Question:
~Maybe we CAN~
I Think the address for John Alden is a branch of Fortis health http://www.fortishealth.com/ I Hope to see more people will respond to this, If we arent willing to fight for one another, then what???? ThankYOU SO much KAY For all your help, and letter of support , It is so appreciated *Smiles* — Ann A. (posted on March 14, 2000)
March 14, 2000
Ann, Vicki Bowen's personal web page has the following statement. I'm not
sure of her source, but it's great! From her page...Morbid obesity is a
chronic, lifelong, multifactorial, genetically-related disease of excessive
fat storage with highly significant medical, psychological, social,
physical and economic co-morbidities. As such, it also involves hereditary,
biochemical, hormonal, environmental, behavioral, public health and
cultural elements. Morbid obesity is, therefore, an extreme health hazard
which is rarely the result of an aberrant moral problem or addictive
behavior. There is an
extremely high incidence of failure to sustain even a 10 per cent long-term
weight loss in morbidly obese patients with any form of non-operative
treatment. Bariatric surgery, on the other hand, has been shown to be the
most effective means to aid in management and prophylaxis of the
life-threatening complications and severe degenerative problems of morbid
obesity. It is indicated due to the ineffectiveness of non-operative
treatment methods for morbid obesity, the high risk of untreated morbid
obesity, and the safety and effectiveness of operative treatment. Safe,
effective bariatric operative procedures increase the longevity and quality
of life in morbidly obese patients. Such surgery is performed as treatment
for the co-morbidities of morbid obesity. Weight loss, while an essential
component of this process, is only incidental to these goals, as is any
possible cosmetic outcome.
Patients with sleep apnea, obesity hypoventilation, cardiac failure, or
other life-threatening complications may require emergency admission and
care. An operation can then be planned at a time when the patient`s
condition is stable with adequate cardiorespiratory reserve. Size
discrimination condemns morbidly obese people to be excluded from access to
medically necessary, quality care. Such discrimination and
consequent exclusion is unacceptalbe. There is, therefore, no justification
in requiring morbidly obese individuals to participate in long-term weight
loss programs or requiring them to surmount comparable barriers as a
prerequisite for approval of bariatric surgery, unless the surgeon`s
judgement precludes same.
I hope I formatted this ok. If not, look Vicki up in the database. It
provides a link to her page. Unfortunately, the harsh reality is that
cost-effectiveness is of equal (of not more!) importance to the insurance
company as is medical necessity. Plead to your employer for intervention
on your behalf. Obviously your attendance record, performance, and
attitude will improve! Get all your claims together and point out what is
obesity related. Facts and statistics. Best of luck to you, Ann!
— [Deactivated Member]
March 14, 2000
Dear everyone~
Just wanted to thank Kay And Melanie for taking the time to help me
figure out where to send the Emails*Smiles*I Do believe that insurance
comapanies are worried about the "almight dollar", but I Also
know that we MUST educate people about obesity, and to let them hear us as
a group instead of individuals. I Believe that how most things are done, in
a process of people gathering togeather to fight for their RIGHTS!. I
realize that this site is about helping each other cope with the decision
to have this surgery and a place for us to ask our medical questions
also,but I also believe that people that are being turned down are feeling
lost, and even ignored on such sites(Please dont come down on me for saying
this, I dont need that right now) But ive talked to MANY On here that say,
they ones that got the surgery dont really want to help the ones that are
fighting so hard to get it. Now of course pleaseeee!Im not talking about
everybody. I Think we all Need to come togeather and fight for one another.
If you are post op, or pre op, or even just considering, or hoping
*Smiles*. Ive recieved alot of support from Melanie and Kay, and Stacy, and
I ThankYou SO MUCH *HUGS*. Ive also recieved some valuable post from Ava
and Roberta which I appreciate also..I Just hope that when the time comes
that I am able to help someone fight for their right..Thankyou so much. And
AGAIN if we stand togeather, we can educate not only the insurance
companies, but the medical profession, and maybe even society. Its a hard
battle, but hell most of us have been fighting this all our life, dont ya
think its time to stand up and Say ENOUGH IS ENOUGH! Thankyou again for all
your emails, post, and love and compassion!
— Ann A.
March 14, 2000
It saddens me to know that there may be members here who were approved for
their surgery but aren't willing to support those who have been denied. I
was fortunate to receive a quick approval, but that in no way colors my
willingness to help others! Getting a denial gives you only two options -
fight or self-pay. So many cannot afford to self-pay. A lot of insurance
companies still view wls as being "cosmetic" rather than
medically necessary, and it's up to US, the ones who KNOW how debilitating
morbid obesity can be to support each other and take a stand against
insurance companies. We are all human beings. We all deserve quality of
life and have a right to it. It should not be determined by corporate
America or our personal financial situation. Stepping down from my
soapbox....
— [Deactivated Member]
March 14, 2000
As I Assumed when I posted earlier that I would get some emails from people
telling me that there is NO one on here that wouldnt give help etc etc. Let
me make myself clear at this point. I WAS not referring to anyone in
particular, I made a general statment, that I and other members in here
have made, saying that they felt lost and alone at times, because when they
were asking questions about insurance or being denied the most they got was
a link to Walters Site. Now, let me add this, I have talked to walter And
he is a very nice gentlemen,and I may end up going that route, if I find I
cant do this on my own. But I Feel that there is more information out there
that should, and can be available to people in the situation that I am in.
