bad news for me

Hi, I had a really bad experience today, insurance-wise. My husband and I went down to Dr. "15th letter of the alphabet" and we were told that he would not be able to do the wls because Medicare is my secondary insurance. Whether or not I have a primary insurance coverage, if Medicare is primary or secondary, he won't touch it. The reason:Medicare doesn't pay him. I have understood that Medicare pays less, but I didn't think they paid absolutely nothing. We were further told that he couldn't take "someone who hadn't paid into the..." and then she stopped because I interrupted her. I wasn't going to hear that "you handicapped people are a burden on the rest of us because you don't pay into the system...." thing. I told her I had worked several jobs and that I was on SSDI (social security disability insurance, that people receive when they have worked) not SSI (for people who have not worked.) She further stated that it didn't make any difference if it was Medicare of Medicaid; it was all the same to him; they didn't pay. She said I'd have to contact the state. I do not qualify for anything from the state except the dpt for the blind and they only deal with employment and they've already said I am "a nonviable candidate for employment," because of the fibromyalgia. (Probably obesity too though they wouldn't come out and say it.) The office person said that the only drs in WA who take Medicare/Medicaid assignments are at UW, because they have to. Some drs with less experience could choose to take Medicare clients but Dr. "15th letter of the alhabet" is "an established surgeon, so he can choose who he will take." He can cherry pick huh. Jeez Louise, all these slaps in the face. She did appologize for that, because she was stuck; she had to do what her employer said. She said she had weighed 350 pounds once and understood that it was a medical necessity but the problem is that insurance companies do not see it that way. So, since Premera doesn't pay for wls, I am stuck with the 2 or 3 years Medicare waitlist at UW, where they *have to take second-class, non-whole, lesser-than, burden-to-society white trash" like me. They don't have the luxury of charry-picking, as my husband puts it. Believe me, this is not the first time I've been treated thusly. I told them that if I was a person of color and excluded like this, the news media would make a stink, but because it's a lowly disabled person, who cares. I really did not need this. It is as though I already knew it, but my idealistic, sweet-hearted, fair-minded husband thought that Dr. "15th letter of the alphabet" would work around my situation. OH no! If they made an exception for one, they'd have to do it for others. Haven't I heard that one before, too. So it doesn't matter that my husband has a good job and a good insurance policy (except for the wls exclusion.) All of my years of work don't matter because currently I am not able to work, so it's like I never have. It's like one is being punished to the same degree, whether it is SSDI or SSI and Medicaid. It is as if they think anyone who *is* on Medicare, SSI or Medicaid are poor, lazy, whatevers. All this negative judgment. So there is discrimination against anyone who has the M word for even their secondary insurance, and we are segregated to the UW hospital because they "have to" take us, because they have state funds. I don't know if there's anything in the ADA regarding medical care. But even then, the receptionist stated that because wls is elective, even if the ADA did have provisions for medical care, it wouldn't make any difference. So. We need to deal big-time with the insurance system to get them over the lowly opinion they have of wls, especially since the NIH does regard obesity as an illness and wls as a means of alleviating other conditions, as in, being a medical necessity. So, while the rest of the nondisabled obese persons have their surgery and live, I'll probably die off before my turn ever comes around. because I have to wait until last. They say we have choices; well some of us are given fewer choices for no good reason. Boo hiss, reow! Lauren

Lauren... Check out these people. You might be able to get help from others who have used Medicare to get their surgeries. Don't give up!! ~~Carla

Dear Lauren, DON'T GIVE UP!!! Keep trying, there are others who have done it with medicare. It'll work somehow for you. Cindy

Hi, Thanks for your encouraging response! That helps a lot. LM

Lauren, I can only assume that you haven't checked out the UW, as one person I know recently had a panniculectomy there, and only waited 2 months. If you haven't checked them out yourself, you can't assume that this 2-3 year waitlist legend is true. And, the Dr's fee is $10,000 dollars - Medicare/Medicaid pays $600. This amount doesn't even cover his malpractice coverage for the procedure. Have you or your husband *ever* paid anyone to let you work? This is why docs don't accept Medicare/Medicaid much anymore. I understand your frustration and pain, but please *stop* slamming this doc for something that is outside his control, also. The receptionist's comments were never made, you interrupted, so you don't know what she was going to say. And it was prolly only *her* opinion, anyway. You can't assign your judgement of what she *might* have said to doc. In the interest of full disclosure, this is my doc. He's awesome, incredible and very compassionate. He cannot, however, afford to pay you so that he can spent hours working on you. No doctor can, unless they are affiliated with teaching hospital or large corporate clinic, which has some kind of subsidy or something.

Lauren, I have Medicare coverae as of Feb 1 this year and I am having no problems. I am going to Dr. David Simonowitz and the scheduler there told me medicare pays 80% and my 20% of the surgeons fee is around $900.00. Si I don't know where some of the information comes from that they only pay &600 of a $10,000 bill because that just isn't so. The WISH center also takes medicare now, but I didn't go through them because I would have been there first medicare patient and they wanted me to do all the billing because they didn't know how. I found that odd. Don't give up, please email me if you would like more info. Kim

Hi, Thanks for your helpful response. I did hear from UW Friday and they did tell me they'll get me into the clinic, but they are still talking about a 2 or 3-year wait. I am going to try more than one dr. and whoever is first will be it, so we'll see where I end up. Thanks again. LM

Call Dr. Lauter in Kirkland. I called to see if they accept Medicaid and they do, not only did they give me info but they also scheduled my consult for the end of the month. The one Dr here in Spokane that accepts Medicaid/Medicare has a waiting list of over one year so I'm very excited to be seen so soon. You should give them a call!!!