Looking for advice and sharing story.

OK  I am looking for some advice from you guys. Befor I do I think I should explain my current situation. I'm a jersey native and have been trying to have weight loss surgery for years now. I started the journey about 5 years ago. I was working full time and my company offered my Aetna for $35 a week. So I took it and looked into the surgery. I found some great/nice doctors who most helpful. They then notified me that Aetna required me to jump through a couple of hoops. I would need to get 6 months of supervised nutritional guidance. I would also need to talk to a psychiatrist for a couple of months too. I didnt really mind. I was fine with red tape if it meant getting the surgery. Well around month 4-5 of the 6 month waiting period, my doctors sent me a letter telling me they were no longer going to accept aetna. The letter said something to the effect  of "We know this sucks, but we cant stand them anymore and wont do buisness with them. Sorry for wasting your time."

So it was a big blow. I was very disheartened and depressed over that for a while. About 3 months after that I lost my job and the insurance went with it. So I was unemployed for close to 1 year. I decided at that point that maybe I want to give medicaid a shot. It was a glimmer of hope in a very dark time. So I went through all the hastle to geta it. and let me assure you that it was a GIANT pain in the arse to get that medicaid. But when I finally got it, I put it strait to work. I had to do a couple of months of research befor I could find a doctor that wouldnt laugh and hang up on me when I told him I wanted weightloss surgery and had medicaid. But I found one.

So I go see this doctor. Who was also in a part of jersey I have never heard of or been to ever since lol I go see him and he tells me that since I have medicaid he will do the surgery but there are certain services that it wont cover and I will have to attend to on my own. for example, I would have to find a lab who will take my blood and do all the blood tests they required. I would have to find a psychiatrist who would accept medicaid. I woudl have to find a gym, etc etc. They couldnt do any of that for me cause of the medicaid.  So I had no idea where to start. No clue where to find a lab to do my blood work and that would accept medicaid. Oh and the doctor also told me I would have to raise $2000 for the surgery.

Now I didnt mind having to do all this work or pay the money that I didnt have lol I need the surgery and my health is decliine quickly. So I uinderstoof that sacrifices were going to be made. So I gave my self 1 week of research to find all these "chores" that needed doing. Needless to say I got no where fast lol So I called the doctors office up and asked if they could point me in the rite direction. They told me they coldnt help for some reason or another, But they gave me a fax number so I could fax over said info and not have to drive and drop it off. So now 2 weeks go by and I'm still not having any luck finding anyone who can fulfill the doctors criteria. I then get a letter from the state telling me I need to go in for a six month reevaluation. I go and they figure that I will be getting a very cut down and very reduced "class" of medicaid. which guess what.... Doesnt cover weightloss surgery.

So I got shafted twice. Once by Aetna and once by Uncle Sam. It was at that point that I sort of gave up on the dream. It just wasnt happening.

Fast foreward 3 years (to today) I am working 2 days (14 hours a week). Got a new job. The economy is in the dumps so 14 hours is the most that I can get. They have insurance.... but guess what they carry. If you guess Aetna, you guessed correctly. My luck rite? They have Aetna lol Well, the problem is that Aetna at that company costs around $90/120 a week. I make about $115 a week. (give or take $10 depending on if im 5 minutes late or not).

Now, Heres the part where I ask for advice.

I NEED this surgery guys. I am morbidly obeese. My health is declining faster than I can type. I am very embarrassed to admit this,(even with the anonymity that the internet provides) but I am close to 700lbs. I am looking an ideas or methods that would allow me to get this surgery. Aetna and Medicaid are out of the question. They have burned me so bad that I dont think I would be willing to risk getting burned again. I just can't go through that again.I

How can I get this surgery? What can I do? What are my options?

I need help and am willing to entertain any and all options/ideas.

If you read this post and make a post of your own I thank you whole heartedly. I thank you all in advanced.

Here are some suggestions (and please don't shoot the messenger)

 

(1) SELF PAY. While I understand you may not have the money now, you can see about getting financial help through a Doctor’s office, or get a loan out and pay that back. YES it could be expensive, but what you need to remember (A) with the money you begin to save with WLS you can pay back the loan (B) your health should be more important that money

 

(2) Go through the company’s Atena plan. You may need to take a 2^nd job, but again you need to decide about your health vs cost

 

(3) I know of a private insurance company that helps patients get bariatric surgery, but (of course) it’s an out of pocket expense

 

(4) Look into becoming a test case patient – Some Doctors (like the ones that I deal with) have clinical trial of various different weight loss procedures. There is no guarantee you will be accepted into the study, and if so there is no guarantee you’ll be success with THAT procedure (and of course you can always be one of the “lucky" one who is picked to be the case patient that does not get the procedure)

 

Those are some off the top of my head. I know it’s not what you want to hear, but that’s the best I can do for now.