The other girl that has John Alden (That is going through emotional hell
over this) stopped posting to this site, because she felt no one cared, or
that her post were not being answered. Ive heard this time over and time
over again, about people that were on the FIGHT For this surgery. I realize
that many do not know what to do, and kind words such as Ava and Roberta
wrote to me, were yes very appreciated. I Am just saying that sometimes we
are so caught up in the "AFTER" surgery that we forget about the
people that are fighting for their lives. I Did not wish to start another
fight about who is best, and what one does, and the other didnt, i was
pointing out that sometimes when we are rejoicing over our battle,
sometimes we forget to look to the people that are still fighting. That is
all. I Do appreciate anyone, and everyone that took their time to write me,
or post.. None went without a thankyou, I was just trying to make a point.
Along with this point , i will just add about me trying to get my denail
overturned, YES that is my goal, to be approved for this surgery, but not
only am I fighting for that for me, I HOPE that i am also fighting for the
person that will come behind me, and need that surgery from that company
too. That is why I thought contacting insurance companies that Excluded the
surgery would be a good idea. Maybe I Am Niave to believe that WE can make
a difference. But I know that 20 Voices can be heard alot clearer then 1.
Yes we do need doctors, and policticians etc to back us. But our voices
Should and WILL be heard. We need to continue to fight for the people that
are in need of this surgery. If i stopped fighting for the RIGHTS Of
obesity and the Discrimination against us, after I recieved surgery, Then
Am I any better then the people that discriminated against me in the first
place. !Just a Thought to think about! Thankyou all And i do Mean ALL for
your time , compassion, and understanding.
— Ann A.
March 14, 2000
I think what we need to remember is to treat others like we wish to be
treated. One person can't help everyone, but if every member here helped
one person, we'd have exponential success! Keep the faith, Ann!
— [Deactivated Member]
March 14, 2000
Ok well Im gonna try to shead some light on my insurance problems *Smiles*
Ok First of all it is my husbands insurance, and he works for a very small
Company of about 8 employees.(Trucking business). The people that own this
company are actually friends of ours,and I Contacted them when I realized
that the Exclusion clause was in there. She had her insurance agent call me
on the phone,and I was told by him, that John Alden Had NO Plans that cover
this surgery.(Im not sure if i believed him) Ok by the way here is another
twist, One of the men that my husband works with has this isurance and was
covered 3 yrs ago with NO Problems. Now im not sure if the policy has been
rewritten or not, because he doesnt have the old policy. So I KNOW for sure
so far that the exclusion clause is from the Insurance and Not the
employers. The insurance agent did call the 800 number for me, and told me
what I had to do for a appeal, he was what i believe to be shocked that
even though they do consider this Surgery to be MEDICALLY necessary, they
still stand behind that Itty bitty Clause *grrrrrrr*. The other girl on
this site, is beside herself with all this, she has been fighting them
since last year, I Only started in Jan of this year. I Am Hoping to make a
difference with this company so that No one else has to go through what we
have. I Can understand why some people just give up (even though thats not
my nature) *smiles* I Do believe in the Voice of the people, and i do
believe that sometimes it does make the difference. Anyway, I Just want to
say thankyou again for ALL The wonderful emails and post. If I can give
back just a little of what ive gotten, then Its been well worth it :o)
— Ann A.
March 14, 2000
The Email address for John Alden Health is as follows, Im Sorry for the
wrong email to many of you this morning *Sigh* Was having one of those
days, where nothing went right *Smiles* here is the address, THANKYOU all
for all your letters, emails, and post.
[email protected].
— Ann A.
March 14, 2000
I've been following this thread with some interest. Ann, I can only
imagine how frustrating this must be for you! I was fortunate for two
reasons - one, my HMO covers WLS, and two, I work for an HMO and knew how
to navigate the system and maximize my chances for approval the first time
around. In my experience, there are two ways around an exclusion for WLS.
First, try to remember that HMOs are not a big, faceless entity, but rather
are made up of individuals who may want to approve you but CAN'T because
it's not a covered benefit and it's therefore their job to deny it, no
matter what their personal feelings are about it. So the best approach is
to try to make an ally at your HMO, and then give them a reason to approve
you! If you have a co-morbidity (high blood pressure, diabetes, etc.) and
your doctor will write a letter saying that the RNY or DS or whatever is
the best way to treat that co-morbidity, then that gives them the option of
approving you for a COVERED service. Try that route, and if that doesn't
work, the second best option is to become a MAJOR nuisance. File appeals
and grievances, write to your government representatives asking for
assistance, and especially write to local and national media with copies of
every letter going to the CEO of your insurance company... MAKE SOME VERY
LOUD AND TROUBLESOME NOISE. They'll approve you just to get you to go shut
up and go away. :-)
— Kim H.
March 15, 2000
Thankyou Kim for your post, as I said in my email to you I use to making
alot of NOISE *Smiles*...I Just wanted to say thankyou for everyones time
and energy to help me and Stacy out. I Also wanted to let ya know that ive
not heard anything from them yet, but I Will keep you all updated. Also
that if you dont hear from me for a couple days, my 5yr old is having
surgery (tonsils,adnoids,tubes) Friday, so i will be out of town for a
couple days. Thankyou again for your compassion and support, and keep your
fingers crossed for me, Im gonna make ALOT of noise *S*...
— Ann A.
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