Question:
My ins. exclusion is iron clad per Walter Lindstrom.. that leaves me with few options

I live in Portland Oregon. I have Regence HMO Oregon as my insurance and unfortunately I work for them too. I spoke with Walter Lindstrom and he said the exclusion is iron clad and he doesn't feel we can win against them. He said however I have an option to pursue this with them as my employer. Basically he says they are discriminating againts obesity! Or I can come up with money to get insurance through an association I have but its pretty darned spendy! I'm a single mom and I have limited funds available. We live paycheck to paycheck. I support myself and my daughter solely on my own. I know I need to do something so here are the options: Walter Lindstrom $700ish (probably more) or Insurance through an association I have at $443 a month (pay two months premium up front and then pay two months each payment after) plus I will have a $400 deductible and a coinsurance to come up with. I average all this to run about $2300. I am looking for a part-time job to take in addition to my full-time job.. hoping it will either help me to get the money to pay for one of these decision or possibly even provide me with 2ndry insurance coverage if I'm lucky and can work at least 20 hours typically at the 2nd job. I'm having a terrible time figuring out what I should do.. I want to chose going with Walter because it seems it will cost less but I must realize there are no guarantees and I run a HUGE risk I feel of losing my job. How many people take on their employers and keep there jobs? Or do I work my butt off pray I can find a part-time job and somehow survive this ok w/ my 9 yr old daughter and make this happen. I love my daughter and I worry that being away from her more than I am now will be hard.. but I am willing to do this as I feel it will extend my time with and allow me to do more with her. I have been applying for jobs left and right.. not just part-time ones either.. heck I'd take a full-time job if the right one comes along. And boy am I watching the insurance that is offered this go round! Do you have any advice? Do you know of any part-time positions in Portland that pay ok and might provide benefits and that are flexible perhaps M-F eves? Do you know of places that will give loans with pretty bad credit? Are there any places out there that might help financially to do one of those options? And finally.. put yourself in my shoes if you can.. what would you do?    — Dawn R. (posted on April 5, 2001)

April 5, 2001
Is changing full time jobs another option? I know that sometimes there is security in maintaining your present status. I do not know what your job is or whether seniority is a factor. But maybe seeking employment with another company would allow you to find the insurance you need and also not require you to spend more time away from your daughter. You have probably already thought of this, but this is the first option that came to mind when reading your dilemma. I hope things work out for you. Good Luck!
   — Shelley.

April 5, 2001
Whoa, Dawn! Sounds like you feel you're between a rock and a hard spot! Take a deep breath and review your options again. Is your weight at this point in time threatening your life (as in do you need this surgery NOW to save your life?) If the answer is yes, I'd consider going with Walter. Do you know that this surgery will most probably save your life but there is no life threatening condition present at the moment? I'd consider looking for a new job; I don't know what field you're in so I can't steer you towards any particular website; or you might retain Walter. It all boils down to whether or not you want to "rock the boat". I'm pretty confrontive so I'd be inclined to have Walter write a very strongly worded letter outlining the discrimination aspects, etc. and see what happens. If the company is so chicken**** to try and retaliate, then sue them for that too. Employers cannot create a "hostile working environment" nor can they "coerce or threaten" employees. I think it's called Title VII under the Federal Labor laws. My LAST option would be to get a second job; I wouldn't be inclined to deprive my kid (if I had one) of spending time with me until I'd exhausted all previous options. If you've read the other posts from people who were denied several of them fought for two years...and most WON. So take heart, take a deep breath, and go for it! Do what your heart and head tells you is best. Don't confuse yourself with "what if's"...just do it.
   — Lynn E.

April 5, 2001
Question: Does Regence not cover WLS AT ALL? or is it just excluded in your plan?
   — careywatkins

April 5, 2001
Regence covers WLS for particular groups.. basically state and federal employees etc. It is an exclusion on my employee plan. In fact it is excluded on all of the 4 plans we can pick from. My profile will show you the exact wording on the exlcusion.. its covered incredibly well. As for is this life threatening right now.. thats hard to say I sure hope not but I am at a critical point. I have been diagnosed with severe sleep apnea, my blood pressure is uncontrollable, my bladder is falling out of my vagina and I am unable to find a surgeon to repair it because the risk to me is too high at my weight. I could probably wait.. who knows how long.. a year maybe more or maybe less... I don't know how much longer my body can take the infections because of the bladder prolapse (I get vaginal, bladder and kidney infections all the time which are becoming resistant to antibiotics). I am hoping I can get a credit card somehow to charge this or find a place to give me a loan.. or again find new employment or additional employment soon to get this going.
   — Dawn R.

April 5, 2001
I am the new HR Outreach Director here at AMOS. We are in the process of setting up information/brochures to help members deal with exclusions and their employer. Have you contacted your HR department yet about their process for reviewing exclusions on a case by case basis. You may want to consider taking this as far as you can personally, before spending any more money. There are members that have worked successfully with their employers in getting exclusions removed. Please let me know if you would like to discuss this further. Best of luck to you with what ever path you choose.
   — Jilda H.