X-Post: What do you do when your excess skin affects your daily life and career? You FIGHT!
Paul, a good guy who often "pays it forward" in our Chicago DS support group, was just featured in this great "Today Show" blog on his struggle to get insurance to pay for his facial plastic surgery after massive weight loss. He gave me his permission to post this story on OH.
http://today.msnbc.msn.com/id/45590135/ns/today-today_health /
His 240-pound weight loss has been incredible and life-changing, but the excess skin on his face and neck is negatively affecting his daily living AND his careeer. He hopes that his ongoing war with the insurance company will help others who will come later down this same path, maybe even YOU:
If you are struggling with this issue, fight your insurance company. Only a few years ago, body reconstructive surgery was not as covered as it is today. Things can change!
BTW, if anyone has any advice on fighting the insurance company, he'll take it. Send me a PM and I will get the message to him.
All the best,
Nicolle
http://today.msnbc.msn.com/id/45590135/ns/today-today_health /
His 240-pound weight loss has been incredible and life-changing, but the excess skin on his face and neck is negatively affecting his daily living AND his careeer. He hopes that his ongoing war with the insurance company will help others who will come later down this same path, maybe even YOU:
If you are struggling with this issue, fight your insurance company. Only a few years ago, body reconstructive surgery was not as covered as it is today. Things can change!
BTW, if anyone has any advice on fighting the insurance company, he'll take it. Send me a PM and I will get the message to him.
All the best,
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
Nicolle-
The comments section on that article are pretty brutal and it really makes one wonder where insurance companies should draw the line on what they will or won't pay for. I think someone mentioned in the comments something about injuries caused when a person wasn't wearing their seatbelt, for example, that an insurance company could deny coverage for that person's reckless behavior basically. It seems if that were the case then they could deny coverage for just about anything under the sun, speaking of which, what if someone got skin cancer who was an avid tanner at one point in their life, well, could the insurance provider potentially deny coverage to that person for their irresponsible behavior; I mean they caused their own skin cancer in essence, correct? Just things to ponder, not that I am taking a position on this matter myself.
However, a part of me does feel guilty about asking the insurance company to pay for such an expensive operation, because in my case, I'm the one that got fat when it boils right down to it. It's just something I ponder. I wonder what people would think if they knew I was asking my insurance company to pay for my procedure. Yet, it may not be such a big deal if the insurance company was paying for obesity-related medications down the road, right?
I'd be interested in hearing other folks' thoughts were on whether or not insurance companies ought to draw the line with what they will cover.
It also seems that more employers are stepping up in a proactive manner these days and offering incentives to employees for getting healthier by quitting smoking, losing weight, etc. I like this approach myself, though I don't know how it will play out regarding insurance companies in the long run, maybe in their favor?
The comments section on that article are pretty brutal and it really makes one wonder where insurance companies should draw the line on what they will or won't pay for. I think someone mentioned in the comments something about injuries caused when a person wasn't wearing their seatbelt, for example, that an insurance company could deny coverage for that person's reckless behavior basically. It seems if that were the case then they could deny coverage for just about anything under the sun, speaking of which, what if someone got skin cancer who was an avid tanner at one point in their life, well, could the insurance provider potentially deny coverage to that person for their irresponsible behavior; I mean they caused their own skin cancer in essence, correct? Just things to ponder, not that I am taking a position on this matter myself.
However, a part of me does feel guilty about asking the insurance company to pay for such an expensive operation, because in my case, I'm the one that got fat when it boils right down to it. It's just something I ponder. I wonder what people would think if they knew I was asking my insurance company to pay for my procedure. Yet, it may not be such a big deal if the insurance company was paying for obesity-related medications down the road, right?
I'd be interested in hearing other folks' thoughts were on whether or not insurance companies ought to draw the line with what they will cover.
It also seems that more employers are stepping up in a proactive manner these days and offering incentives to employees for getting healthier by quitting smoking, losing weight, etc. I like this approach myself, though I don't know how it will play out regarding insurance companies in the long run, maybe in their favor?
It's a very complicated issue, which cannot be discussed without discussing economic and politics. I for one do not think the insurance company should be required to pay for plastic surgery. And I have a very hard time believing this is medically necessary. At some point, we have to be responsible for our decisions and their aftermath.
We all pay for this when insurance does...increased premiums, taxes (which go toward medicaid and medicare), etc. It all depends on what we think society is responsible for in terms of paying for individual needs/desires.
