Anyone hear of SC State Ins. making exceptions to the Exclusion policy?

Talk about feeling snakebit. I was told today that husband and myself didn't qualify for Medicaid due to his making only $300 more per month in his UNEMPLOYMENT PAY than the Medicaid rules would allow. He is being considered for a permanent State Job with State Benefits, but it looks as if they will no longer cover any of these WLS, read the SC Insurance Benefit Guide online. I was wondering if anyone had heard if they would make any, ANNNYYY exceptions to their Exclusion policy??? For almost three years now, I have been praying for something in our lives to change and make it possible for me to get this surgery. When he was "LET GO" from his IT job, I was almost thankful that I might qualify for Medicaid just so I could get this surgery. In the past, I have gone through the entire pre-op process, only to have my coveraged yanked away, and now, I can't seem to get coverage that will help me. I just can't catch a break. Any, any, information would be most appreciated. I keep praying that maybe with medical necessity, but it appears they have even shut that out. Thanks in advance for any info... Deb

The laws have changed and I had helped out with the insurance coverage, and I think they will allow it, but the person to ask is Amanda Budack at MUSC. She is the nurse Program Manager and will know first hand what is covered and not covered. Email her and ask, then you will have your answer, cause on here, there are 20 different ones, and she is up on the latest and most correct info. [email protected] Good Luck and I will pray you will get a great answer!!! God has His timing and there is always a way in His perfect will, so prayer works! Deb

Thanks Deb for your encouraging words. I will do as you suggest. I have also written to a local WLS Center here in Columbia, SC and asked for info. Someone eventually will give me the scoop and I too will pray it will be good news. Discussing self pay at my house seems to cause a great deal of tension, understandably I guess. Anyway, thank you so much for taking the time to respond. It really helps to renew hope when others show they care, so thank you again. I will keep you posted. God Bless, Deb P.S. You sure moved a long way away from Charleston!

Hey Deb, Ive been praying forever to get this surgery, went through all my tests and appointments and got BCBS 8 yrs of medical records with all my illnesses and co morbidites and all weigh****chers plans Ive been on with 3 of my pcps letters stating that this is medically necessary. A letter from my kidney specialist because I also have kidney disease and have one small kidney left. My surgeons office called me yesterday saying they want something now from this year stating I was on a weight loss program. or I would be denied. I am so upset right now I cant think straight. They have me so stressed out Im home sick today from work. It seems to me they are doing everything in their power to find something I cant give them just so they can deny me. Its not enough that this disease runs in my family and it only gets worse not better. My mom cant even walk to one room to another with out feeling like she is going to pass out. My younger sister just had the lapband surgery and she said all the people she knows that has the RNY in New York never had the problems dealing with the insurance Co as I have. I guess they rather keep paying for my medications and other health problems then just trying to solve them all with the surgery. Please keep me in your prayers and thank you for letting me vent! Denise

Dear Denise, I can certainly relate. It does sound like they are just stalling, and making excuses not to go ahead and do what they know they should. It is so frustrating. No worries on the venting, I think we all have to do it or we will loose it! I think they would be happy if we all just dropped over dead and then they would be free of the responsibility. They have all that money paid to them on our behalfs, and then if we die, they can just keep it, so they truly DON"T care. The obesity Action Coalition seems to be trying to fight the good fight against this mindset, but we live in SC, so who are we kiddin? We are in the land of good ole boys scatchin each others backs, etc. It will be a bloody miracle to get these Ins. Co's to start paying for this kind of care, or at least, it will be years and years, and our lives will be spent waiting and waiting for something we may never get to use. I vent too, see! I can't help it, it is hard when we KNOW how MUCH this will help us not to become completely insensed about them ignoring our needs. How long DO we have to suffer???? I KNOW you know what I mean. Vent away whenever you have the need. My husband is SICK of hearing me complain to him! This treatment IS crazy making!!! Deb

Hey again Denise, I understand completely how frustrated you must feel. I stay home with my 3 year old and she surely doesn't understand why Mommy is so moody, and crys sometimes for what seems to her no reason. I try to explain why I am sad in a way she will hopefully understand, but I know I need to try to save it for when she is not present. It is difficult though, especially when WE know there is NO good reason for our being shut out from this help we need. Greed and power make men do evil things. They all will answer for it one day. In the meantime, your right, try to keep busy, keep from thinking about it too much. I know it is difficult. It is hard feeling like your whole life is in limbo and someone else is in total control of your ultimate happiness. I SOOOO can relate. If, if, if, I ever get the surgery, it looks like it would have to come from our thread bare pockets. Even if we were able to come up with the money, I don't think my husband would pay for this with our money willingly. He has suffered through two painful, painful, layoffs in his IT profession and he is desperate to have some financial security in case it ever happens again. The last thing he wants to do is get off such a large sum of money right now. In fact, there are times when he says he will never sign his name on another line concerning money again. This subject never fails to cause extreme tension and disagreements between us. Yes, keep me posted on what is happening in your journey, and I will do the same. I will pray that we both have some miracles happen for us. Your Friend, Deb

Hey Deb, I am so sorry that you are going through so much yourself and it seems to never end but I know prayer helps and someday this will all be in the past for us both. When I called my surgeons office to send off the rest of the information they needed and she told me they called the day before to say I was denied It was like a kick in my face! Its funny how they can sit there and lie to you and tell you to have the last of your paper work in on a certain date and then deny you anyway before your time was up to get it to them. Like my PCP told me " insurance is just a big scam" I havent gotten one bit of help from them since I started this process even tho I gave them everything they had asked for, YOU are so Right! they have NO GOOD REASON for this. but they seem to have the power to answer for you on having this surgery that can save our lives. I will not give them the power because I am going to fight them every way I can. Think positive and prayer always works. Im praying that our day will come Deb and we also will be on the loosing side with everyone here on OH!! There are so many wonderful people on here that really do care and support us. Well Good Luck to you Deb on this journey and I will be praying for you. Denise