HELP!!!

I am new to the site. I have to have gastric surgery. But my insurance claims they do not cover it.My doctor has had one on one meetings with the medical director for BC/BS to no avail. Medical records have more then proven the medical need of my having the surgery. Besides I have a 20 year old special needs daughter, who I am the sole care giver for. She was a 3 month premiee at birth and has had 78 surgeries.She has many medical issues and behavior issues. There is no one at all who will watch her, because she has sever issues with self abuse. A nurse even left her alone because of it. I have to be around to care for her, and my own medical issues continue to get worse and worse, because of my weight. If I am not around, my daughter would be placed in a **home** where she would be drugged to keep her from hurting herself and or others. But then she would be a zoombie. And what kind of life is that???NONE!! And one she should not have to live. I have no way of affording to pay for the gastric surgery,I have sleep apena and I have lymphedema in both legs,have had 4 hernia repairs, that the last one the doctor told me if it had to occur again would be a major major surgery. Have been in the hospital 4 times for my legs, and once for a part of my kidney dying off from a blood clot. My insurance will pay for all these hospital visits and continue to pay for them, but will not pay for gastric bypass.These hospital visits have all occured within the past 2 years. I have tried so many diets so many exercise programs to no avail. please help someone. I am desperate!!

I don't know what to say except that I pray they can find some way for you to get insurance approval for the surgery. Is the insurance through your employer?

yes the insurance is through my work. I have asked them if they could change the plan, they claim it would not be *cost effective* to do so.The surgeons office that I went to seminar for gastric surgery. The nurse called and asked if I would have it done, when I explained to her that my insurance wouldn't cover it, she said oh to bad, why not just go get a loan. I have NO way to repay a $25,000.00 loan, and thats only if things go ok.Or it will be even more. :-)

Your employer makes the decision to include or exclude treatment for obesity in the health care plan. For a lot of companies, especially small companies, the rider to cover WLS is just too expensive. To include it for the handful of employees who "might" use it would drive up the premiums for everyone on the plan. I work in human resources for a private university. When we changed insurance carriers last year we looked at including WLS in the plan. You would not believe how much it would have increased the cost to our employees (and the university since we pay 60-65% of the premium). I know of 3 people on campus who have expressed an interest in surgery. We currently have less than 200 people on the insurance and it would have put the cost of health insurance out of the range of affordability for most of the other employees so we chose to exclude it. I am on my husband's policy which covers the surgery. I feel bad about having to tell one of our employees that our policy won't cover WLS. Especially when they come to talk to me about it because they see what a difference it has made in my health. They understand that there is nothing I can do about it and that I am just as disappointed as they are. I know some people on the board have changed jobs to get insurance that covers the surgery. Is that a possibility for you?

changing jobs is not possible for me. As I am paid to watch my special needs 20 year old daughter. I had to get a special waiver from the State in order to do this. I had tried for over 7 years to find an agency to help watch her, while I worked. Afetr having used so many different agencies that claimed to have people trained to watch special needs people that have sever self abuse issues(my daughter head bangs,scratches, bites,and is VERY strong when she is in this *mode* it takes 6 adults to hold her to just draw blood and she is only 4' 11" and 88 pounds) And because she has a feeding tube per TN State law it has to be a rn and or lpn tha****chs her. One nurse left my daughter alone, because she started self abusing. My daughter stops breathing at times from seizures, so requires 24/7 care. She has other medical issues as well. PLEASE do not get me wrong. She can be and is a very loving, happy person, most of the time. And has brought unlimited amounts of joy into my life.That is why I am so scared about my health getting even worse, and not being here for her. I know from dealing with her for 20 years and from dealing within the area, that she would be placed in a **home** and drugged. As it is easier to handle her as a *zoombie** then dealing with her self abuse when she does do it. It is and can be very difficult to handle at times. But she doesn't do it all the time. And as much as she has lived through already, she deserves to have the best possible life I can give her. With trying to wait for nurses to show up to watch her,I lost 2 different jobs and had had a surgery cancelled because of them NOT showing up. So no changing jobs is not something I can do. And I understand it would not be cost effective for the company I work for to try to have that as a covered service. But it is amazing that if I did not work at all and relied on the state, that Tenn care DOES cover the surgery. But I have a house payment and just normal everyday expences that trying to apply for disability and tenn care(with no saying I would even get approved) and would also make me loose self respect. Because I love to work and pay my way within life, as any other person does.

Alice, someone is wanting to talk to you. Her post is on the TN borard a few up from yours. It says Need Tennesssee Help. Her name is Yovonne McCarthy. Hope all works out for you. Ellen

Sorry for the confusion. I didn't know Alice has already posted. I didn't expect her to join and post so quickly and I wanted to help her so I posted without seeing her post. I am just glad she's here so she can get the support and information she needs. It's just nice to know that we can depend on each other and my prayers are going for Alice. Thanks so much!