EXCLUSION AND DENIAL OF INSURANCE
Hi to anyone who wants to listen. Insurance companies have started excluding WLS from their policies as they renew this year. I have UHC and discovered after our renewal of our group policv in April. I am 62 years old, diabetic, HBP, severe pain and arthritis, and more. My current weight is 350 lbs. I'm on 12 different medications and have been hospitalized 4 times in the last 6 months. I have 3 doctors who all agree this would be considered a medical necessity.
I would like to hear from and correspond with others in the same boat. There must be some way of banding together to fight this.
Insurance companies will pay to transplant all my internal organs and then pay for the medications to prevent rejection for the rest of my life; but, they will not pay for a relatively "inexpensive surgery" in comparison. Help!
I also have United Healthcare PPO and I was told that they dol cover it when I called their customer service line. I was also told they cover it by the rep at Weight Loss Center in Orange Park, who works with Dr. Webb. Have you been officially denied? I'm hoping to find out within the next two weeks if I'm approved. I have completed all prerequsites except for the PCP letter of recommendation.
Hi I agree. I recently posted on the main message board my dilema 7/7/04. I too work for a organization that placed an exclusion (per the insurance representative at United Health Care Choice Plus) this year not to cover WLS. I have always as a child be chubby and heavy so as I grew older I learn to accommodate and grow to love this beautiful total package 
that I am. Over the course of the last 5-8 years I have developed some health issues, hbp, gall stones/bladder, leg lymphodema, allergies, gerd, pneumonia to name a few. Most recently due to my weight..I'm 5'5 and currently sashaying I'm somewhat embarrassed to say close to 400 pounds. Thus my leg lymphodema has gotten worse, with the pain, the tenderness and hard knots on my legs from the failure of the lymph system to work as it should. Over the course of many years I have tried almost every diet known, to only lose and once I stopped I regain and accept/add more pounds to this "total package". The last major attempt was a combination of Xenical and Fit America..I was successful as long as I had the funds to accommodate this expensive venture. But unfortunately, since the insurance would not cover the meds or products, and my savings could no longer endure the monthly withdrawals of funds, I gain every pound lost and added about 40 more.
The pcp that I went too would all say basically the same thing...lose the weight...exercise...go on a diet...None of them seems sensitivity enough to want to talk or listen to the pain and fear that I am feeling and experiencing while also attempting to hide these fears from others about my weigh and how I want to live and be that healthy person that God wants me to be.
Recently, I again contacted the insurance to get a copy of my policy exclusion as this information was not accessible on line through their web site. I'm awaiting for that to come in the mail so that I can see for myself this exclusion and then I'm considering contacting the Human Resource Director to see what can be done.
Currently, I'm without a pcp as the last one that I had contact with seemed attentive, referred me back to the specialist regarding my leg lymphodema, again reminded me of my high risk factor of the high blood pressure, and weight, yet when I attempted to make contact with him after consulting with the specialist he seem to be avoiding me or lets say was not responsive to my messages that I'd left personally with his office manager. She assures me that he received the messages and that he is usually very thorough in returning the calls. I have attempted to reach him three times and finally the other day I went into the office to confront him only to be informed that he was in a meeting and if I wish to make an appt I could do so. At that point my conclusion about his behavior was obviously he has too many patients to return phone calls, for some unknown reason that I'm not aware of feels the need to avoid me, he really isn't as sincere and attentive as I thought.
SO I NEED TO FIND A PCP.
Hopefully one who is sensitive and has a history of dealing with beautiful obese people. If anyone reading this can offer any names of doctors I would greatly appreciate it. I'm in the NW section of Miami. I'm hoping to establish a relationship with a pcp in the surrounding area, Hialeah, Miami, North Miami, North Miami Beach, Miami Lakes, etc. Hopefully close to work or home environment.
I don't know if I would or will ever be able to get the WLS but making a sensitive pcp could offer some other methods or suggestions to prolong my enjoyable day on earth.
Thank you for allowing me to vent a little and I hope that someone reading this might be able to offer some suggestions.
that I am. Over the course of the last 5-8 years I have developed some health issues, hbp, gall stones/bladder, leg lymphodema, allergies, gerd, pneumonia to name a few. Most recently due to my weight..I'm 5'5 and currently sashaying I'm somewhat embarrassed to say close to 400 pounds. Thus my leg lymphodema has gotten worse, with the pain, the tenderness and hard knots on my legs from the failure of the lymph system to work as it should. Over the course of many years I have tried almost every diet known, to only lose and once I stopped I regain and accept/add more pounds to this "total package". The last major attempt was a combination of Xenical and Fit America..I was successful as long as I had the funds to accommodate this expensive venture. But unfortunately, since the insurance would not cover the meds or products, and my savings could no longer endure the monthly withdrawals of funds, I gain every pound lost and added about 40 more.
The pcp that I went too would all say basically the same thing...lose the weight...exercise...go on a diet...None of them seems sensitivity enough to want to talk or listen to the pain and fear that I am feeling and experiencing while also attempting to hide these fears from others about my weigh and how I want to live and be that healthy person that God wants me to be.
Recently, I again contacted the insurance to get a copy of my policy exclusion as this information was not accessible on line through their web site. I'm awaiting for that to come in the mail so that I can see for myself this exclusion and then I'm considering contacting the Human Resource Director to see what can be done.
Currently, I'm without a pcp as the last one that I had contact with seemed attentive, referred me back to the specialist regarding my leg lymphodema, again reminded me of my high risk factor of the high blood pressure, and weight, yet when I attempted to make contact with him after consulting with the specialist he seem to be avoiding me or lets say was not responsive to my messages that I'd left personally with his office manager. She assures me that he received the messages and that he is usually very thorough in returning the calls. I have attempted to reach him three times and finally the other day I went into the office to confront him only to be informed that he was in a meeting and if I wish to make an appt I could do so. At that point my conclusion about his behavior was obviously he has too many patients to return phone calls, for some unknown reason that I'm not aware of feels the need to avoid me, he really isn't as sincere and attentive as I thought.
SO I NEED TO FIND A PCP. Hopefully one who is sensitive and has a history of dealing with beautiful obese people. If anyone reading this can offer any names of doctors I would greatly appreciate it. I'm in the NW section of Miami. I'm hoping to establish a relationship with a pcp in the surrounding area, Hialeah, Miami, North Miami, North Miami Beach, Miami Lakes, etc. Hopefully close to work or home environment.
I don't know if I would or will ever be able to get the WLS but making a sensitive pcp could offer some other methods or suggestions to prolong my enjoyable day on earth.
Thank you for allowing me to vent a little and I hope that someone reading this might be able to offer some suggestions. Most Active
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