Hi everyone!! Can you please help??

Hi! My name is Tracy LeAnn. I usually don't post much, just read. I am from Ohio, so the MO board is new to me. I am actually looking for answers for my brother in law who is from MO.His name is Lee. Lee is probably close to 500 pounds. He is 6' 3" maybe.I know that he has several co-morbidities, but I am not sure what all of them are. I do know that he has to sleep sitting up in the recliner or he can't breathe, he can't tie his shoes, or put socks on. The insurance he had was going to approve him and now the Company he worked for sold, and his insurance is Mercy Insurance. They have a written exclusion for WLS and I know he can't afford to self-pay. Does anyone out there have any ideas for him, that I can pass on?? If anyone would ever benefit from this surgery it would be Lee. By the way, he is only 23 years old, if that matters. PLEASE help me help him! Any suggestions would be most appreciative. Thanks, Tracy LeAnn

You might want to check with obesity lawyers to see if they can help. Sometimes they are able to get around exclusions, it kind of depends on how it is worded and if your brother had prior approval. Sometimes they can help. Capital One has given loans to people for surgery. Some people take out loans on their homes. I know of people who have done fund raisers to make money for surgery. One lady had her friends help her and they had a babysitting marathon, they canned special jelly to sell and I think special recipe chili they sold. Sometimes you have to think out of the box and figure a way around the problem. If you have friends or relatives to help maybe you could figure out some sort of fund raiser. Many people have gone to Mexico for surgery as it is cheaper there. I know a lot of people have gone to Arkansas for surgery too. Is there any way he could continue cobra coverage with the old insurance? These are just some ideas to start with. Good luck I know nothing about this particular insurance.

Tracy... I'm sorry to hear that your brother is going through such a mess. Looking into the possibility of COBRA is not a bad thing... the worst they can do is to say no. Also he needs to really delve into the wording of his present coverage with Mercy. Is it an outright exclusion or does it give a little leeway with the wording of medical necessity? If so, he might have a bit of a battle but it is still worth the attempt to try. Also has he ever qualified for disability and/or Medicare that could possibly come with it? Vocational Rehabilitation is another avenue worth exploring. Some folks have said that they WON'T pay and others HAVE had luck with them. Please let us know what you find out... Best wishes... Elizabeth~

Hi Tracy, Definitely check into the policies exclusion. Medicare does pay for this surgery BUT a person can't get Medicare right away, it's at least a year wait just to qualify. Medicaid DOES pay for it but there are very long wait lists for most doctors, sometimes a year long. Also, being on disability is a struggle, I only get $800 a month. There are all sorts of things they want you to pay for out of your disability checks, premiums, co-pays, etc. It does sound like your brother has sleep apnea. Before I was diagnosed, I couldn't sleep lying down and would wake up sitting on the edge of my bed if I had tried. Sleep apnea is very serious and it can lead to all sorts of problems. The best thing to do is check into his exclusion policy. DEFINITELY recommend that your brother have a sleep study done to determine if he has sleep apnea. If he is still able to work, maybe look into switching jobs, but I wouldn't recommend him applying for disability except for a very last resort. I wish your brother good luck in finding a solution that works for him. Lia

Thank you all so much for the advice. I will be passing it on to Lee. I am sure he will appreciate all the help he can get right now. He is just now getting his internet hooked up. I would love to refer him to this site so he can get all the encouragement he needs. Thank you again, Tracy LeAnn