PETITION SC INSURANCE COMPANIES by DR BYRNE

Hello All!! If you are trying to get surgery, had surgery, or have a friend who needs gastric bypass, then this is for you!! Dr. Byrne in Charleston SC spoke tonight at our bypass support group. He asked EVERYONE in SC to please write letters to the congressmen, and to Senators, and to BCBSSC. The Doctors who are responsible for allowing gastric bypass to be covered are in Columbia. They are the medical directors for BCBSSC. He and 2 other doctors from Greenville and Lexington, I think, all met in Columbia one day to plead with the medical director to allow gastric bypass to be covered. It will take "The People" to get out there and petition the lawmakers and insurance companies to have gastric bypass covered. He stated in 2004 they did 360 surgeries 2005 they did 260 surgeries He predicted in 2006 to only do 160 surgeries because of insurance denials. These insurance companies are denying people who are perhaps months from death, and because of the new "rules" they put up, or barriers to prevent people or discourage them from having the surgery are just beyond comprehension. 6 months to 12 months supervised diet??? by a physician?? But you have to maintain a 40BMI to have the surgery, so if you happen to lose enough to drop your BMI, but not enough to save your life, you can't have the surgery?? Who are these people that make the rules? Do they even get it? People are dying because of these companies who will not recognize they are cutting off their own noses in spite of their faces. They would rather pay over many years for problems associated with weight gain, diabetes, knee surgery, heart dx, High BP, and the myriad of other problems we all face as being overweight, not including the medicines. This surgery works, bottom line, and many people leave the hospital off many or all of their medications never to go back on them again!! We know this surgery saves lives, lets please pass this on!!!! Dr. John Little [email protected] Britt, will you please post the other doctor's name who we need to contact? Here is a link to the SC Senators and Representatives http://www.visi.com/juan/congress/cgi-bin/newseek.cgi?site=ctc&state=sc Please visit and email each one of them and tell them they represent our needs!! The people of SC are dying because the state will not cover gastric bypass!! Getting off my soapbox now, but we all know Dr. Byrne is hot on this subject, and after what he has done for all of us, let us support him!! Thanks, Deborah Schueler

Hello Senator, I am a republican and I voted for you last time. I am going to get right to the point. I was a severely, morbidly obese person in August. I had gastric bypass surgery, and it saved my life. I was fortunate to have an insurance company that covered this surgery. I have since become very active, no longer need diabetes medications, and have lost 80lbs in 4.5 months!! I know this saved my life, literally, and it is very disappointing to see others who NEED this lifesaving surgery, but cannot have it do to the red tape of the insurance companies, especially BCBSSC. This one company is the benchmark for all other carriers in SC. I am BEGGING you to intervene any way you can to ask BCBSSC to cover gastric bypass surgery. I also do not believe any hospital should be able to do the surgery, but only centers of excellence who have met strict guidelines and have good statistics. I had my surgery with Dr. Karl Byrne at MUSC. I had absolutely no complications and was home in 2 days, feeling great! While many would say this is unusual, it is not. It is only because we hear about the bad cases. Dr. Byrne is one of the top rated surgeons in the country, and SC is lucky to have him. He performed 360 surgeries in 2004, 260 in 2005, and predicts to only do 160 in 2006 because insurance companies would rather pay for long term health issues that will cost more than the surgery. I don't see how companies can think it is better to pay for someone to have kidney problems, transplants, and a lifetime of medical problems, and medicines than pay a one time fee for the surgery, and get the patients off of medications and back in a normal life, where they are productive and active. Please do anything you can to help people who need this lifesaving surgery. I am begging you for your help. If enough of us write, perhaps we can make a difference! Thank you, God Bless you and your family! Deborah Schueler

It will get tougher once the proposed Medicare changes go into effect. http://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=160 I encourage writing to Senators, Congressmen, and local officails. I have sent my 2 cents in.

