Frustrated

Well, it is January 2008 and I have hit my last road block that is stopping me from getting the surgery.  I found out the the reason my insurance company won't pay for the surgery is that they believe it is too risky and they don't want to take on the risk.  I even sent in an application to the University of Iowa hospital and since my surgery has two (2) exclusions regarding obesity, they won't even put me on the waiting list.  I have been hopeful but now the air is slowly deflating out of my balloon.  I know I could self pay if I could afford it but that is not an option.  I can't try to finance money when I have no extra money.  It is getting harder to walk and breathe for any distance.  My husband now has to help me put on my socks because I can't bend over that far.  I am 38 years old and sitting at 447 and miserable.  I live in Iowa, so traveling is also an issue for long distance.  I know there is no miracle drug out there, because I think I have tried them all.   I have learned that if you think it is too good to be true, it is!  I have cut back on my calorie intake but now since I have a mobility problem, exercise is quite difficult.  I try to do as much as I can.  I even went to the different talk show websites, like Oprah (for example) and told my story but I haven't heard from any of them in over a year.  My insurance is with United Health Care and I even had my HR person contact them, and they won't budge on their decision.  I have went thru 3 levels of appeals with all declines.  I am married but my husband is disabled and can't do alot of part time jobs.  I have two children and I just want to be able to go for a walk with them.  Taking a bath in a bathtub without any aids would make me on cloud 9.  Is there anyone out there that could let a little light in at the end of my tunnel?

Hey, first off I do want to apologize that I dont really have any other words of advice or options I can think of, BUT that  MY HEART AND PRAYERS TRULY GO OUT TO YOU in this time of need and struggle.  I dont know if you have done this already, but you may want to try posting this post to the Insurance Forum and see what kind of responses you get.  Just a thought.  Well, take care and remember that everything will work itself out the way it supposed to in the end.  Just keep praying and trust in God.  He will take care of you.    *hugs* Always, Tonya

Get a different job with different insurance.  I had mine at the U of I....Only had to wait two weeks for an appointment and had my surgery two months from my first appointment date.  I have Blue Cross Blue Shield.  If you can't get a different job, take out separate insurance maybe?  I'd do whatever I had to! Shannon

The only problem with your advice is that there are not alot of jobs in my area that can pay me what I make right now so me and my family can live from month to month. 

Have you tired to see if UHC will approve lap band?  There are very few risks and almost no long term complications.  Yes, you would lose wt slower, but I think it's safer in the long run.   That said, I have RNY almost 4 years ago.  I have nesidioblastosis (the beta cells of the pancreas produce way too much insulin), iron deficiency anemia, for which I get iron infusions every 6 wks or so, and osteoporosis.  If I knew then what I know now, I would never have had RNY.  I would have had lap band.   So now I have only 40% of my pancreas (60% removed in hopes of stopping the low blood sugar), no spleen since the pancreas and spleen share the same artery, I still have hypoglycemia, I have to have labs and infusions every 6 weeks.  I'm not happy about all this. 

Yes I have asked about Lap Band, but that is considered obesity and any type of obesity is not covered.

I understand exactly where you are at.  I was originally approved for surgery in 1999.  Yep, eight years ago.  There was a problem with the insurance and I wasn't able to have the surgery then. We were uninsured for several years after that due to self employment, and then when my DH finally got a job, it had the WLS surgery exclusion.  Unfortunately, when there is that exclusion, there's not a whole lot that can be done to fight it.  :-( I FINALLY got a job last year that had BCBS insurance and I was on top of getting the surgery. Is Medicare or Medicaid an option?

My story is much the same as IowaGirl.  I was all set, and THREE days before the surgery, the insurance company called and said, "Oh sorry, we changed our minds".  I was devestated!!   That was in 2004.  I now have BCBS, and am all set to go in just three weeks.  My first appointment was December 17, & my surgery is Feb 21.   Do what you have to.  I hope things work out for you!!

Go to your loacal DHS office and file for Medicaid.  It is possible that you could qualify. If not for straight Mediciad possibly the Medically Needy program.  Then you have to pay a small portion depending on your household income. GOOD LUCK!!

I know this is a little after you asked the question - but also check into the IowaCare program with DHS.     If you are overqualifed for Medicaid - IowaCare can be an option, and one of the providers is the University of Iowa.