We all pay for this when insurance does...increased premiums, taxes (which go toward medicaid and medicare), etc. It all depends on what we think society is responsible for in terms of paying for individual needs/desires.
Are you so sure you're 100% responsible for being overweight?
My grandmother was over 500 pounds when she passed. I've got POS which statistically says I'll be overweight. So genetics, disease (discovered or undiscovered) make me more susceptible. Then there are the societal influences, nature vs. nurture a few other things.
So what percent of obesity could you avoid?
I'm not being nasty with ya hun..just older than you and been fighting to get up the down escalator for two long. I'm so tired of thin people thinking it's just a matter of diet and excercise. You get two steps forward and end up three back. Once your BMI is up there (I can't remember the exact number) you only have a 5 percent chance of ever losing weight and keeping it off. Is this a disease or a life choice?
What I had to look forward to before this surgery was heart failure, stroke, I was only a couple of years out from riding around on a scooter, the diabetes probably would have taken a limb or my sight. Who would have paid for all that? Disability, caregivers, someone to wipe my rear after the stroke, perhaps going to a school to learn braille through voc rehab. Hmmmm sounds costly.
At least this surgery gives me the chance to have some control of my destiny and a way to work toward a healthy tomorrow. It gives me a chance to get back to work and contribute to society instead of taking from it prematurely.
Hell yes the insurance companies need to pay. It will save them tons of money in the long run.
My grandmother was over 500 pounds when she passed. I've got POS which statistically says I'll be overweight. So genetics, disease (discovered or undiscovered) make me more susceptible. Then there are the societal influences, nature vs. nurture a few other things.
So what percent of obesity could you avoid?
I'm not being nasty with ya hun..just older than you and been fighting to get up the down escalator for two long. I'm so tired of thin people thinking it's just a matter of diet and excercise. You get two steps forward and end up three back. Once your BMI is up there (I can't remember the exact number) you only have a 5 percent chance of ever losing weight and keeping it off. Is this a disease or a life choice?
What I had to look forward to before this surgery was heart failure, stroke, I was only a couple of years out from riding around on a scooter, the diabetes probably would have taken a limb or my sight. Who would have paid for all that? Disability, caregivers, someone to wipe my rear after the stroke, perhaps going to a school to learn braille through voc rehab. Hmmmm sounds costly.
At least this surgery gives me the chance to have some control of my destiny and a way to work toward a healthy tomorrow. It gives me a chance to get back to work and contribute to society instead of taking from it prematurely.
Hell yes the insurance companies need to pay. It will save them tons of money in the long run.
Hoosiermoma-
I don't know what I think anymore! Ha! I need to stop thinking and just act! I think too damn much! I will say that something in me compelled me to start overeating as a child and to keep on overeating and overeating and overeating. I'm sure environment played a role but it feels bigger than that too, more complex. Yes, at this point now it's probably useless to discuss this philosophically because it has grown into its own little living monster, my fat has taken on a life of its own that I may never be able to take back without help from a man made source, hence the DS.
I don't know what I think anymore! Ha! I need to stop thinking and just act! I think too damn much! I will say that something in me compelled me to start overeating as a child and to keep on overeating and overeating and overeating. I'm sure environment played a role but it feels bigger than that too, more complex. Yes, at this point now it's probably useless to discuss this philosophically because it has grown into its own little living monster, my fat has taken on a life of its own that I may never be able to take back without help from a man made source, hence the DS.
We are taught that this thing is totally controllable therefore we are 100% responsible. We are lazy and weak, no self worth or we would be thin. We must be mentally ill to overeat to this point, and my all time favorite " you have such a beautiful face, if only...."
I don't pretend to know what part is in our genes, what part is our "weakness" and what part stems from a strong link to the primordial ooze that forces us to gather for the winter and whatever other contributing factors are involved. I'm not that smart but I know I'm not here by choice and I never have been. If it's an addiction, so be it, insurance covers addiction without having to jump through mega hoops to qualify. I don't have to spend 6 months seeing an addiction counselor to teach me to have smaller, less fatty portions of heroin before I can be considered for treatment.
What I sacrificed to get the insurance to save my life, I won't tell you. I've done my dues over and over and I get so tired of the prejudice and ignorance people spew in the comment sections of articles like this.
