Tired of the Crap -- LONG

I hate insurance. I have been paying my insurance premiums for over a decade...but when I need something it's denied. I don't have to lose 100 pounds..I need to lose 300 pounds.  But I'm healthy...or so they say.  I have sleep apnea, but my sugar, blood pressure, cholestorhol, etc are all great.  Insurance says I have no medical necessity and won't pay for surgery. The years of WW (although this is what MY DOCTOR) told me to do to try and lose weight isn't "doctor directed".  I tried to start another "six month" diet but it snowed and I missed an appointment and was told I had to start all over.  I can only have surgery in the summer since I work two jobs in the winter ( I do taxes).  So, starting the six months AGAIN...is useless, because that puts me into tax season. We won't mention the bottles of pills, and other diets I have tried.  I really understand they want to make sure you have tried to lose weight..but c'mon -- like I said -- it's 300 pounds....I think they are just hoping I croak.  I can't take it anymore. I just want to be normal.  I'd be so happy if I only had 100 to lose -- at least the comments would stop.  I am so tired of hearing from people and doctors alike -- "Have you considered WLS?"  WHAT?? THERE'S A SURGERY OUT THERE?? MORONS. Do people honestly believe that I wake up each day and say "thank God, I'm Fat and not normal like everyone else?" I've contacted a lawyer and I have asked my surgeon to please resubmit my paperwork for the bypass ( i wanted the sleeve, but right now I'll take anything).  I called Monday and she said the person was out but she'd leave a note and the person would be back Tuesday. I called Tuesday and they said the file was on the surgeon's desk.  So I called back Friday only to be told that the surgeon had spoken to her (office manager that was out on Monday) and she's off on Friday.   ThIe lawyer said she has an 85%-90% success rate.  I just want to have surgery soon -- I am so tired of being fat.  I've been dealing with my weight for so long -- don't I deserve some help too? I am so tired of watching others get what they need from insurance -- they get their drugs and surgeries...but I need to pay someone $900 to get help.  I feel like it's just more discrimination...when willl I get a break? Sorry to be so long..just very frustrated.

((((Jobsies)))) I feel for you... and yes you DO deserve some help.  However, I do feel that having a lawyer get the job done for you really IS the best way.  I, too, am having difficulty.  I wish I had some doctor friends that would write out a 6 month history for me with all the information I KNOW the insurance company will want, and just have it over with.  I have had countless diet histories, some of which were doctor supervised, but I have no documentation.  I don't know any doctors personally.  But, that would be the easy way out. Behavior modification is a real issue with me.  I've got to start now, or I'll not be successful after the first 8 months of surgery.  I understand the first 6-8 months are pretty much a given that you will lose weight.  After that, you've got to have the healthy habits in place or you'll gain the weight back or get very sick from vitamin deficiencies.  I am also tired of waiting.  If I could pull some strings, I would.  Unfortunately, hiring a lawyer is not possible.  I've yet to be formally denied, but I have a feeling it will happen.  Keep your chin up and you will be successful.  Anything worth having isn't easy, and take a lot of time. 

My issue is I have done this.  The first time I looked into WLS ( a few years back), my dr told me to go to WW for at least six months.  I went for 18 months..and lost a nice amount of weight.  But even though my dr and I discussed it, I didn't go "monthly" with her and the ins doesnt count "WW" as a diet they won't count it.  They also won't count the second diet I did with the doctor because I missed a month when I was working 85 hours a week and it snowed. Oh, and since one of the months I went when I had a cold as well -- that "doesn't count" since obesity wasn't my primary reason for going. Apparently, I have to have two separate appointments and two seperate copays. I have done a personal trainer, curves, a gym...I just want my chance to make this work -- I am sick when i see people that started their journey at 195-225 pounds and we both have to meet the same requirements??  That's crazy!   MY GOAL is 195-225!   It's a never ending cycle...during tax season I am working 7 days a week, two jobs, from 7 am -10pm making it hard to get to a  dr's appointment so I can't do the six month diet -- but if I do the diet in the summer I can't have the surgery until the following year.  By the time I get this done, I'll be even heavier. It's bull****the insurance companies are thrilled...just take my money and pay nothing out. If the lawyer doesn't work, I'm calling my Senator and Congressman.

