It only took 3 years to get to this point.....

It's a long story but if you have time keep on reading. I am mainly posting as I feel after hitting all the road blocks I have come across, and I know I am not the only one and they aren't any different from anyone elses.

I started on my journey by attending 3 different WLS seminars to be able to meet different surgeons and see what the requirements were. Before doing that I contacted my insurance company to see if they cover it. They said no but put me through to another department that indicated if I completed all of these things, it could be appealed and they  would probably cover it if certain criteria were met.

I went through the process of getting all my medical records together to show my weight history. Then the health reasons as to why WLS would be beneficial, sleep apnea testing, psychological evaluation, nutritionist appointments, eventually the cardiologist based on something the doctor saw. Then they required a 6 month under doctor supervision diet. After 9 months of waiting and testing they came back and said no. They were not going to cover the WLS it was not part of the insurance plan and they didn't know why I was being sent over to this other department. So I went up the ladder. The insurance company ended up reimbursing me for the expenses I paid for all of these appointments that I didn't need based on what their people kept telling me.

Needless to say I was devastated.

I had to back away from everything having to do with weightloss but took the information I needed and took the next 2 years and kept researching and practicing good eating habits.

I went through being depressed and frustrated and angry.....

Now, I work for a company that does cover the WLS. I am in the process of only having to go through 2 more appointments to be able to schedule a surgery date as long as the insurance approves everything, which according to the people I am working with should not be an issue.

I am not sure how I am feeling. Scared possibly some due to, could it happen again that I am in the process of changing my life that it could be thwarted all over again. It was bad enough the first time.  I know I am much closer than I was the last time.

I am trying to make these feelings go away as this is something I have wanted for my family, and my health for a very long time.  I thought it was fear of the surgery...but I am finding that, that is not the case.

I have been staying on course and trying not to deviate from the goal. There is no guarantee of anything and I think at this point I need a guarantee of sorts.

Anyway....onto something a bit more positive!  Even given all the challenges this time around included, My first appointment this time was on April 20th.  I could be headed for surgery before the end of June if all works out right..

In a way (Since I have a hard time asking for help)  I am reaching out...for some positive thoughts and kind words. I know I am doing what's right for me...I need some reassurance it's right. :)

 I do hope that things work out for you---WLS is a very personal decision and we have all been through the ups and downs of the road you are on---my journey has been a long one too---for different reasons---but here I am waiting for a date---I am sure if your company covers WLS then things will work out for you! 

  Try to stay positive and keep doing all that they are asking of you and you will get there!

Best of luck!
Maureen 

I'm afraid I have no wisdom to offer (I'm just the local  photography and computer geek :-), but wanted to wish you all the best.

I hope you'll get "there" - wherever exactly that "there" may be for you.

Hello Miss Kasey,

Please keep your chin up - my story is very similiar to yours.  I started looking into WLS about 10 years ago.  Had Boeing Traditional insurance at that time and they did cover it.  My family and friends talked me out of the surgery - they felt it was too dangerous, etc.  I had done diet pills nutri-systems, TOPS, weigh****chers, Jenny Craig and more.  I was even a lifetime member of weigh****chers.  Well - I tried weigh****chers once more and I did it - I lost 100 lbs!!!  I kept most of it off for about two years and then I paid for a tummy tuck, and liposuction out of my own pocket - lots of money!!!  THEN within the next couple of years I gained all my weight back plus more!!!

I was very angry at myself and my friends and family because I felt I should have had the surgery back when I really wanted it and now I had wasted so much time, energy, money, and years to fail again!!!  I went through very heavy depression - quite severe depression - didn't care if I lived or died.  Just plain didn't care any more.  I finally hit rock bottom and decided this is my life - it's not anyone elses.  We had changed insurance companies in the meantime.  My family was finally supporting me for the most-part now.  This time insurance didn't cover WLS and I was turned down!!!

Once again back to trying to loose weight on my own - just to loose and gain again, but each time getting harder and harder.  Now in my mid 50's. 

Open season again for insurance with Boeing - talked hubby into switching back to the Boeing Traditional which covered it.  Went to seminars while waiting for coverage to start, chose a doctor, got ducks in a row.  Discovered after submitting all my information to insurance that I didn't have enough documentation to meet the 12 month doctor supervised dieting.  Denied, sent in more information to insurance.  Denied again.  In the meantime insurance actually changed in my favor.  The 12 month dieting was dropped to 6 months. 

