LOOKING FOR GUIDANCE

I filed for WLS back in February of this year. My insurance denied me because my plan had a WL exclusion. I have been fighting them everysince. I then found out that the same insurance paid for a person I work with to have the WLS.( I am very happy for them!) I fought even more. The insurance co. then called me and asked me to have the doctor refile EVERYTHING. I was soooo excited, I could see the light at the end of the tunnel. I called the insurance co. yesterday and they have denied me again, this time the reason given is that I haven't been morbidly obese for five years, only 2.........but close for 3. I cried on the phone . Now what ? The girl on the other end said it was too bad that my blood pressure wasn't high........by the set standards (although high for me in my thinner days) because that would be a co morbid factor ,then I would be approved. Any suggestions? She said I should see the family doctor and have her go over everything......she even said diabetes is a shoo for WLS? I am sooo depressed, I don't want to be Obese another day much less three more years just to get medical attention......Thanks everyone for letting me whine.

Here's some info: Individuals who are morbidly obese have a dramatic increase in the number of serious diseases which they acquire, and an impressively shortened life span. Amongst the major causes of death in the morbidly obese are: heart attack, stroke, and diabetes. Other serious, and potentially life threatening problems commonly seen in the morbidly obese include: hyperlipidemia, hypoventilation (sleep apnea syndrome), kidney disease, deep vein thrombosis, pulmonary emboli, and pulmonary hypertension. While all of these diseases are seen in the general population, they are much more common, and often more severe in the morbidly obese. For more info on obesity and it's challenges, see http://www.drhaicken.com/aboutobesity.html There is also a legal firm working on behalf of obese patients - check it out at http://www.obesitylaw.org I believe they file motions based on discrimination and use the Americans with Disabilities act as well as the insurance company's own approval history. There are lots of resources on this website as well. Good Luck. I hope you get approved soon. GJ

Geni - I agree with Georgine. I am not what actally causes an insurance company to approve one case and deny another simular case. I am aware that at times it also depends on who the approver is and what conditions the person has as issues. If you have been denied twice - I would recommend fighting this until you get an approval. If I were in the situation - I would get an attornery. Not sure what the number of years has to do with all this. To deny because you have not been obese for 5 yrs has to do with this - check with an attorney.

there is an attorney who does nothing but take care of us and fight the gov and insurance cos. So many have used him, but my memory fails. Perhaps you can look him up in the library. He is so busy it may take awhile, but there is a flat fee. And he will tell you up front if you have a chance. It is something like Obesity Law. I wish I could remember his name.

Thank you , all ,for your advise and support. I am so glad that this website is here and that I have folks like you that I can go to. I am not giving up and I saw my family doctor the very next day. She has taken up my cause and so on I go! Bless you all and thank you . Geni H