TO: Vickie Downs, from Trish

Hey girl First I want to say I would try emailing you, but for some reason I don't think that button works for me, So that's why I will be calling out in the title line to you, and you to me cause I don't ever get an email from the board, anyway with that cleared up , lets talk. Conference Thursday, and 2:00, got the letter out of the mailbox Saturday moring, it says, they are staying with their decison of denial based on the fact that CJ is not a full blown diabetic, out of control for 12 months, and futher its says that according to medical literature and the Hayes Tchnology Assessment Report, that CHA has determend that the ONLY life threatening compication of obesity for which bariatric surgery has been shown to have positive long-term health outcomes is diabetes. CJ has been overweight since the age of 10, I had proof of the peds office every visit we discussed his gaining weight, but don't you know when we were denied the first time I called the peds, to get his childhood history of long he has been fighting obesity, they had already been distroyed, because we had not been there for an office visit , since they sent us to the endocronoligist Dr. Borst. I was furious, a person life long medical history gone. We started with Dr. Borst when he was about 16. He is Insulin Restitant, has a gorter, is on synthroid, and metformin. He has high tryglicirods and cholorstel. Diffitculy breathing under exceriosnion. He mets the National Ins. of Health starndars, by at least 3 times over he is 475 and bmi of 83 is only 5'6" tall. ARE you aware that CHA has paid for lots of WLS over the past year, and that they only involved the diabeitc critera FEB 14, 2004. WE started the process in January, and yes I will go for the external appeal, and if that does not work, I will get a lawyer, and CHA will not hear the end of this. It is not fair, We have been told all our life's how important it is to maintain a healthy weight, and now they have the nerve to say losing weight only has long term benifits, for a diabeitc furthermore, our surgeon, says he would not operate on a diabetic, in the condition they are calling for. It is a tactic to save CHA money, We pay our own prem and 2 other family's that work for us. It wil be hard to write them the next months prem check, I can tell you! Sorry to be so long, and I am sure I misspelled alot of words, can't find a spell checker here. What comorbities do you have, are you a diabetic? If you are denied again, what will you do? Trish

Hi, Trish. I was afraid they would use the diabetes angle. I'm sure I will get my letter Monday. I have high blood pressure, high cholesterol, degenerative back, knee, and hip disease, stress incontinence, plantar fascitis, have had gall bladder disease, depression and more. Diabetes runs in my family, but I haven't gotten it yet. I know CHA paid for everybody *****quested it before Feb. 14. I can't believe that one test determines who they approve. I will also do the external appeal. My sister is also trying to get approved. She did HMR medical diet for 5 years but she doesn't have diabetes. The doctor who runs the clinic has done lots of research and believes that only about 25% of diabetics are obese. I hope something works out for your son. It is so sad to sit by and watch our children suffer without being able to help them when there is a solution - surgery. I hope he can get the surgery one way or another. Continue to keep me posted and I will let you know when I receive my leter. Vicki

Hey Vickie, Yes please let me know what happens with you too. I will not give up, maybe I will start something we can all work togther on. Who do you have CHA thru, "employer or "? Your symptoms, sound just like me right down to the planter faceites.sp I also was going to get the surgery, I am 100 pounds over normal wt. and bmi of 47. With CJ I can't beleive but I am glad he does not as yet have the back, knee and feet problems, that are assoc. with me being overweight. Things diffently need to change with the Ins. Co., Have you signed the onling petition to make it a federal law that the ins. co. have to cover it if they meet the NIH reqiments? Keep in Touch Trish

Hello. No, I haven't signed the online petition about ins. covering this. Where do I go to sign it???? I still haven't heard from the ins. company about my appeal. They have until the 13th of May before my 30 days is up. Maybe no news is good news but I doubt it!! It will probably show up tomorrow! I am a teacher so I have CHA through the state. That was our only option. Our premiums keep going up, too! Let's stay in touch about this! Vicki