they see you, let' s me know that they have not intention of helping me or changing their plicy. I am not going to give up, I may have to seek employment elsewhere after I investigate their coverage plan. I will hang in there, God is still in the miracle working business.....

I am sorry your insurance company is giving you a hard time. I was under the impression that vocational rehab did pay for the surgery before but apparantly their policy has changed. On a side note, I had Dr. Moran as a surgeon and he was wonderful. Janelle handled everything for me (insurance, appointments) and they were always available to answer questions. If I can be of any assistance let me know. Good luck!

Sorry I wasn't more help. Sherry

Tracy, I changed jobs 3 times, and surgeons twice, took me nearly 4 years, but I finally got approved and had surgery 7 days ago. DO NOT GIVE UP!!! Yes, changing jobs MAY be needed, but I would consider that a last resort. Have you considered talking to Gary Viscio? He's an attorney that specializes in fighting cases where there are exclusions that are based on physical appearance versus medical necessity. Last time I looked, his service was very reasonable considering. He is also a WLS patient himself. His link can almost always be found here on OH somewhere.

Thank you so very much, you have given me some hope! I will not be discouraged I am going to look up the attorney and see what he can do, however, I am fighting a County Government that obviously has more money than I do. The struggle will continue. Thanks again for the support

I also have United Healthcare and prior to my surgery I had called tham to inquiry if they cover the RNY and they said yes as long as my BMI was greater than 40. Then, when my doctor's office submitted my paperwork so that they could get the pre-approval in writing, United Heathcare responded 30 days later telling me that there was an exclusion in my company's policy - - they even quoted it from the insurace policy and named the page and paragraph where the statement was located in the policy. I wrote them back asking them how this could be when I was verbally told by them that I was covered. Sure enough, 2 wks later, I received a letter stating that I was approved (no exclusion in my company's policy - - - so how the heck did they quote it, page and verse?) and that they were sorry for the inconvenience. So my advice, is to fight the denial.