Ok, my dogs are going ape so I'll get off my soapbox now LOL...this isn't directed at you, just the topic :)
I don't pretend to know what part is in our genes, what part is our "weakness" and what part stems from a strong link to the primordial ooze that forces us to gather for the winter and whatever other contributing factors are involved. I'm not that smart but I know I'm not here by choice and I never have been. If it's an addiction, so be it, insurance covers addiction without having to jump through mega hoops to qualify. I don't have to spend 6 months seeing an addiction counselor to teach me to have smaller, less fatty portions of heroin before I can be considered for treatment.
What I sacrificed to get the insurance to save my life, I won't tell you. I've done my dues over and over and I get so tired of the prejudice and ignorance people spew in the comment sections of articles like this.
Ok, my dogs are going ape so I'll get off my soapbox now LOL...this isn't directed at you, just the topic :)
"We are lazy and weak, no self worth or we would be thin. We must be mentally ill to overeat to this point, and my all time favorite " you have such a beautiful face, if only...."
Oh do I hear that! When I was MO before surgery, I "succeeded" at diets where I did not put solid food in my mouth for 8 months. No will power? Let some of those normies try that! I also lost weight the way you are "supposed" to through 4 years of diet and excercise. I did 3 triathlons (running, biking and swimming) while outweighing even the heaviest of the men. (I weighed 220 when I did this.) I was working out 30 hours a week. That is insane! I decided that I had to quit that maddness and THAT was when I started researching WLS. I KNEW I would gain the weight that I'd worked so hard for 4 solid years back because I was cutting my activity level.
Oh yeah, I was mentally ill...to do those crazy diets that helped contribute to my MO state!
Should insurance have paid? Yep. I did everything I should have done! Genetics was against me and the diet industry wanted to keep us coming back. Now, it turns out they would have paid for an RnY, close to my house but I chose to self pay for the DS. It was all about the quality of the rest of my life. My medical costs have gone way down - even with my increased blood work to make sure I stay healthy!
(PS: Insurance will now pay for the DS but no one in system does it so they deny it!)
Oh do I hear that! When I was MO before surgery, I "succeeded" at diets where I did not put solid food in my mouth for 8 months. No will power? Let some of those normies try that! I also lost weight the way you are "supposed" to through 4 years of diet and excercise. I did 3 triathlons (running, biking and swimming) while outweighing even the heaviest of the men. (I weighed 220 when I did this.) I was working out 30 hours a week. That is insane! I decided that I had to quit that maddness and THAT was when I started researching WLS. I KNEW I would gain the weight that I'd worked so hard for 4 solid years back because I was cutting my activity level.
Oh yeah, I was mentally ill...to do those crazy diets that helped contribute to my MO state!
Should insurance have paid? Yep. I did everything I should have done! Genetics was against me and the diet industry wanted to keep us coming back. Now, it turns out they would have paid for an RnY, close to my house but I chose to self pay for the DS. It was all about the quality of the rest of my life. My medical costs have gone way down - even with my increased blood work to make sure I stay healthy!
(PS: Insurance will now pay for the DS but no one in system does it so they deny it!)
SW / GW / CW 5'10"
306 / 165 / 140
With the DS: there is no stoma, so no stoma strictures; there are no limitations (other than volume) against drinking before, during or after meals; 80% of ingested fat is malabsorbed; 98.9% of type II diabetics are CURED of this devastating disease, with data showing stable cure over 10 years out; there is the best average weight loss and most durable (average 76% excess weight loss going out 10 years) of all of the bariatric surgeries. That's why I had a DS!
NoMore B.
on 12/13/11 7:02 am
on 12/13/11 7:02 am
Des,
Here are my thoughts on it. Let's even put aside the "obesity as a disease" issue (which I believe it is), and let's say that it was 100% our behavior and habits that made us this way.
Even that being said, where do you draw the line? Deny the person with lung cancer and emphysema treatment becasue they chose to smoke? Deny the Type 2 diabetic insulin because perhaps they didnt cut carbs and exercise enough? Deny the ovarian cancer patient treatment because she didnt report her symptons soon enough? Deny the accident victim treamtment because he drove without a seatbelt?
My point is, that everything in life is a result of some type of action or decsion we make, If not, we'd be living in bubbles in our bedroom and never leave the house (and maybe need treatment for heart disease due to lack of excercie, KWIM?). Yeah, some of my examples might be extreme but the point is where do you draw the line?
I definitely think most excess skin issues fall under "reconstructive" and not purely cosmetic. Most insurance will pay for breast reconstruction after mastectomy, this shouldn't be any different, IMHO.
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