Finally!!!! yipee! yikes! Can you believe it from a self funded company with an exclusion!

Hi Everyone, Its been awhile since I have posted but I have been lurking. For those *****member I have been trying to get my surgery approved from my husband employer who had the exclusion for weight loss surgery. I had my doubts since they were a self funded company from everything that I had heard about, things didnt look to good. I had to wait a couple of months for the trustees meeting over some technicalities but..... They read my letter along with all the doctors letters and APPROVED MY SURGERY in 3 days. I still cant believe it. I got the letter today! My surgery is scheduled for August 17th. MY birthday. I feel that if anyone wants this surgery bad enough dont give up. I had the rep from the the HR department tell me they werent going to approve it because she has read all my information and said its for weight loss and they dont cover anything for weight reduction and they specifically said Gastric bypass surgery. I told her that I wasnt going to base the rest of my life on her personal opinion and that I wanted her to present my letter to them anyway. The point is dont let people intimidate you! and give up. I do feel fortunate that my husband trustee committee is very compassionate as they could have flat out denied me based on the exclusion. They made the exception so it can be done. Now I am nervous and scared as all get out. I go tomorrow to see the surgeon. I put things on the back burner so I wouldnt emotionally get so worked up but now I need a crash course again on what to do and how to eat. If anyone has some tips or suggestions PLEASE tell me. I need all the help I can get right now. If you want you can email me. I appreciate all your help. Thanks in advance, Sharon

Sharon, Congrats on winning the insurance battle. They can be a nightmare as I read....I didn't experience that. Are you seeing the CHRIAS surgeons? If you are they have a program through PMRI that go over everything you need for this surgery. PMRI has support meetings too. See the CHRIAS site at ChristianaCare.com and you should find out the info on the next support meeting and topics! Good luck! Debbie

Hi Debbie, Boys are we up late! I've been nervous all day since I got the letter. Yes I am seeing Dr. Wynn. She will do my surgery and Dr. Iragu will be doing my appointment tomorrow. I will check out the web site. Thanks for the info. I heard from Mary Ellen when I went to St. Francis that they would be moving the meetings and their offices to Delaware. Do you know if they did or is the PMRI meeting one in the same? Sharon

Sharon, Congradulations !!!! I think your post will give so many people hope. There is rules with insurance companies but they do look at the bigger picture when things are presented to them in the right manner. The best advise I can give you is attend as many support groups as you can. This is where you will find an answer to any guestion from the people who know from being in your shoes. Keep posting and reading post. We are all in this together and always remember you are never alone in this battle of Obesity. Check out people's profiles whenever in doubt and please feel free to email or call anyone. They will be glad to hear from you. See you lighter. Joanne

Hi Joanne Thanks so much for the support!! I've been reading profiles for a long time and have gained alot of knowledge from them and encouragement. I plan on finding a support group close by so I can continue to receive support as I make my way on this journey. I dont know that I did anything different in my appeal but I do believe anyone who wants/needs this surgery needs to be totally humble and honest about why you need this surgery but yet not begging. I feel fortunate to have my husbands employer willing to cover the surgery after hearing two people in the HR Dept. say they dont think it will be covered. If you never submit by taking someone elses word, who has no part in the decision making, you'll never know what could have been. Thanks for your support and encouragement. Sharon

HUGS Welcome to the family... I had this done almost a year ago and although it is nerve wracking, it's well worth it. Sorry I'm not more chatty. Hugs again Rachel

Hi Rachel, Thanks for the welcome. I have been on the board since January of this year and posted for awhile and then became a lurker. I remember seeing your picture and your posts. Hopefully now I can put a picture up too. Where are are the people? It seems like noone post much anymore? This board use to be booming! Hopefully its because its summertime and everyone is busy. Anyway, I'll be seeing you on the boards. Take Care. Sharon

Hi Sharon, The lack of ppl is one of the reasons I forget to come back as often as I should. It's hard to want to come when you don't get answers but peoples lives change, things happen and I TRY to understand that, just wish I didn't always seem to get the shaft. Hmm... Anyway, I've got to get to bed... it's midnight and exhausted!! HUGS Rachel

Sharon, Congrats. Some Insurance co's are starting to ease up a little. Thank Goodness. This is no easy journey. What a great b-day present for you. Stay focused & positive. Get the chap stick ready. Have you been to any support group meetings? It's cool to meet others and talk about your concerns & sponge information in both pre & post WLS. Good luck. ((HUGS)) Elissa

Hi Elissa, Thanks for the support. I have the chapstick ready. LOL I havent been to any support groups. Right now i am out of town but will be back by the weekend. I NEED to start going. I just need to find the closest one to elkton, MD. Hopefully, there will be a few that I can go to this weekend. Take Care. Sharon