Bad news, but I'm not giving up hope...yet

I called my insurance company after the seminar I went to on the fourth. I asked if WLS was covered and I was told it was if there was a medical necessity. Dena from Dr. Hornbostles office called and was told it was an exclusion, so it wasn't covered. Then my husband asked the lady that handles the insurance where he works and was told it does cover if there is a medical necessity. So I called and told Dena this, and meanwhile I called the insurance again, and was told it wasn't covered. And Dena also called again and got the same answer but she was told the company does cover it but our policy doesn't. So that sucks big time!! However I'm not giving up hope. My husband said that there are several policys at work that they have to choose from, and in the fall they can change but only once a year "I'm just glad the once wasn't in the spring, or worse June! That's usually how my luck runs" Anyway so I think I'm going to call and talk to the insurance lady at work and see if she can figure out what we need to change to to get my surgery covered, if there is a plan that does cover it that is offered at his work. So please pray for me that we will have an insurance plan to cover this, I really need this I'm so tired of carrying around this extra person. I have a very physical job, I'm a dog groomer, I pick up dogs large and small, and am on my feet all day long, and at night my hips and knees just throb, and my legs are swollen up like sausages, my back hurts all the time too and if my body breaks down I don't know what I'm going to do, this is my business and I have no employees, I do it all and the business would fold if I couldn't do it anymore. And with large business loans I can't afford for that to happen.

Marcia, Don't ever give up hope. We'll all be praying for you and that your pain will lessen even before surgery. Lana

yes what Lana said and just make sure that when you change policies that it does not have an exclusion in it for wls. We will be praying for you to be able to change it soon and then will get the surgery you so need . Stay with us and dont go into hiding. we are here to support you . and let us know what all is happening in your life. Jan

If they cover it I definately won't go into hiding. If they don't I'll probably be too jealous to come here unless things change, as bad as it sounds. Though I might check in from time to time. It used to be my nightly ritual to look at the before and afters and imagine myself thinner. I can't even look at them now because I don't want to get my hopes up and I'm afraid that will never be me.

Marcia... This post of yours really struck a nerve with me... I so feel for you as I WAS you several years back. I was a regular at this site and tried vainly for several years to fight insurance denials and exclusions. I lurked and posted seldom as the pain was just too intense. I was happy for those that gained approval and had their surgery but I was so sad for myself. Like you I just tried to envision what I would look like if only........ I just want you to know NOT to give up. No matter what...keep fighting and DON'T STOP. You are so worth it, your life is worth it! I didn't stop fighting and lo and behold things finally worked around and I was able to buy into my husbands plan that did cover WLS. It still wasn't an easy process as I still went through denial after denial but I kept on fighting until lo and behold I WON!! My surgery was September 23rd, 2004 and I am officially down 171 lbs. I have gone from a BMI of well over 50+ to one that is completely normal. NORMAL ... never in my life would I ever think to see that! I am of normal weight. Please know that we are here for you... do not give up honey. Don't go into hiding either. We are all here for you. Elizabeth~

Elizabeth, I just spent the past hour or so reading your journal. I have the same things going through my mind as you were saying. "Am I going to have to pay this higher premium for a year and still not get approved?" I do not have insurance through work of course as I'm my own boss, I am now on my husbands policy at work but it is a very minimal cost to us, but there are several plans and if we find one that doesn't exclude WLS I'm not sure if I can switch to that one without my entire family switching too, and we simply can't afford too much more. My husband received a 500 per month paycut because of the economy and the plant trying to stay afloat and we are having a rough time of it as it is now. So if we do make the switch, I am not organized. I have no documentation so to speak of weight loss, just this spring I remember throwing out all my weigh****chers stuff that documented my 100 lbs weight loss and now I regret that BIG TIME! But at the time I looked at it and thought "Why do I still have this?? It's just a reminder that I'm a failier!" I moved here from SC about 9 years ago, brought alllll my medical records with me that documented my doctor trying to help me lose weight with relefin, and it also documented finding I have acid reflux, and joint pain ect. I went to a doctor here, gave him my stuff, went there a while, didn't like him and switched doctors. She tried 2 or 3 times to get him to send her the records and he didn't. Now he is gone, and so are my records. So all I have are me going to the doctor for the past 7 years for various sicknesses like bronchitis, and nothing much else. I didn't keep my weigh****chers weight off very long, I don't know if it is documented much in her records. I do remember years ago going to my GYN after I lost my weight, then going again a year later having gained it back and he made me feel so bad about it that I broke down in my car after my appointment and I haven't had a yearly since. I'm sure he still has those records so it would show a loss, and gain. But I don't know if that's enough. And I am "I guess" considered a lightweight, I laugh at that, but I don't know if that makes it harder for me to get it or not. I usually weigh somewhere between 240 - 250 and am 5'6" Anyway I do want to fight this just don't want to get my hopes up. If I have to self pay I will try, but I'm not sure how I would come up with the kind of money I'll need.

Marcia, I too have an exclusion in my policy.Don't lose hope. A Missouri senator named Rita Days is proposing a bill that would mandate insurance companies to cover treatment for morbid obesity.The bill was shot down this year but she isn't giving up.She is working with some insurance companies on the wording of the bill to make it more acceptable to them so we can get it passed next year. You are a perfect person to start writing your senator and letting them know how you feel about this discrimination. Get everyone you know to write too.If you look in your policy I would bet it covers drug/alcohol addiction treatment and anorexia/bulimia--mine does. We have to speak out and stand up for our rights. Write your senator and senator Days supporting this movement.It may be your only option.My company has different plans to choose from but all exclude and treatment of obesity/morbid obesity. Dannielle

Hopefully it is worded "surgical" treatment, because yes my insurance company probably covers drug/alcohol addiction treatment and anorexia/bulimia but all of those are "non-surgical" my insurance also covers "treatment" for the condition of morbid obesity as in psychological counseling, physical therepy etc. But NOT surgical treatment and as we all know we don't need someone to tell us why we are fat, or show us how to excersize after a lifetime of dieting, WE GOT IT! We need surgical help.

I tried to find a copy of this bill on the internet to see if it included weightloss surgery, and found very little on it and no copy. Bummer! I did find out that Rita Days is a Democrat, Hmmmmm guess some Democrats aren't all bad afterall lol.

That's it girl: don't give in. I have been wanting this surgery for a long time, I wasn't told by the insurance but by my dr. in the beginning that i was not a candidate due to complications in a previous surgery I had had. When I moved in 2005 ended up in the hospital in the area where I live now, I really liked the Dr. that took care of me there so I switched to her. We had a talk about weight loss and she suggested the WLS I about fell out of my chair. Told her that for a couple years I was trying to get my other dr. persuaded to let me have it, she couldn't understand why not. Anyway I am on the road now just waiting for Medicare to approve the hospital then I get a date. So don't give in. That old saying of Where there's a will there's a way. Patience and perserverance pays off in time. My prayers are with you. Good Luck Tressia