Can you explain this...

Wayne, I am so sorry that you are having to fight for  your benefits. That is really stinky. My dad is a veteran and he has had to fight for every surgery that he has needed. He even had to fight to get his insulin. So, I understand completely. It will be better when you get on Medicare. I am on Medicare and they will pay for the surgery at 80 % as long as you are on Original Medicare. A medical advantage program will not pay for it. Medicare does not pre authorize. It is a crap shoot, but my surgeon has told me that Medicare will cover it IF you have a BMI over 40, 3 comorbidities, and you have completed a 6 month Dr supervised diet where you weigh in and see the doctor every month. YOu also have to have been obese for more than 5 years. Hope this info helps.
Emily

Wayne:

First of all, let me just say that I don't think everyone is missing the point.  We have all had our issues with whatever agency is standing in our way of getting what we want or need.  Yes, specifically WLS as well. A lot of the posters here have chosen - yes CHOSEN - to sideswipe those in their way and handle things as self-pay.  Luckily that option existed for them, but that does not "lessen" the fact they still had to "fight" for what they wanted.

Some, like yourself, have fought for years as well, either their doctors, their families, their insurers, etc.  I think it is unfair of you to make the statement about the "system" you are fighting in being any different than the ones they have had to fight in.   All "insurers" have some level of risk assessment, be it gender, age, mental status, weight needing to be lost, particular tests that must be completed, etc.  So I think that everyone here UNDERSTANDS AND EMPATHISIZES with your feelings. 

This forum - specifically this Oklahoma forum - is comprised of such a broad level of patient that even though there may not be a "veteran" here, we all have felt the same roadblocks you are feeling.  We hate it, we verbalize it, then we try to figure out what we can do to surpass it.  Sometimes it works, sometimes it doesn't.  But at least we continue to look ahead and know that if we don't succeed at getting to our surgery at least we TRIED!  I love the people here on this forum and feel like they are my family!  They understand more things about this journey than my actual family because they live and breathe it daily!

We also become advocates for others, such as us attending the Walk from Obesity a few weeks ago, being supportive to others during their journey, advocating via the Obesity Action Coalition, support groups, Meet & Greets, etc.  So if you are looking for support you are in the right place, but lobbing a statement such as "you folks are missing the point entirely"  or "I really should not have posted here knowing that only a veteran in the system would understand" is not going to help others see your point of view.   Every one of us has had obstacles to our journey and continue to forge ahead for what we wan and need.

Please know that we (of all people) are on your side! We know that we are discriminated against because of our weight.  Obesity SHOULD be labeled a disability, but I don't see that happening during this lifetime so....

I hope you continue your fight - it is worth it no matter how long it takes or what it takes to get there.  Good Luck!

 

Wayne, I have never heard of anything that indicates a man is at any more risk than a female.  As for the age, I know some bariatric surgeons have an age cut off point.  I think it is usually about 65ish.  I don't know the reasoning but I do know there can be an age cut off.

Good luck fighting the horrible burearcracy.

 well said Ruth, well said.  I got your point.

Wayne,
I read all this and the replys. You mentioned delay tactics....well  let me gentle here.....It seems to me and including myself here....Everyone wants to walk into the hospital and have the surgery and have it now!!! Talk about delay tactics!! We delay losing weight, knowing full well it is for the best.....We delay walking, knowing it will help our health...We delay pushing the plate away, for fear it may be a couple hours before we eat again.   You have been fighting for this weight loss surgery and are not fighting to lose the required weight amount?? You want to fight them on that aspect.... That my friend, is delay tactics!! I know this because I did the same thing...I wanted to have a quick fix. of what I broke and it doesn't work that way.
Lose the weight....then come back here with the letter saying that you still can't have it....I will listen to your complaint then, but for now......Think about this...
I see Verterans with no legs or no arms or come back in body bags and you are worried about losing 40 -50lbs before you can have your surgery???  Think about this....What are you willing to sacrafice for the  gov. paid surgery?? 40 or 50 lbs???  I don't think you have a complaint until you have fulfilled your end of the requirement from them. I know many regular people paying for this out of their pockets because their insurance won't pay at all! You are complaining because the VA wants you to lose some weight for your own good, before they will pay for your surgery?? Before you think...I wouldn't understand....I am the daughter,  granddaughter,niece, sister and cousin of many Veterans. Don't pull the I'm a Vet card....We all want the same thing. We are all equal in the requirements necessary to make sure we come through this without complications.  Let me know when you have done what they asked and then I'll gripe about the VA with you...OK..

P.S. I went to your post and read what was actually said in the letter and it was NOT a denial at all...I felt they were very respectful and concerned with your health.  I didn't think it was harsh at all.
They pointed out the fact that you needed to be under a Psych.s care and stated the reasons. We all have.
They stated you needed to be seeing a nutritionist. We all are......
I see nothing in this letter to be riled up about.
We are all willing to help be a support team for you....I appreciate your service to the country. I however do not think you appreciate what this country is doing for you. For you to post an entire site about how bad the VA is, is part of the disrespect this country has for our government entities. I understand the system may be broke right now, but I resent your making this a personal attack on you by the VA. Like I said before....and I know the batttle of trying to jump hoops to get weight loss.....I know the need in you heart and mind  I have deep compassion for the pain of being overweight. But it is not the VA''s fault you are where you are....
Please do some deep thinking and come back and understand that we do want to help you through this path...We do want to help support you. We are not the enemy nor is the VA. We all want what is best for you....Come back to the Board as an average Joe who just wants this surgery or who have had it, and you will get the support you need...I promise you that.
By they way, this board can tell you some of the best Doctors around this city area!!

Wayne - read your blog and your post. Here is my take on this:

I went to the seminar for WLS knowing my insurance would not pay for the surgery; thankfully I was prepared to pay for it myself. I wanted the Gastric Bypass at that time and the cost was $24,500. So I fgured it was a done deal - I had the cash, I was ready and set.

So, I went to my consultation with Dr. Broussard, I could have paid for my surgery on that day - so, here is the outcome (and let me tell you, I felt like a deflated balloon when I left, because I had figured this would be easy):

Get psych evaluation; Get cardiac clearance (and ended up having to have an angiogram); Sleep Study test ( and ended up with a CPAP machine); and to put the icing on the cake, lose 50 to 60 lbs before surgery, which meant being under the care and guidance of a nutritionist for almost six months - yes, with cash in hand I had to wait six months for surgery.

Was I disappointed? At first yes, but I was also determined and I knew that I was in the right place, because it was what was best for me, to be sure of a successful outcome.

I don't know anything about the VA or any other government programs, but here is your choice:

You can complain about them, or you can get started - your choice.

I wish you the best!

I was denied by my insurance and went self pay, and yeah..it was for he $24,500. I almost didn't get the surgery because the cardiiologist refused to sign off for me. He's a butt, but I digress.

I had to lose 30 pound before surgery, and no amount of fighting made the insurance company pay. So, I'm paying and will be for awhile, but this "new car" is one that will last a lifetime, and I'd gladly do it all over again.

NOTHING was going to stand in my way..not even a stupid cardiologist.

Everybody here has a different story, BUT we are supportive of each other and have walked the same walk you and others on the pre-op side are walking. We care and empathize with all of you.