Hell Revisited

Jupiter6
on 9/27/07 10:48 am - Near Media, Pa- South of Philly, NJ

His HR department reports they made an error previously-- they never DID cover WLS of any kind. They have an exclusion, which was not mentioned when asked in March. He's been pre op dieting since March. Had three sets of labs, plus sleep studies. Paid $350 in lab fees, $50 to get a doctors letter. Went to six monthly physicians appointments, paying $20 co pays each time. Created a perfect chart no one could deny-- and convinced his girlfriend they'd get through this together. We're in agony. And I ...am alone.

"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
     Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U.   Upper and Lower Bleph/Lower Face Lift
     12/08
     Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09  -Dr. Pontell, Media PA Mastopexy/Massive
     Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
     6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
     Total Cost: $33,500   Start wt: 368   RNY wt: 300 Goal wt: 150   Current wt: 148.2 BMI: 24.7

Neecee O.
on 9/27/07 10:51 am, edited 9/27/07 10:53 am - CA

I can only imagine his pain...and yours of course. It is a let down. Is there any way on earth he can self pay? You guys are young enough that it would be worth it. When it comes down to it, Shari, we are all alone in this journey. All he can do is try his best, take it off himself to the best of his ability.

Jupiter6
on 9/27/07 10:55 am - Near Media, Pa- South of Philly, NJ

RNY on 07/16/07

It was his idea, his timetable-- and now I'm the one with the ruined guts. Ironic. In any case, no--he makes #32k and has 8 kids...self-pay ain't a'happenin'. GAH.

"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
     Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U.   Upper and Lower Bleph/Lower Face Lift
     12/08
     Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09  -Dr. Pontell, Media PA Mastopexy/Massive
     Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
     6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
     Total Cost: $33,500   Start wt: 368   RNY wt: 300 Goal wt: 150   Current wt: 148.2 BMI: 24.7

violamom
on 9/28/07 2:32 am - veradale, WA

2 options - did he get his employer to put it in writing that WLS was covered? ANYWHERE? if he has an email showing that it is covered he might be able to claim under thier E&O coverage. OR maybe he qualifies for public assistance? 8 kids on 32K is definitley lower income. I dont't know about YOUR state - but I know that here in WA if it is excluded and you would qualify if you were uninsured you can still get the assistance. It is worth a shot.

What I've eaten is here for the world to see
336.1 (8-1-07)/319.0 (12-28-07)/200 (goal for 12-31-08)/160 (goal)
Next mini goal is 290 by 1-31-08

Jupiter6
on 9/27/07 5:40 pm, edited 9/27/07 5:41 pm - Near Media, Pa- South of Philly, NJ

RNY on 07/16/07

At 1600 calories, and doing 45 minutes of sweat dripping cardio a day, he's been holding at 329 pounds for over a month. His weight isn't moving. He is going to get sick, maybe even die, and all I can do is sit here and watch it happen. Jesus. How can I share my successes now with him? How can I stay afloat? How do I help him? I cannot stand that I am leaving him behind. It truly TRULY should have been me. I can do it alone-- I don't think he can. Holy f*ing crap.

"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
     Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U.   Upper and Lower Bleph/Lower Face Lift
     12/08
     Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09  -Dr. Pontell, Media PA Mastopexy/Massive
     Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
     6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
     Total Cost: $33,500   Start wt: 368   RNY wt: 300 Goal wt: 150   Current wt: 148.2 BMI: 24.7

Jupiter6
on 9/27/07 5:38 pm - Near Media, Pa- South of Philly, NJ

RNY on 07/16/07

Check my blog for details. I am sleepless, I am in agony, and I have no idea what to do. I'd give ANYTHING to trade with him right now--- anything.

"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
     Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U.   Upper and Lower Bleph/Lower Face Lift
     12/08
     Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09  -Dr. Pontell, Media PA Mastopexy/Massive
     Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
     6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
     Total Cost: $33,500   Start wt: 368   RNY wt: 300 Goal wt: 150   Current wt: 148.2 BMI: 24.7

MelindaR
on 9/27/07 10:45 pm - Lansing, MI

VSG on 01/16/08

It makes me so sad to hear that your Sig Ot was treated this way. It really is heartbreaking. I'm sending hugs your way and lots of support. Shari have you posted on the Insurance board and asked Gary? It might definitely be worth a try to ask him about your Sig Ot's situation. It looks like there was a major breakdown at not only Aetna, but also at Ray's company. The fact he was told WLS was covered by AETNA and his company referred him to the website, but didn't get him a copy of the policy as he requested could mean grounds to appeal. It's definitely worth pursuing. The big question...did Ray get the name of the rep he talked to at Aetna who initially said it was covered? The only other ideas I would have, which I'm sure you've thought of, are marriage if possible or Ray looking for a new job. Be good to yourself and tell Ray to hang in there. When the lord closes a door, I truly believe he opens a window.

brko
on 9/27/07 11:41 pm - MO

I don't know what to say. I can feel your pain through your words. I would appeal and see what happens. Does any insurance company ever make exceptions, especially when he was misinformed and had to paid a lot of money and probably lost time for work? I know some insurance companies document their calls on their computers. Maybe try and get the doctor to go to bat for him. I've seen it happen on that show "Big Medicine" and "Inside Brookhaven Obesity Clinic."

Brenda

Elle B.
on 9/27/07 11:37 pm - TX

Lap Band on 12/10/07

Shari... Big Hugs to you Mama!!!...We all know how much you love him and it shows.. the fact that you are agonizing over his trial... just make my heart cry.... But this just may be the start of an appeal battle.... You have to be strong for the both of you right now..... You cannot let your progress be hindered.. but at the same time you have to help him thru his trial.... I am keeping both of ya'll in prayer... trust things may turn around....

violamom
on 9/28/07 4:39 am - veradale, WA

Ummmm YOUR insurance covers it.... Have you ever thought about gettin hitched? (Please dont kill me - I'm just sayin....)

What I've eaten is here for the world to see
336.1 (8-1-07)/319.0 (12-28-07)/200 (goal for 12-31-08)/160 (goal)
Next mini goal is 290 by 1-31-08

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