Great Link!! This is what we need, more people who know exactly who to write. I will also send in my 2 cents. This is a start!! Let's all email to this link too!! Thanks GF!! You are helping a lot!! AGAIN, HERE IS THE LINK TO SEND IN YOUR 2 CENTS (Maybe we can make $100.00 with everyone sending their 2cents!) http://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=160

I work for BCBSSC and was actually blessed enough to be covered for WLS for the 1 1/2 years they decided to cover the procedure. It was quite a surprise when they decided to no longer cover it as if I recall correctly due to complications and the lack of centers of excellence to do the procedure (or something along those lines). I'm not sure what kind of data they were getting from patients having the surgery causing them to make such a drastic decision. Don't get me wrong, I agree with you, I just don't know what prompted their decision. They even had a $25K reconstructive benefit and covered a lot of my plastics after having the surgery. I hope at some point they will add this procedure back as a covered benefit. And one thing everyone needs to remember is that it's not the insurance company who decides what is covered or not. It is the employer you work for. So if you have been denied for WLS as a policy exclusion, then it's because your employer decided to not cover the procedure, NOT the insurance company. A lot of people don't realize this and get really mad at the insurance company. In my case, I actually work for my insurance company so I went to my HR VP and started inquiring about why it wasn't covered. It happened to be around this time that the board was reviewing adding the procedure. Said all that to make the point that talking with HR reps at work where you've been denied can be helpful too as they can decide to change the policy.

INTERESTING, MS KIMBERLY. I DIDN'T REALIZE THAT THE EMPLOYER MADE THE DECISION AS TO WHAT TO COVER ... OHHHH PLEASE, FOR THE BENEFIT OF $25,000.00's WORTH OF PLASTICS!! WHAT AN AMAZING BENEFIT. SINCE YOU WORK FOR BCBSSC, CAN YOU FIND OUT WHY THEY QUIT COVERING THE PROCEDURE? OR AT LEAST, CAN YOU GET US THE NAME, TITLE & ADDRESS OF SOMEONE WHO IS IN THE POSITION TO MAKE THESE DECISIONS SO WE CAN WRITE THAT PERSON WITH OUR POSITIVE (AS WELL AS NEGATIVE) WLS EXPERIENCES HOPEFULLY INFLUENCING HIM/HER/THEM TO RETHINK THEIR POLICY ABOUT COVERING WLS. THE PROBLEM IS THAT WHATEVER BCBSSC DOES, MOST OTHER INSURANCE COMPANIES FOLLOW THEIR LEAD, WHICH LEAVES THOUSANDS OF OBESE PEOPLE TO EVENTUALLY DIE FROM THEIR CO-MORBS ... CO-MORBS THAT CAN BE LESSENED OR EVEN STOPPED JUST BY THE SURGERY & DIET CHANGES. I'M WILLING TO WRITE ANOTHER LETTER IF YOU CAN GET US THE NAME, TITLE & ADDRESS. WLS SAVED MY LIFE; I WANT IT TO DO SO FOR OTHERS. GOD BLESS DAWN & NICK

I'll have to see what I can find out. We're so darn big of a company that trying to pinpoint a single person is sometimes very hard. I've been debating lately though with the idea of asking to go before the board who makes the decision for our company at least and give them some of the positives as I'm sure they are used to only hearing and seeing the negatives.

WE'D ALL APPRECIATE YOUR EFFORTS, MS KIMBERLY, IN GETTING THE NAME OF A CONTACT PERSON. IF YOU DECIDE TO GO BEFORE THE BOARD ... LET US KNOW & WE CAN WRITE OUR OWN STORIES FOR YOU TO SUBMIT ALONG WITH YOUR TESTIMONY. MAYBE IT WOULD HAVE MORE IMPACT IF YOU COULD COME WITH LETTERS FROM OTHER WLS PATIENTS RATHER THAN A SOLE PERSON. GOD BLESS DAWN & NICK

Yes, You are correct. He also mentioned last night about also contacting the company's HR or Insurance rep that you work for to ask about coverage. They also mentioned last night, that most companies who don't know about medical procedures, will also follow the lead of the state health plan, and that most of them have been referred by the state health plan for their coverage. If you have other ideas to help, please let me know and post it here Thanks for your reply! Deb

UPDATE: We were asked to please not use Dr. Byrne's name when writing because of conflict of interest, and the specific area to target is the SC State Health Plan. I know one email for that plan is John.Little@BCBSSC He is the Medical Director for the State Health Plan I also know that the State Health Plan sets the benchmark for employers who are saying that Gastric Bypass is not covered, so that is why it is important to target the State Health Plan, which I believe to be BCBSSC. I have a link that will put you in contact with these plans. If I get more info, I will post it here. http://www.medhealthinsurance.com/southcarolina.htm