My Heart Aches

Hi everyone.
 Im Amanda, Actually I am the wife of the patient in question.
 My insurance, BC/BS... Gilsbar has denied my husband for the surgery that he desperatly needs. He is hovering around 500 lbs, with a BMI of 74.1. but yet they say it is not "medically necessary"... whatever.
 Its very sad what he has to go through daily. I won't share the details, because I would not want  to humiliate him by giving details.
 He just underwent a test for sleep apnea last night, and without telling us directly that he had it, they simply told him he would be back(for the study with the CPAP)
 It makes my heart ache to see him not be able to do the things he loves, like play sports, walk with me and the dog, or even rough house around with our son without losing his breath.
 He has so many other medical issues that under lie from his childhood, and he is currently awaiting on a decision from disability. Perhaps if by the grace of God he is able to get that, maybe the insurance he will have through them will cover it.
 Surely they would want to approve the prodecure, which will allow him to shed alot of theese health problems and get back to work, allowing him to get OFF of disability.... you'd think, right?
 I hear about all of the things that he used to do when he was lighter, and I see the pain in his eyes, and it tears me apart inside.
 I just dont know what else to do... he had had almost EVERY one of his doctors/specialists concur that he NEEDS this to survive. But apparently, its not necessary according to my insurance.
 If anyone knows any other way or ideas, please share with us so we can get something done about this. I would like very much to live for the next 50 years with the love of my life...healthy.
 Thanks for listening.

All I can say is is if you were denied, APPEAL!  I have bc/bc of az  and they denied me first and i appealed and was approved.

I'm so sorry to hear the trials you are both going through.  PLEASE, YOU MUST NOT GIVE UP!

I have been DENIED (way more than once!) also (have Great West)........and am in process of appealing. 

Just keep moving forward and DON'T GIVE UP.  That the insurance company is trying to say he isn't medically in NEED of this life saving surgery.........is a CRIME.

Best of luck,
Gwynn

I am sorry to hear that.  I was denied by my insurance company.  And I said forget those guys, I will pay for it myself.  I had to cut back on a lot of extra spending, but I got a medical loan with very low interest, and I make a monthly payment.  It is the best thing I have ever done in my life.  I would do it again in a second, and I would pay double what I pay every month If I had to.  It saved my life and well worth the sacrifice on something else.  I got a five year loan and the payments are not that bad, you might want to check into financing, it is worth it.  Trust me. Besides, I spend so much less money on food, it made up the difference.

Good luck,

Jennifer

                   Call the insurance comp and get their criteria , then give it to your Dr and have him/ her write your appeal letter,  dont take No for and answer !  If you have to  check into legal assistance.

You just can't give in to the insurance companies.  They want you to give up.  Don't go away and don't let them win. Keep appealing.  If you need to hire a lawyer it is far less expensive than self pay and it seems like he automatically fits the NIH criteria especially since he now has sleep-apnea.  Keep in the fight.  I used Walter Lindstrom and Kelly Brown Lindstrom at the obesity law and advocacy center.  They are the only one's now doing this type of appeal, but well worth the money in my book.
Deanne

I can tell you this.  I am disabled.  It took awhile to get approved for it but I did.  Though Medicare I has Aetna which was a BIG mistake.  They added so many requirement for WLS that I would never got approve.  This year my wife and I did a lot of research and calling companys before we picked up.  I took Humana this year and it was easy to get the surgery done.  I know how you and your husband feel.  I too could not be a father and do normal daily things and it was killing me.  The more I could not do them the more I would gain.  The depression at times kept me from doing anything.  But my wife and family did not give up nor did I.  I can say that after my bypass my life it so much better.  Just DO NOT GIVE UP.  DO NOT TAKE "NO" for an answer. 

I have BCBS of Arizona too and it took me THREE appeals/applications before I got my approval. It's all about the documentation with these people! Do you have the number for the approval/application line? If you have AZ BCBS PM me and I will be happy to share it with you. Keep the faith- it took me more than a year- but I am now three months out and feeling like a new person!

Well, hi again everyone.
  Since I made this post, Larry has been approved for Disability, and he will be able to get Medicare starting in June of next year.
 Now, I just have to keep up the hope and the faith and prayers that Medicare will approve him to have surgery.
 I really think they would be crazy not too, as if he can get some of the weight off, all of the things athat are causing him to be disabled will go away, and he can get back to the way he really wants to be. He can even get OFF disability.
 So, anyone know of any surgeons  in the state of AZ that will fight with Medicare for WLS?
 Thanks!

Hey there!
I'm pretty sure that Bridges St Luke's is one of the only programs left that works with Medicare?  I think they require surgery be at a "Center of Excellence"?  ......  I'd suggest getting their criteria from Kelly at Bridges St Luke's and getting started with the "gathering" of things right away.  Then when June rolls around you'll be ready set to pu**** through  and begin "anew"!!!  .....  I think Dr. Terry Simpson also take Medicare come to think of it? 

Good luck!  ....  June is just a hop, skip and a jump over a few Holidays til it's here!  ....  Join us at some support meetings near you til then....helps you gather information, stay motivated and be completely armed to succeed!

Hugggzzz!