End of the road before it began???

I have been researching having bariatric surgery and was really getting my hopes up this might be the answer I've been looking for. I was diagnosed with MS over two years ago (was overweight at that time) and due to the problems with that I am really unable to exercise so by the moment I'm getting fatter and fatter!! I called my insurance company and they said my husband's employer specifically excludes this type of surgery. So, is that it?? There's no way around it??? No way if a doctor said it was medically necessary to get it paid for?? Are there any doctors in NE Ohio that offer a cheaper (but just as professional) surgery for those of us with no insurance to cover it? I am soo disappointed and just looking for some support and/or advice. This seems like a great board! I was relieved to find it.

Hi Kris, I know your frustration. It acutally can be the end, or it can not be. My sister is going thru this also, Depends on your husbands company size. My sister"s husband went to the boss, told him about her medical condtions, and the boss contacted the insurance broker to see about taking the exclusion off, this was for anthem insurance she has, For them the company is small with only 75 employees, and they have it you need 100. Everyone I have spoke with so far says, this is a pre exisiting condition also so again is it? I'f it is, then it should be covered under the pre exisiting, if your insurance company except's pre exisiting conditons, so have the dr summit the paper work and see what happens. I want this surgery also and I dont have insurance at all, so im calling every insurance company I can find, I just ask them do you cover baratric surgery or surgery for severe overweight, seems if you look at the exclusion some of them it states morbidly obese isnt covered, but some it doesnt say anything about severe obese, so may depend on how it is worded. Check with your surgeon and the hospital, I dont know about up there, but The kettering Bariatric Center and Kettering -Sycamore hospital do have a payment arrangement plan. That's my calls tomarrow to see how they plan it and what I need up front, they also have lenders who will lend you the money, as a loan type program. I'm even opting to second mortage my home, My sister is checking in about borrowing the money from her life insurance policy or hubby's 401k. I hope I have given you some kind of options, I know how your feeling and am praying you find a answer. Here is the site for the surgeons we went and seen, we did the seminar on Wednesday Feb. 7th and my sister got her appointment on Feb 9th, 2 days later. They was awesome, the staff is incrediable. I know medina is a ways from Dayton, but if they can work a plan with you, and you like the staff, then maybe the trip would be worth it? http://www.ketteringbariatrics.com/ the phone number to call for the payment program is this 1-937-298-4331 and speak to Debbie Finch. Good Luck in your journey, Let me know if you find something, If I find out more, I'll post soon again. If you need to vent you can reach me on my site here, denise45372 Denise

Thank you Denise! It is extremely frustrating, but I am not giving up hope. My husband works for a very large company and so I am going to plead my case to the "powers-that-be" and see what happens. Heck, if I don't try I'll never know! I am seeing my reg doc later this week and asking her to write a recommendation for the surgery, along with one from my neurologist and see where it takes me. In the meantime, my girlfriend and I are going to Dr Ben's seminar Monday night. I might as well get the ball rolling just in case I can get coverage. Thank you to all you posted to my reply. Not giving up...yet, Kris

Kris, If you have an exclusion it's nearly impossible to beat in our experience. Sorry. Dr. C Cincinnati, Ohio Got a question? Ask the doctor at www.TheBandDoctor.com 877.442.BAND DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

My insurance company is Anthem Blue Access PPO and I live in the Cincy area. I was turned down in my second appeal before a board from Anthem. My doctor (God love her) Wrote a wonderful letter. She explain I have all the co-morbidity factors AND she wrote that she believes surgery is my only chance at life. I decided on the lap-band for many reason and have to pay for it myself. Dumb insurance companies! ~Nancy

I found a new job that had the insurance to cover it. If you want it bad enough, go make it happen. It is so worth it. Hugs, Darlene

Darlene, Your story is truly inspirational. I am waiting on insurance apprpval, and it is frustrating to say the least. Reading about your struggle and WOW your victory is a reason to keep praying and pushing for what I believe in. Thanks, and God Bless you and your family. You look awesome!

Hi Kris, Im sorry to hear about your plite. If only insurance companies would realize that with this surgery, in the long run it saves them money b/c most patients (from what I have read and heard) are able to go off their med's (saving $$$), don't need to go to the dr. as often (saving more $$$) and become healthier which helps their families become healthier (again saving $$$). Its all about the almight dollar. That's all. Im sure it is very discouraging. Don't give up. There is an answer for you out there somewhere and some how. One lady I had my PAT's with, she and her husband paid for this surgery for her on their own. I don't know to many people that are able to do that but I know it was quite the expensive thing. I know that's probably not the answer that you want. Im sorry. Best wishes to you in your journey. We are all here to support you the best way we can. Kym

From the "Obesity Action Coalition" The OAC encourages patients to become advocates for change. Patients can impact how others view obesity and impact decision makers. Help us to eliminate the negative stigma associated with this disease, and make sure that obesity is treated as a disease, allowing for increased access to safe and effective medical treatment. Below, please find links to help you get started. For instance, by clicking on Educate Legislators, you will be able to locate your representative and view tips on how to advocate. http://www.obesityaction.org/walk/walkfromobesity.php just some good info to pass on gayle

Sorry about the exclusion...I had the same problem. I self paid for the VSG. He isn't in NE Ohio but in Detroit. My mother is from NE Ohio, Youngstown area...It took her about 3-3 1/2 hours to get to the hotel where I stayed for surgery...not that far away. My surgeon was Dr. Pleatman. He does self pay, costs compete with those in Mexico. I paid total $11,100. Here is his website... his sight says RNY is $11,500. http://www.laparoscopy.com/pleatman/index.htm