Question that I'm hoping someone has an answer for:)

Ok I'll make it short! My husband and I moved here in February only a few months after my gastric bypass. I've seen my surgeon 2 times since then at 1 week and 1 month, since then I've done this all on my own with no Dr supervision, and I know that isn't good for me at all. I have no insurance through my job, my husbands insurance will go up to 5times his rate by adding me, and we don't qualify for any state help. I've been trying to get a private health insurance policy but the kicker is no one will insure me since I weigh 220#'s even though I've lost 125#'s I'm just at my wits end here and I know the surgery was worth it, but sometimes I just get really down about it as well. I need insurance so bad, but I can't afford to pay hundreds of $$$'s a month. Can someone please lead me in a good direction to getting some insurance. Any help will be greatly appreciated. Sorry I've not been to the meetings or online my father died a month ago and things have been really tough for me. Have a great day, Anita

Anita I am so sorry that your going thro this alone. I wish I had an answer for you but unfortunatley I dont since I am on MO Mediciad due to my disablity. We sure do miss you at the meetings and if there is anything I can do please dont hesitate to drop me a email. Your in my thoughts and prayers sweetie. Keep up the great work!! God Bless Melissa

Anita, You are in my prayers for the tough times you are going through right now. I can only tell you I know insurance is high in cost. Have you considered just seeing a doctor for follow up since your surgery. I had to go 1 week, 1 month, then 3 months and then I have to go again in Sept. The cost for those visits are about 130.00. Maybe that would be easier for you to save the money for each of those trips. Just a thought. Colette

Anita, I know what you're going through. My husband lost his job and we lost our great insurance. We could of had COBRA, but it was $942 per month for the 2 of us--he was jobless and we couldn't afford it! I did some checking for insurance. I finally got some short-term health insurance that costs me $267.70 + 19.99 (prescription card) per month. It is through HPA (Health Plan Administrators), Inc. The insurance is with Standard Security Life Insurance Company of New York, Inc. It's not the best insurance in the world, but it's better than nothing. However, so far I haven't got them to pay for anything! The won't pay for my RNY so I am self-pay. I found out today they won't pay for a sleep study for my husband. But maybe they will pay for something in the future. There is another option. It is a discount policy. It is not actually insurance, but it works something like insurance. But instead of paying the facility or doctor, they pay you and then you pay your bills. If you are in the hospital, they'll pay you $1,500 a day for each day you're in. There are a lot of other advantages, too. I found them on the internet. I did a search for "health insurance" and then just started filling out their online paperwork to get quotes. They started calling me and I just kept a notebook on each one that gave me information. Then I picked the one that best suited my needs. The discount plans are fairly reasonable per month. I believe one of them that I almost purchased was something like $137.00 for my husband and I both. The name of the guy I talked to is Christian Zimmerman at Health & Life Direct. His number is 1-800-277-5011 ext. 1104. He was awfully nice when I talked to him. I believe he is either in New York or Florida--I can't remember which. The discount plan I talked to him about was $367.50 per month for 2 of us. There is a $100.00 startup fee that is a one-time thing. I chose this plan because it gave me the most benefits for my money. I have been told that after we have gastric bypass surgery other insurance companies will not insure us. I've been told that by my State Farm Insurance agent and my present agent. Now, there is the Missouri Insurance Pool and they have to take you on as a client. However, they are extremely high!!!! When I checked into it, it was as high as the COBRA we couldn't afford. I hope this helps you. But do try the internet for some options. When our short-term runs out in a year, we'll have to start back with the internet, too. Good luck in your search... Linda