I disagree. Studies show that the six month "supervised" diet does NOTHING to suggest success with surgery.  It's just a stall factor so that insurance companies don't have to put out the money.  I don't have a choice about working two jobs..the hours I spend at the tax office gets me through the rest of the year.  So yes, I sacrifice those months of my life to get me through the rest.   Please don't suggest that I just take the time off -- that's not feasible. Plus, I have to work three times as hard to prove myself, due to the discrimination of the obese. I have watched others, not as big as me, but big -- call out, not take pride in their work, etc.  It reflects on me -- So I put in the extra hours, I put in the extra work, so that no one can call me lazy -- like the call the others. I have a hard enough time making ends meet..and to be honest, have skipped appointments due to the fact that I just didn't have the money for the copay.  It's just me..and I need every penny.  I'll admit it drives me batty to have to walk in, pay $$ to step on the scale and have the doctor say, see you next month.  I can't control the doctors office...or the doctor. I can only control what I can do...I have done my part.  I have tried every pill that comes down the pike, every diet plan that screams success, I have tried and tried and tried. It cracks me up...they say that WLS is the "last resort" and for me it is..but can each person that just did the six months and wow they are approved -- can they truly the same thing???  I understand -- some idiot in a suit says show me proof that you tried, i have a decades worth of proof.  I have been obese for two decades.  I'm tired of failing, I need help. I don't want another year of this..if I am going to do this, I need to do it this summer, so that I am able to work both jobs come December.  If I can have surgery in July or August -- then I can be sure I am physically able to work the long days.   If I had a choice, I wouldn't work -- I'd sit at home and collect welfare or disability.  But, instead I choose to work hard and should be punished for it. 

Hi Jobsies, I kind of know where you are coming from. I have been denied twice also. Please listen to the wonderful insight Paul is giving you, it is from the heart and for your benefit.  The insurance company does not want you to fail, they must have requirements and they have to be the same for everyone, to protect themselves and you.  I wish you well. Peace, Linda

Hi Paul, You are really very well versed. You have indeed given Jobsie's ALOT to think about. I know the replies I received from you a couple of weeks ago were very informative, and by the way, I haven't posted yet, but I got a call Friday to cancel my level 2 appeal hearing conference call, because the RN that was acting as my moderator reviewed everything I sent in and said my case is approvable, so it's in the system as approved. I called the surgeon's office right after and I am scheduled for July 14th.  Thanks for all the support, now even more. Peace, Linda

I do understand what everyone is saying..i guess I feel like at my size, it shouldn't be this hard. I went to my obgyn recently and got a lecture about how I need to have bariatric surgery..when I tried to explain I had been denied for lack of medical necessity, I was told "that doesn't make sense, you are extremely large".   Gee thanks.  Not to mention, I was originally told that my WW would count, if I had it documented by my dr. WHICH I DID.  So after months last year, oh and $2000, and going back and forth to seven doctors, who said I need surgery -- I get denied for lack of medical necessity..and have to start all over again.  I used all my vacation days and worked overtime to make up for the fact that I took time off to go to the dr.  Keep in mind others do it, but when someone my size does it -- we're lazy.  I saw this with two of my larger coworkers and i didn't want to have that same attitude directed to me. I missed a month because of snow, start over...it just seems like they set you up to fail or just give up.  So, here's a new year..and they want another $2000 (the cap on my 20%). I don't have a husband, I don't have anyone to help with the bills.  I do it on my own...$2000 is a lot for me.  I just want someone to say -- yeah, she needs this, cut the crap and let's get it going.  It's like telling someone in the midst of a heart attack -- we have to check your ekg and do a stress test before giving you any nitro.