Need some advice from you all PLEASE!

Hello to you all. I have been researching and researching the web for ways to get my dad a chance at life. He is obese and his current weight  is 364lbs. We both went to the seminar at Nash Day Hospital a.k.a. Nash General Hospital in Rocky Mount, NC. He went through this and paid the fee of I believe of $300.00. He had been told that he would have to visit several different doctors that would evaluate him for the surgery. After completion, they informed him that he was eligible for the surgery but however, his insurance didn't cover it. BCBS-GA I called them and they said that they don't even cover it even it was an emergency-type surgery (blockage, etc...) After all of this, my dad went through a state of depression because he was so looking forward to this surgery and getting his hopes up about it, just made the whole ordeal worse! My dad was hospitalized for 3 weeks following a severe nerve pinched in his back "sciatica" and he says it is excruciating pain. Once in the hospital, he developed a fever, resulting from an unknown cyst in between his legs. He is a diabetic Type II, and having weight issues, back issues, and knee problems, asthma, and sleep apnea he finds it really hard to do much, even the smallest activities. He now has to walk with a walker/cane and this is just becoming unbearable b/c he wants to do something about it, but just can't afford the surgery by himself. He is currently on short-term disability and hopes to be able to go back to work sometime after January. I informed him to quit work and get on long-term disability so that he may be able to apply for Medicaid to help with the surgery since his insurance through work isn' t doing him a bit of good. His medicines each month are around $500.00 I will post more later on his condition once I get some responses back. Please, I am begging each one of you out there that has been in his shoes, to respond!!! I really want to find out more for him and what our options are. If you had assistance with your surgery or know of any programs that will do charitable type surgeries, please respond. May God Bless each and everyone of you, before & after!!! Sincerely, A Daddy's Girl!!!

I'm so sorry that you Dad is struggling in so many ways. I don't know of anyone who does this procedure as a charitable venture. However, if he is found to be totally disabled and ends up on Medicare, they absolutely will cover it if he meets their criteria. If he did have Medicare to pay for it, he would need to have it done through on of the Medicare Approved Centers Of Excellence for Bariatric Surgery. Duke is one of about 8 in the state. I don't know of Nash is certified or not, but they can tell you. First, he needs to get stabilized and then his Dr's can determine his disability status from there point of view and if he is found disabled by SSDI ... Medicare may take care of things re: WLS.

Hope that is some help.

All the best,

Barb

Thanks Barbara for the information. I spoke with him tonight and he said that it wasn't the insurance company that didn't want to pay for it, it was the company that he works for, well when he was able to work for them. They chose a plan for the entire company and just so happens, bariatric surgery doesn't fall into this plan anywhere. I will be contacting Social Security tommorrow to find out more on his situation.  Also, I will be looking into medicare/medicaid eligibility. So, I trully appreciate your response and will be looking more into things such as disability, medicare/medicaid options, etc... Good luck on your own adventure of weight loss and healthy living. I know it has made a BIG difference in your life, hopefully more good than bad! I looked at all the before/after pictures and I can't believe the pictures of some of those people. It is a "total transformation" Best of luck to you!  Sincerely,  Daddy's Girl

I have some personal experience with SSDI and I know that it is a process. Basically, he first has to be found disabled by his drs. That disability has to run from short term, to long term and exhaust long term. Then you go through a relatively rigorous process where Social Security determines if you are or are totally disabled ... it often goes through a denial and appeal process. Once you are determined disabled by SSDI, then you become eligible for Medicare. I think looking at the Vocational Rehab route might be worth looking at.

Re: the Transformation ... You are so right. It has transformed my life in many ways. I am so much healthier. On top of that I am told that I look better ... and for the most part I can see that I do. I would absolutely do it again.

Wish you and your father all the best,

Barb

Was he simply denied, or do they just do not pay for this surgery for anybody?  If the former, keep going through the appeal process. 

Are you working with the folks from Southern Surgical?  I've seen that they are now doing surgeries at Nash so I'm thinking that might be who he met with.  If so, have him talk to Tina there at SS and she can let him know if this particular BCBS plan has approved folks or not. You might also want to go post in the main forum here to see if others who have BCBS GA have been approved.  Be sure to put BCBS GA in your subject line so those folks will see your post easier.

Good luck.  Keep researching and make sure it's not an issue of simply being denied vrs. his BCBS just not covering the procedure.  Also, I suggest you spend some time plunging around their web site to see if you can find if they offer this coverage.  It may be that his particular plan doesn't but another of their plans does. Since this is Open Enrollment time of year, perhaps he can change to a plan that covers it, if they have one.

What about Vocational Rehab? Is his weight and subsequent depression affecting his ability to work? Worth a shot.

Hi, thank you for the advice as to some of the others responding have said that it's worth a shot too. Anything is worth a try at this point and time. He is in a state of depression b/c he feels so helpless and trapped. He wants to continue to work and stay as active as he possibly can, but his body is saying "No, not today!"  He's has always held down a job-sometimes two- and doesn't know any other way. I spoke  with him tonight and he said he's got an appointment tommorrow to see his back doctor about possible solutions to the "sciatica", if any, and he said he would mention the Vocational Rehab to him. He also goes to therapy three times a week and they are doing an assessment on his progression tommorrow. So, if I find out any more info on the Vocational Rehab, I will post on here. One more note: My heart goes out to all of obese men and women who are struggling to lose weight and keep it off because a lot of people don't see the daily challenges that they face. Best of luck with you and your transformation.  A Daddy's Girl

Give Vocational Rehab a look, here's the website for North Carolina... http://dvr.dhhs.state.nc.us/ Take care and Good luck. Ellen

thanks for all the information. Went to the website and it is helpful and I will be calling the local office tommorrow. Thanks again, it sounds promising so far from what I have read on the website. I had never heard of Vocational Rehab before this so it's all new to me. It states that he "must have a medical emergency and already have a work plan in place and that the medical emergency must be keeping him from following through with the plan." We think it's a medical emergency, but the doctors may not seem to think so. How does this work? Do you know? I know the insurance would still consider his surgery a "cosmetic" surgery so I don't know if the doctors will be willing to state otherwise. Anyway, thanks again for your input on this, it means alot! Sincerely,   A Daddy's Girl