Anita... Please understand that I don't wish to add to your "plate" right now but I do want you to understand the dilemma otherwise known as insurance.... it is a pain in the rear end most of the time. There are NO stand alone (otherwise known as private insurance) policies out there that are going to cover WLS treatment (including followup for those who have already had surgery)... These private purchase plans are basically for folks that are incredibly healthy and have no coverage. If you have preexisting conditions or EVEN IF you don't have a thing wrong with you medically other than being overweight.. most if not all will deny you coverage. So what that means in basic lay speak is that most people out there cannot find self pay private insurance to fit their needs. Weight wise is enough to disqualify you right off the bat. Throw in the fact that you have had WLS ..and that is a big STRIKE two... if you have any other medical issues... well STRIKE three and you are definitely out of the game. I used to manage a life/health insurance agency and I would argue til I was blue in the face for my customers. We were independent so we sold all companies. I could have someone that was perfectly healthy... NO MEDICAL ISSUES... only problem might be slightly higher weight..(not even overweight or even close to Obese) ...we would get denied time after time.... Your best bet IS going to be to suck it up and pay the higher premiums. Group coverage through employment IS pretty much the only option unless you are lucky enough to gain coverage through a governmental plan such as medicaid or medicare. They HAVE to take you (plans through work)...depending on if you have had continous coverage or not will spell out if there are any exclusions for X amt. of time due to lack of continous coverage. I battled to have my WLS for years... finally my husbands policy changed so that they would cover it with proof of medical necessity. I had to suck it up bigtime and pay the premiums for a year and then fight them on top of it just to have this surgery. It was hell for us... we did NOT have it in the budget... tight was not the operating word. 12 months of hell was. But we did it ...and I will be 2 years out on Sept. 23rd and this is the best thing that I have ever done for myself save for marrying my husband. I would do it over again in a heartbeat... Since I do not have his coverage any longer I cannot see my WLS surgeon unless I private pay. Whereas he did an excellent job with the surgery, his aftercare sucks bigtime. I just cannot justify 200.00 an office visit for him to spend 10 minutes with me , asking me how I feel. No measurements, no pictures... nothing. I can order my labs every 6 months under my PCP who does not order it under the listing for WLS... so it is covered by MY insurance (which excludes WLS ) so I have that covered... so basically I don't need to see my WLS. Sorry for the rambling post... just trying to give you some ideas so that you are not chasing your tail down a path that isn't going to help you out any... Are you having medical issues right now? Or is your need for treatment just regular routine followup? Elizabeth~

Anita I do hope that I might be able to help you....My sister could not afford insurance and she is obese and had to keep working even....She went to Family Services and applied for a medicaid card to help her with Dr. bills and meds.....Even though you are able to work but you cannot afford insurance Medicaid will provide for you....She paid 145 dollars for her card at first she told me. Also something about if she could not afford the 145 then there would be a spend down...If I were you Anita I would look into this...Then when you reach your goal and no longer have to go to the Dr. for post op appts. then You can cancel the medicaid.......If you would call your local family services they could give you more information on this topic....But yes. non disabled citizens can receive medicaid now. .................God Bless Craig Lee

The following information is what it seems that your sister is on. Unfortunately for Anita she would not qualify for this.... btw...the following is non copywrighted public domain information from the state of Missouri for public use. Medicaid Buy-In For the Working Disabled The BBA gives states the option of "selling" Medicaid, at state-set "reasonable" premiums, to working disabled persons who meet the SSI asset and disability tests (except for work activity prohibitions: the substantial gainful activity, or "SGA", rule) and whose net income, using income-counting methods at least as liberal as SSI's, is below 250% of the federal poverty level. This coverage group includes not only those who are leaving SSDI to return to work, but also working disabled persons not yet on SSDI or SSI whose clinical condition, without the SGA test, would qualify them as disabled. Many such persons would secure employer health insurance (some might already have it, or get it, as dependents on working spouses' job health plans), thus minimizing Medicaid's cost exposure and holding out the hope of eventual total reliance upon private sector income and health programs. This program option is separate from the Section 1619 program (which offers continued Medicaid to ex-SSI recipients who leave SSI to return to moderately-paid employment and whom Missouri is required to cover if they were on Medicaid too when work commenced). State eligibility officials are now considering whether to take this option Craig, it seems that your sister is probably on this program and qualifies for it medically AND financially. Unfortunately Anita is not going to be able to qualify for it on either count... a good program that can help many folks... but for the majority ...it falls short.. darn darn DOUBLE darn. Elizabeth~

Hi I just wanted to thank all of you for your support and opinions on how to proceed with this insurance issue. As far as medical goes I'm ok and haven't had any problems with this surgery. I'd like to have some lab work done to know how I'm doing in that regards, but otherwise I'm in good health. Thank you so much for all of your advice. Anita

WHEW!... I'm glad to hear that no medical issues are happening and that you just want baseline bloodwork.. *s*... What I would do is call around to some of the urgent care clinics and possibly also see if there are some sliding fee scale clinics based on income (I believe there ARE some in the Springfield area)... get your list of medical tests that you want run and trot on down. Explain the situation and see if maybe some of the drs. can help you out! That is exactly what I would do if I were in your situation. Also is there anyway that you can try to find a different job that still lets you do what you love doing...but that offers you medical insurance? It is very important to have.... Best wishes... keep us posted! Elizabeth~