 

Hopefully others will have better advice.

 

Just know I am here to help.

If you have truly hit bottom and have insurance that will cover it you should use the insurance. I had an Aetna/Blue Cross Blueshield policy and yes you will have to jump thru hoops but those are put there to save the insurance company money and weed out people who are not willing to put in the work to get to have surgery.  In my case they almost won, I did think twice and it took me a few months to decide that they were not going to win ~ I was going to.

Call the insurance company and see what their requirements are and have them send it to you in writing plus take the persons name and operator number when you talk to them plus also write down the date and time you speak to them.

You can do your medically supervised diet at your Primary Dr's office so you really don't need a gym and yes you may have to pay for some things out of pocket like the therapist appt and the nutritionist appt but in the long run it will be worth it.

Just remember the surgery is only a tool and you have to be willing to make some major life changes and be willing to work hard for your own health, it is a journey not a marathon..

Good luck, I hope it works out for you.
Stella
 

ok first things first -- do you still have medicaid?? get on the phone and call different doctors -- there is going to be a dr that will accept your insurance -- most medicaid policies are now HMO's with private insurance companies -- Blue Cross Blue ShieldNJ Family Healthcare is MEDICAID but when you call the dr office you tell them you have BCBS and then they will ask you what type of BCBS you have and you tell them NJ Family Healthcare -- you do not need MONTHS of psych -- it's only 1 visit -- you don't have to find a gym -- the dr should be referring you to labs, cardio, pulmonary, psych and everything else -- don't let the dr just take your money -- there are plenty of free support groups to attend -- keep asking around -- keep calling different dr's --ask your primary dr to refer someone -- most insurance now won't ask for the 6 month diet -- more surgery types are being accepted by insurance -- there are resources out there and there are dr's out there who take your insurance as payment in full -- if a dr accepts your insurance then they accept what the 'fee schedule' pays them as 'in full' and they can not bill you -- i'm a biller -- call different hospitals and see if they have a bariatric service and talk to them -- ask for a service coordinator to help you sort thru stuff -- it doesn't have to be stressful and it doens't have to cost alot of money -- good luck

Contact the show Big Medicine and see if you can get them to do the surgery for free. Garth Davis came to an OH conference in Rye last year. He was a nice down to earth guy. I would contact doctors to see if they would do any pro bono surgery. I don't know which doctor wanted you to pay $2000 out of pocket but from what I know about medicaid there are no co pays required. I think you need to bring your case public and see if there is a surgeon who will take you under their wing, including a hospital covering all the costs.

Thank you all for your responces, most kind of you to take the time to respond. I think what i'm going to have to do is see if I can get a couple of extra hours at the current job and see if I can make Aetna work this time.

I wouldnt know where or how to start finding/calling doctors and asking for pro bono work. I wouldnt know how to "ask" lol

Thank you all so much.

Contact these folks, the Weight Loss Surgery Foundation of America (which is a grand name for what is still a very small organization, but hopefully it will take off and grow into its founders' aspirations) and see if they might have some ideas: http://wlsfa.org/

 Lots of good advice and here is some more.
My brother in law was in the same weight area as  you.   Went right up to surgery date years ago only to find out the day before surgery medicaid had pulled his operating abilities. 

Finally after advice from another man who was in the same weight area as well he found his surgeon.  My brother in law also had  medicaid.  We had to drive almost 4 hours to his office but 350 pounds and 3 years later he is well on his way.  Can't hurt to give the office a call.

www.obesityhelp.com/morbidobesity/bariatric+surgeon+profile+Vincent+Iannace+qpl.html

I don't know if this information will help, but I think Aetna has changed about weightoss surgery.  I had to jump through a few hoops, but they got it done, recently.  You can always give them a call and see what kind of coverage your job has. 

Best of luc****ep us posted.

Hello!

I first want to start by saying, thank you so much for sharing your story!!! You are a very brave person and I hope you know that. I am a weight loss counselor at Physicians Wt Loss Centers NJ. We have often helped clients lose 200+ pounds through tailored meal plans (we are medically supervised). If you are interested in learning more about us please contact me at 732 968 0200. I understand the money situation is tight right now and we are definately willing to offer you personally an exclusive discount on any services you would choose here at the center. The consultation and body composition analysis is completely free and you are under no obligations. Even if you decide this is not the program for you, we will be there to lend a listening ear. Hope to hear from you! Good luck!