Insurance company

So, I sent a nice email to the insurance company today.  I also sent it to my PCP.  I hope that this email gets them thinking about how ridiculous their policy is.  See an excerpt from the email below:

I have been researching WLS and after discussing this difficult decision with my PCP, have decided that this is the best course of action for resolving my weight issues.  I am at the point of trying to get insurance approval.  I have decided on a bariatric program and procedure (Lap Band), only to discover that my only best course of action will be to wait until next May/June to enroll in UKPPO, which is something that I do not want to do.  Prior to my research for a surgeon, I had every intention of coming to UK for this procedure.  However, I have since discovered that the UK Bariatric Program is defunct and when they were active did not provide the procedure that my PCP and I have agreed upon.

  My family history and personal medical history are such that I need to lose the weight or I will be dead before the age of 50.  I truly want to see my niece and nephew grow up, get married and have kids of their own.  I find it extremely discriminatory that I can not get approval for my WLS because I would have to go to an out-of network provider.  Why am I being penalized because there are no in-network providers that provide this service?  It is, also, especially disheartening when I am hearing from others, in my research, that they had no co-morbidities besides an elevated BMI and they are getting approved in under 24 hours for their surgeries.  I am 31, with a BMI of 46.  I have non-alcoholic fatty liver disease, which has been tied to directly to my weight.  My blood pressure is consistently elevated at my doctor's visits.  My cholesterol is over 200 and I am also currently being treated for depression, which according to the NIH is a weight-related co-morbidity.  I have been on and off Weigh****chers since the age of 15 and while I have had success losing weight initially, I can not seem to maintain those losses.   I am not trying to be difficult, but from my perspective UKHMO would be saving money in the long run by allowing my to have this procedure.  Believe me when I say that I know that this is not a quick fix, but that this will require a great deal of work on my part.  I am mentally and physically prepared to take this step, otherwise, I would not be fighting so hard to get this covered.

What do y'all think?  Pretty good, huh?

 Why not send this information as you typed it to UKHMO? What's the cost for an out of network procedure?  It sounds to me it would be worth considering the expense to make that happen for you, but again I don't know your financial cir****tances.  Maybe UKHMO would make an exception for your to enroll in the UKPPO right now in a compromise of sorts?

Best Wishes.  If you have chosen Drs. Weiss and Oldham, you have chosen the absolute best.  I'm just out from RNY on July 11th and they are wonderful.  Routine procedure and am recovering well at home.

 

Here is my insurance battle update.  So, I spoke with the people at UKHMO and they basically told me "No, not unless you are really close to dying with an acute, life-threatening illness."  So, I tried another route with the benefits advocate in the HR department here at UK.  I asked her if it would be possible to switch to the UKPPO now, instead of waiting until open enrollment next year.  She told me she would have to check with her boss if that would be okay and that she would get back to me as soon as possible.  Well, lond story short, she called me this afternoon and I have been approved to change my insurance plan NOW instead of waiting until open enrollment next year.  I am so excited, I think I could spit.