OK... any comments or ideas on this letter to my HR Director?
As you know, I have been trying to get certified with Aetna to undergo RnY Gastric Bypass Surgery. I decided to look into this after my PCP informed me that it was medically necessary to deal with my condition of morbid obesity and my related comorbities after years of attempting to combat it with unsuccessful dieting, nutrition and exercise programs.
Our current health plan covers such treatment, but won't after Jan. 1 unless our company buys an additional rider.
Here's a brief history of what I've been going through:
In May, I was very close to getting approved by United Health Care, when I learned we'd be switching to Aetna. I began researching Aetna's requirements and going through the steps to approval. My initial plan was to postpone the procedure until our magazine went into bimonthlies next June, so as not to impact production of the magazine. In August, however, I learned (and not from Aetna or anybody associated with them) that Aetna was eliminating coverage for weight loss procedures after Jan. 1 of 2005 unless employers opt to purchase an additional rider to cover obesity-related procedures and treatments. I confirmed this with Stacie, who spoke to our Aetna representative.
I had hoped to complete the three-month multi-disciplanary education program, then undergo surgery over Christmas, after shipping SF1. Aetna's in-network doctor, however, doesn't operate after the second week in December because of the holidays.
When it became clear I wouldn't be able to make the deadline, I decided to see if I could self-pay for the procedure, which again, has been prescribed by my doctor as being medically necessary.
Unfortunately, that has become an unrealistic option at nearly $23,000.
So, now I am back at square one.
For that reason, I would like to formally request that our company purchase the additional rider to cover weightloss procedures and treatments for employees.
Again, our current plan offers this benefit. After Jan. 1, unless we take proactive measures, it won't.
In an era of ever-dwindling benefits, this could be one of the most important that an employer could offer its employees. If our workforce is representative of US Society, it would be a benefit of interest to a significant number of our employees and their family members:
? Obesity is the second leading cause of death in Americans and is considered a medical problem by the National Institute of Health.
? Approximately 127 million adults in the U.S. are overweight, 60 million obese, and 9 million severely obese.
? The number of adults who are overweight or obese has continued to increase. Currently, 64.5 percent of U.S. adults, age 20 years and older, are overweight and 30.5 percent are obese. Severe obesity prevalence is now 4.7 percent, up from 2.9 percent reported in the 1988 - 1994 National Health and Nutrition Examination Survey (NHANES) by the Centers for Disease Control and Prevention (CDC).
? Obesity increases the risk of illness from about 30 serious medical conditions.
? Obesity is associated with increases in deaths from all-causes.
? Individuals with obesity are at higher risk for impaired mobility.
? Overweight or obese individuals experience social stigmatization and discrimination in employment and academic situations.
I hope this request will be seriously considered. Our current coverage includes it, but Aetna is deciding to limit that coverage, and thus our benefits. Please contact me if you have any questions or need any more information. I look forward to working on this with you.
Ted,
I'd add some information in there about the statistics (NIH?) regarding the exrtremely small percentage of morbidly obese people who are successful at losing weight and keeping it, and the fact that surgery is the only real solution. Otherwise, we all know that "normal" people think we're just lazy, undisciplined people and could lose the weight if we just stopped eating and started exercising. So why should they pay thousands of dollars to allow their employees to take the "easy way out."
Also, you may want to add in there the costs to business in terms of lost productivity, increased sick time use, etc. You touched on the increased risk of illness and death, but try to concentrate less on the attractive employee benefit aspect of it and make it more attractive to their bottom line. Frankly, unless you work for an exceptional company, that's what they're going to care about.
Good luck.
Janice
Hmm...I'm not sure I understand this reply, since there's only one person on this thread that has had surgery. The original poster has been denied and is trying to get his employer to change insurance companies, and may or may not be successful. I have a future surgery date listed, but I'm self-paying because my insurance company won't pay for my surgery.
Having said that, I guess I may be lucky from your perspective, since my insurance will pay for an RNY. However, since I've chosen not to have an RNY but to have the DS instead and my insurance company refuses to pay for that, I'm having to self-pay. I'm traveling to Brazil, though, since it's a fraction of the cost of having it done here. It will cost me about $10,000 total for surgery, airfare, and hotel for a two week trip. I plan to take out a home equity loan to pay for it and once I add in some of my other debts, I'll be paying less per month than I currently am for those debts, plus getting my surgery in the process. And it's tax deductible, so it will end up being even less, although probably not much.
I don't know your situation, but if there's any way for you to come up with about $10,000, or possibly less depending on where you go and what type of surgery you have, there are many surgeons outside the U.S. with excellent credentials and experience. You may already know this, but if not and you want further information, email me.
Janice
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