Question:
Insurance will not Pay...I need help

My name is Reba and I am 5'3 and weigh over 350 pounds. I live in Oklahoma City and Medicaid will not pay for Bariatrics Surgery in this state. I am on Disability and have been for 10 years.... My health is going down very fast and I have tried everything to lose and cannot....I have high blood pressure, severe Aortic heart valve leakage. My legs swell all the time, I have had knee surgery and the doctor says that I would be in a wheelchair in a few years.... I do not have the money to pay for this surgery and Medicaid will not pay so what do I do... If anyone can help with information on this Please I am desperate... I am 44 years old.. I don't want to die, I live with my Mother she is 81 years old and I should be taking care of her instead it seems she is taking care of me...thank you Reba    — Reba (posted on April 10, 2003)

April 10, 2003
Is your weight one of the factors that you are on disablity? If it is, I think I would try talking to someone from medicaid again, it would be cheaper to let you have the surgery than pay your benifits for the rest of your life. Could you get the surgery done in another state? Do you have a relative that you could move in with that is in a different state, that will pay for the surgery. Sorry, that I could not help, but I hope you to find a way to have the surgery.
   — cindy

April 10, 2003
Hi there! I don't really know what to tell you about Medicaid -- from what I've read here, all state/govt funded insurance programs are real jerks about WLS. I have an idea, and although it may sound far-fetched, you just never know what will work -- write your story to the daytime talk shows (oprah, ricki, maury, montel, etc.) Tell them your story and how dire your health is and that you are on your way to wheelchair and maybe even death. Tell them about your heart problems and how WLS would help, but your insurnance won't pay and you can't afford to self-pay. I would keep your letter down to 1-2 pages so they won't feel overwhelmed reading the whole thing. Offer to let them follow your journey if they could help you have surgery or help you find a surgeon that will let you make payments (you don't want to ask out and out for them to take care of all of the expenses for you.) I know it sounds crazy or like a long shot, but you just never know who might say "Hey, we could do this!" WLS is a pretty popular topic these days. What do you have to lose? Except weight, of course! :)
   — beeda

April 10, 2003
Also, forgot to mention, you might want to check out the website at wishcenter.com. I haven't looked at it and don't really know what it's about or if you have to have insurance there, but it's worth a look.
   — beeda

April 10, 2003
Just a thought...have you tried Vocational Rehab?
   — Debbie B.

April 10, 2003
Hi Reba, Sorry to hear about all the problems you are having right now. I was told that as long as it is medically documented that you need this WLS to survive that medicare would pay, they have no pre approval policy. If you are still looking for a WLS Doctor maybe you should check a different state, I did and I am glad I did. If you need anymore info just let me know.
   — tonyskid

April 10, 2003
Reba, There is a posting by Melanie Harris, [email protected], concerning her dr., James Totoro, MD, and the fact that she has Medicare - Parts A & B. Is that like Medicaid? Have you tried Rehabilitation Services? I understand they pay for WLS in some cases. Good luck. Donna
   — Donna M.

April 10, 2003
Reba, I'd do more checking on your state medical system. Most states I've heard of (I'm west coast though) will pay for this surgery if you can prove medical necessity. Maybe you're getting the runaround? The other thought I have is that with being disabled that you should qualify for Medicare. I've read posts on here that say that medicare does pay for this surgery. Both would certainly be worth checking out. I agree with the other poster that officially moving to another state who's medical would more readily cover this procedure is an option, I also know however what a huge and sometimes unfeasable burden that is especially with aging parents in our care. No matter what, I wish you the best of luck.
   — Shelly S.