It's Friday!!! Ready for this one?

Okay - here's the thought/question of the day.  This one could be a little intense, but I thought it would a great 'something' to post.  I think I have an idea of how some will post on this one and I want to see if I am right. Here goes: Yesterday on Oprah she had Michael Moore and several other health care/insurance people on there as well.  As I'm sure a lot of you know, Michael Moore filmed the movie 'Sicko', which I haven't seen, but think I want to see. First questions...how many have watched any of the info on Michael Moore and his movie 'Sicko'? With going to have/having had your wls, how does this film impact you?  I'm not talking in the direction of 9/11 - because I think we are all on the same page with any and all of those people that were there need to have the medical care they deserve.  I'm just talking wls here. My thoughts: I am one of the fortunate ones that had my insurance cover 80% of my surgery, but find that they really don't want to cover fills - but I'll take what I can get. With seeing how healthy I have become and with not having to go see my 'regular' physician very often at all, I think that the insurance companies/businesses that don't cover wls are completely crazy.  It doesn't make sense to me that they won't cover - when in the end - they will save money. Here is my other thought.  I'll eventually want to have plastic surgery and I'm hoping that insurance will pay on some of that.  I think those that have plastic surgery and it turns out well - because sometimes it doesn't or they become obsessed with having more and more done - it instills an even greater deal of self pride - which cold lead to less mental health issues.  I know that one could be really far fetched, but it is something to think about. So, with my intense thinking ...what do you think? Tonja

I personally like Michael Moore. But I haven't read or seen anything about SICKO. So I can't comment on it specifically. Maybe I will at least visit his site and read a lil about the movie. As far as insurance paying for WLS. I agree that they are crazy not too. I don't know if any of you are familar with IHS. IHS: Indian Health Services provides free medical care to tribal members at IHS owned hospitals and clinics. It can be great. Now let me get on my soapbox.... Native Americans have the highest rate of diabetes for all ethnic groups. We also have a huge obesity issue in our community. IHS spends on average $400-500 per month on medication for ailments directly related to obesity in patients. Yet they will not cover WLS and treat the underlying cause.  Let's take my sister for an exampl (I promise she doesn't mind). My sister has been overweight most of her life. At 42 she is dying. No exageration. She is 5' 7 and weighs about 350 lbs. She has had to heart attacks and had to have an Angio Seal put in place. She is insulin dependent diabetic. She has high blood pressure, leg issues and so on. All are a result of being overweight. IHS provided her heart surgery, her medical care is handled thru IHS as well as her medications ($650.00 a month). So per year just on medication they spend $7800.00. I can only imagine what her heart surgery cost 2 months ago. She has to see a doctor 3 times a month for monitoring.  To me WLS surgery would be a better financial decision for IHS. This is something that I get emotional about. I am lucky and have alternate insurance to cover my WLS. But not everyone is as lucky. I have started writing letters to IHS and key government officials. I hope I can begin to make a difference.  Sorry this is so long.

I totally agree with everthing I to am Indian and I love getting medical free for me and my kids WWOOWW but yes if they would offer WLS they could cut there cost just in Diabetics alone it would be drastic. At Talihina Hospital their Surgeon actually done  RNY for years before coming to the Hospital and now the hospital has not approved WLS so they have a Surgeon who could do them and are not using him. That is even worse to me. But don't get me worng I am thanful for my CDIB and my medical We make to $$ for soonercare or anything like that so I would be inbad shape if I had to pau out of pocket evertime one of my 3 kids got sick. I think the isurance and Docs are in it for the $$$ and something needs to change they should have to do so much probono work or something I know there is a lot of folk who need medical and can't afford it.

I saw the show-I intend to see the movie.  And my caveat-I usually don't let myself rant about this, but SINCE YOU ASKED: The insurance companies are in the business of practicing medicine, it's not longer the doctors.  The doctors have to get permission to do the surgeries that the insurance is supposed to cover.  So, even if you HAVE insurance, it doesn't mean you are covered for what you need.  They were perfectly willing to rebreak my foot and mend it back so I could walk, but not pay for the WLS that would keep me from having to break it a third time in 5 years or so.  Weight is a lifestyle issue, so they say.  What about drugs?  I asked them to assign my "druggie benefit" treatment dollars to weight loss surgery, but they don't do that.  Why?  Well, because execs are not fat-they do drugs and they need those benefits.  (I know that is simplistic, but it's not too far off the mark). I paid for my own WLS and I am not yet done with BCBS by a long shot.  I just have to lose weight, PROVE that it would have been an effective treatment, and then I'm going back after them.  Not out of hate, not for money.  I only want to help pave the way for someone who is still struggling with them. The only appeal I was ever given was a chance for a re-review-I was not allowed to bring my doctors in, etc.  That is not an appeal, that is a pardon.  I felt I had no rights AND I was being asked to prove that I was in fact, a failure, unable to do this on my own.  I am quite sure that it gave me several ego blows but that only made me stronger, I woke up and said "No, BCBS, you don't get to decide my destiny". Behavior modification (somethng they shove down your throat) is good-and will work for youngsters, etc, but for those of us who are dying now, we need more drastic measures.  I'm getting my life back, but not everyone will or can unless they are helped by the companies who are being paid to help them. And heaven help the ones who don't have insurance at all.  Actually, I know of a couple of social security/disabilitied types who got the surgery with no problem because Medicaid recognizes WLS as a valid treatment for the individual and cost saving for the institution and the greater good of society.   So, go ahead and be a crack addict, you can get private insurance treatment and publicly funded dollars to help you out.  But get fat-sorry, you're out of luck. Plastic surgery is sometimes covered if there is an underlying medical reason (rashes/etc).  I'd give up my PS coverage if they'd just cover WLS, but truly I think there ought to be some insurance benefit for it.  What on earth are we paying for if not to be taken care of?