To make a long story shorter - after years of Hell I WAS FINALLY APPROVED AND MY SURGERY DATE FOR RNY IS MAY 21ST 2009. 

But one more problem - failed my breathing test so now have to see a pulmonologist for surgery clearance.  Terrified again that I may not get my surgery and I now have two different appointments before my surgery date to see two different pulmonologists (my insurance does cover this and covers 2nd opinions too).

TO HOPEFULLY GIVE YOU SOME GOOD ADVICE AND LIFT YOUR SPIRITS: 

1.  Do keep posting messages on this website - the people are fantastic and so supportive and helpful during this process - they are a big part of what has kept me going this long ordeal.
2.  Find a support group or two or more and start attending them to meet others in the same boat as you.  Meeting people face to face and getting hugs greatly helps - plus you can add this meetings into you insurance information and it shows insurance you are serious and dedicated to WLS.
3.  Make sure you have a copy of your insurance and WLS requirements in writing.  Never trust what an insurance person states over the phone - many times I've discovered they don't know how to read correctly.
4.  Make sure you correctly understand specifically what your insurance requires.  If something is foggy - get clarification in writing!!!
5.  If you have a 6 month or year doctor supervised weight loss requirement make sure it is more than complete!  My doctor just had my weight, blood pressure, height, and stated following diet, or still dieting.  That wasn't enough!  I was denied!  They want it spelled out clearly such as:  patient is following the Weigh****cher diet plan under my supervision - they want a specific plan you are following.  They want behavior modification notes:  such as patient is drinking at least 8 - 8 oz glasses of water a day, eating only lean proteins, no frying, limiting fats to......etc., Exercise - they want to know what you are doing and how much.  Be specific and show improvement on exercise each month.
6.  Most insurances want a letter from you stating your willingness to comply:  List your past dieting attempts and failures, be specific with names of diets and dates.  List what wls books you have read to learn from, list any support groups you have joined/are attending.  List WLS on line groups you are a member of, list statistics about WLS and how it helps diabetes, sleep apnea, high blood pressure, etc.  List statistics on how much longer people live after having wls.  Let them know you are throughly informed and are not taking this surgery lightly.
7.  State spefically why you want this surgery, how it will change your life, tell them about the vitamins, mineral, supplements you will have to take for the remainder of your life and tell them your source for purchasing them etc.
8.  State any and all medical problems you have:  diabetes, high blood pressure, sleep apnea, COPD, etc.
9.  If you have seen any specialists - get a letter of support from them too.  The more doctor's support letters you have makes it harder for insurance to say no.

It took a while and in the end I faxed over 72 pages of information to my insurance company, BUT THEY DID FINALLY APPROVE ME BECAUSE I DID MEET ALL THEIR REQUIRMENTS AND I WENT ABOVE AND BEYOND.

PLEASE DO NOT GIVE UP.  INSURANCE WANTS YOU TO GET TICKED AND GIVE UP - THEY ARE INTO MAKING MONEY! 
IF YOU MEET ALL THEIR REQUIREMENTS THEY CAN'T DENY YOU - OR IT COULD MEAN A LAWSUIT.

I know this is long, but I hope it does give you some valuable information you can use, that perhaps you hadn't thought of and I know if you dot all your i's and cross your t's, you will get what you want! 

Best of luck and I hope we both make it to the looser's bench soon.

Donna/ragadolly

Boy that is tough!

I can understand why you are worried that you're insurance company will pull the rug out from under you again. One thing that MAY give you some piece of mind is to get a copy of your insurance "certificate of coverage". This is the document that will be somewhat long (100 pages?) that goes into great detail on what is covered and not. Find the sections that talk about WLS, obesity surgery, etc and read them carefully. If they don't list it as an exclusion, you are good to go, just follow the process given in the policy or by your insurance (get it in writing if desired). It might be listed as what I'd call a qualified exclusion that may say something about being medically necessary or that you need to meet certain criteria. If so, dig a bit deeper and find out more details on just what that language means to your insurance company.

In any case, my suggestion is to arm yourself with as much knowledge about your coverage, etc as knowing exactly where you stand might give you more peace of mind.

I hope everything goes well for you. I had a bypass a bit over a week ago and can already tell what a positive difference it will make.

David

Hi David,

Thank you for the information and the postive support!

I go into any challenge armed with knowledge, however, I didn't know the policy for health insurance was that long. I am going to contact them today.

Good Luck in your journey Iwish you all the best.

Thanks!
Kristine