Feeling Hopeless and have Group Health Insurance

Hi Everyone,

I'm new here and to the state of Washington and have been researching WLS for around 2 years now.  I've been in the dumps for awhile regarding my inability to lose weight and seemed to have lost all hope and motivation to do anything else about it. But I know I'm in a dangerous place with my health and want to overcome this monster somehow.

I  have "co-morbids" but I'm not sure it will turn out to being diagnosed "sleep apnea" etc. I do snore and don't sleep well at night, though, I've always had some form of insomnia. I also have fat around my neck and chin area and have pressure when I sleep due to the nerves in my cervical area being compressed and it makes my fingers and hands tingle at night and this adds to even less sleep. I also have high cholesterol and PCOS and recently been having chest pains. I am very afraid I will die without ever knowing a life without this constant struggle to lose weight and stop eating.

I'm going to the doctor for a sleep study and for a stress test. I don't want to have any serious conditions but of course in order to make a case for WLS stronger those would help.

Also, I don't think my plan with Group Health (through Boeing) covers WLS. Other GH plans do I think but this one doesn't so I was wondering if I did have the co morbids would I be able to appeal the policy and get them to pay for the surgery?? I haven't discussed this with my Doctor yet because I've only seen her once and get the feeling she would not support me. Sorry, but she is very thin and willowy and she handed me a diet even after telling her I had compulsive issues with food. I'm new to Group Health and want to feel my way around before venturing into the stressful process of approval/denial. I also don't want to get my hopes up anymore. The last insurance I had also did not cover WLS.

Does anyone here have the basic Group Health plan and have you been approved for WLS?? Any other feedback and suggestions from my fellow Washingtonians would be great!! Thank!

I have Group Health and yes I was covered and approved on my first try.

You may want to call customer service at 888-901-4636 and they will help you and tell you if you are cov

If you feel your PCP doesn't support you, find another PCP or see a PA.  When I asked my PCP about surgery, he just "rolled his sleeves" and got right to work and do paperworks for referral.  He was and is very supportive!  

Any questions, you can private message me.

Good luck!

Thank you I will write you a PM. Thanks so much!!!

Same here...GH covered my WLS, and the process was quick and fairly painless:  labs, sleep study, documentation of co-morbids, approval, labs, nutritionist, orientation, pre-surgical appt., nutritionist calls, surgery.  There is a requirement of a psychological, which I did not do, due to their oversight...
If you GH Plan doesn't cover WLS, YOU CAN APPEAL. A co-worker of mine years ago had GH and appealed and was approved (then she chickened out).

Good Luck-
Kathy

Hi,
I don't mean to rain on your parade, but I have Group Health and my plan does not cover it. It really depends on what your employer has selected for coverage. I have other insurance so did not have to attempt to use my Group Health insurance and thus have not had an experience with an appeal.
I wish you the best of luck,
Michele

AS far as your sleeping issues---they sound alot like mine and even though they did not diagnos me with "Sleep Apnea" they did say in the report that my sleep would be greatly improved with WLS---I do not have your insurance---but I do hope that this info helps

Maureen

  Thank you Kathy, Maureen, Mauringa and Pixie. I'm crossing my fingers that I can change insurance with (Boeing) Group Health to a plan that covers the WLS. I only have this upcoming week to figure this out.

Can I ask those of you who have had GH insurance how you broached the subject with your doctors? I have only been seen by one doctor at Bellevue and I'm not sure I want to continue with her as my PCP.

This process is a mental one. I feel like I've had to fight things all my life and now one more battle ahead of me. If I could pay out of pocket I would. I've heard good things about a couple of doctors in mexico for under 10,000 dollars. I can't swing that right now and I'm not real keen on the idea of going out of the country for something this serious of a procedure. So...

How have things gone with your lapbands and the VSG??

You were all very kind to respond, 

Golden

Hi!  

Back in 2005 (that was when they didn't offer lapbands until late 2007), I emailed my doctor asking him about WLS, and he responded "that is a reasonable consideration" and sent me links to lapband and bypass.    It was put on the back burner because I was having other health issues that I wanted it resolved first before I could proceed with the surgery, health issue not related to weight. 

Fast forward to May 2008, I made an appt with my PCP and just told him that I was considering surgery and he was very supportive and did the paperwork and submitted it for insurance approval and I got approved very quickly.

Again, i suggest you contact HR or call GH customer service and see if your current plan covers it. 

 

Regarding approaching your PCP:  I made an appointment with the female PA at my GH office. I discussed my blood pressure, as it was a bit high, and started on meds. I also discussed  my history of weight loss/gain/loss/gain, etc. etc. I then asked her for a referral for WLS. She said all she had to do was refer me to the nutritionist (waste of time-I already was a pro at reading labels) and then my PA filled out the paperwork for the referral. WLS in the Puget Sound area is not uncommon, and GH performs its' surgery at Overlake, which is in process of becoming a Center for Excellence...

I am loving my RNY. I debated back and forth between band and bypass, and finally decided on RNY. I've had no major complications, and at 3.5 months out, all my labs continue to be great. I track my food on nutridiary.com, and am mindful to get all my water in, as well as working out. 

I think I posted earlier that a friend of mine appealed to GH and had WLS covered when her plan initially did not cover it. The cost of surgery vs. future costs of co-morbidity complications is a "no brainer".

Good luck-
Kathy