Msla-MT John Alden Ins. Problems? Advise?

6+ months ago John Alden Ins. Denied my claim. BMI of 42, extremely high Triglycerides, very low "good" cholesterol, and type two diabetes. On top of that I now have sleep apnea and I am on a Cpap machine, I have Neuropathy in my feet. I am on 8 types of meds. (Thats 8 consistant monthy co-pays approx. $300). Not including the Cpap machine payments, doctor and lab co-pays. etc. You would think the insurance company would approve a sugery that could elliminate all their costs PER MONTH due to problems ALL related to weight. Has anyone had the same problems? What to do? I have been researching my next steps. Do I hire an attorney? Has anyone here? What are your results? 28 years old, mother of 2 - wife of nine years and lately I have been looking into the "black hole" is what I call it. Not knowing if these diseases (morbid obesity) and diabetes is going to finish me off before my oldest graduates the 8th grade. I have thought and researched this surgery for almost a year now. Attempting to decide if this is right for me. Now that I know it could very CHANGE my medical problems PERMINATLY - I am finding it VERY hard to believe after all the information out there on WLS and the effects of it - that the ins. compnay wouldn't want this for someone in my place........ A N Y advise from ANY one would help! THANK YOU MUCH! Paula ---- PS... On a side note. I KNOW this sugery isn't a FOR SURE cure. BUT - there is a chance. 13 years ago April 10th - my grandmother who suffered from the same problems as I (minus sleep apnea) - died. I know the ending if I keep on this track, I want to try another....

Paula, The only real thing you can do right now is file an appeal. If the policy has an exclusion, there's not much you can do. However, I would specifically ask for a copy of the policy and see what it states for the treatment of obesity. My insurance doesn't cover any drugs, but did cover surgery. Like I said, it's all in the wording of the policy. Have you spoken with the folks at St. Pat's? I'm pretty sure that they have a medical loan situation in place for just such things. Where were you going to try to have your surgery? I think most hospitals, etc. have ways of getting medical loans. I'm sorry I couldn't help much, but I would definitely look into these things. Linn

I plan to file an appeal - although I have no doubt they will deny me. So for the appeal I am going to attempt to hire an attorney. As you can suspect I have financial issues. I am going to be asking for a copy of the policy as soon as I get my regular doctor to get me a copy of my records. (That is proving to be interesting). When I got my reply from the first inquiry they stated it was not "medically necessary". But about the specifics I don't know. I talked to the people at St. Pats but to be honest I got the impression that they might not want to pu**** to hard for me - (they made me feel like they had other people that were a for sure thing.... So.. why help me) type of thing.. Since then I have talked to several other WLS offices and have talked with my husband about having it elsewhere. (diff, city or state)... I have looked into the medical loans but at this point - without knowing for sure if I will have to take my meds after - at almost $350.00 in meds a month a loan payment would be impossible. I know it is like what almost 98% sure that I wont have to take insulin and what not, but walking into a loan like that not knowing.... Knowing MY LUCK?? hehe.. Not a good step... But I am leaving it for the last bit alternative type thing... You help more than you know... Knowing that someone else has been down the road is help..... Even though this site is filled with people in my spot or who have made it past my spot... You responded... With concern... And That helps!!!! Thank you, Paula