Insurance Question

Can anyone explain to me how these insurance companies can just drop wls?! Even if deemed medically necessary?! What are people going to do? ~Kristin

Yep, my insurance co Aetna/ushc is dropping WLS as of 01/05 for everyone. Which means I can't have the surgery unless I hit the lottery! I did receive an email from a group who is supporting a class action lawsuit against these insurance companies. Not sure where it will go? Not sure how they can deny a medically needed surgery? love, linda

HI everyone,... I have Aetna too.. and when I heard they were dropping coverage of the surgery in January.. I went into a full blown panic attack! Luckily, I have a surgery date in December, the 20th. It kinda sucks to do it so close to christmas.. but considering the alternative.. I'll take it. I work in health care, and believe you me, I wasn't going to just up and forget about it just because "my" surgery was going to be covered.. I thought of all the hundreds/thousands of people who will come after me.. so I called Aetna, and gave them a what-for about it.. I actually got through to some medical director,.. who proceeded to give me some BS line about newer studies showing that the risks are far greater than previously believed & blah blah blah. Long story short,... it turns out Aetna *will* be covering the surgery come January.. *however* your employer has to carry a separate rider for it. So if you know someone with this insurance who needs to have this surgery after January,.. have them discuss it with their employer,.. it's not hopeless. Good luck to all, Laura C. 9 days to surgery & counting!!

It doesn't make sense. There are studies that show that morbidly obese men on Medicare incur an average of $6-8,000 more medical expenses annually than non-obese men. So you think, well, surgery pays for itself in less than three years. But how many of our employers have changed their health care providers in the last five years, and how many times have they done it? Even those that stay with the same insurer change their plans and benefit levels. The problem is that insurance companies are thinking that they will not have you on their rolls for more than three years - so they would not be able to "make their money back" on WLS. That is their logic for saying that WLS doesn't pay. Intuitively, it DOES pay. The problem is that it might not pay for any individual insurer ALL of the time. It's B.S. So many medications and procedures ARE covered, when no one's life is on the line (VIAGRA and other sexual aids being my favorite), but when it comes to Morbid Obesity, it's still not getting treated seriously. The discrimination against the obese is UNREAL. The only way to make sure that everyone has access to WLS is to lobby the government. If our regulators weren't so worried about Janet Jackson and Nicolette Sheridan, do you think they could maybe pay some attention to a national health crisis? I'm so frustrated, I might have to move to Canada. Jen

It just plain stinks!!

I have a question? What is the AMA going to do about the insurance industry? If the AMA stands by its claim that obesity is a disease why don't they lobby the government to force changes in the way insurance companies deal with WLS. The surgeons interest is at stake here, tons of money will be lost.... love, linda

Hey Laura, My husband's employer is GE. Even with all their employees and resources they aren't going to have a rider for the surgery. I was told by two Aetna rep's GE would cover it but, then finally found out they wouldn't. So I wonder how many companies will actually have the rider, can't imagine smaller companies putting out the money!! Good luck and lots of health with your surgery. love, linda

Hi Kristin, I actually met you at Dr. M's seminar! You are my inspiration. I am 7 days post op. Anyway, my suggestion is that all employees need to go to their Human Resources/Benefits Administrators and discuss their issues and needs with them. They need to emphasize how much money this procedure will save the company in the long run. These are the people who decide the benefits for their employees. If a company switches to another insurance carrier because it won't cover the surgery we will see how fast that will change! I was lucky, but admit I made sure I did it in 2004, just in case. We are all our own advocates. Educate ourselves and speak out! God Bless! Fran Crouch