Question:
Looking for viable self pay options

Approximately 2 years ago, I started the process to get approval for WLS (surgeon S Fox Ross). After months of jumping through hoops, I was finally approved (Western Teamsters & PacifiCare). My first surgery date was postponed due to a family crisis. Second was postponed because a hospital employee "overlooked" securing approval for the hospital stay. The third, and final, appointment was canceled completely because I was laid off and lost my insurance coverage. The new insurer, Washington Teamsters, point blank refuses to pay for WLS, regardless of co-morbidities. They consider it a cosmetic procedure and informed me that under no circumstances have they ever paid for it. I am single, I work part time because I am disabled (I have MS), and am under the poverty level for Washington State. I am trying to find surgeons who might offer a sliding scale program, universities that would donate the surgery services by letting medical students perform it, clinics that possibly offer a generous repayment schedule, etc. It's getting to the point where I am really desperate. My weight continues to climb due to both the MS treatments (periodic steroid infusions) and the lack of physical strength and stamina to exercise, and I've tried every diet that I know of, with little or no results. I am desperate. And completely willing to travel, if that's necessary. At this point I fear for my future, that I will eventually end up in a wheelchair on a permanent basis because an already weakened body is even further stressed by the excessive weight. I don't know what to do and I'm very scared. Thanks to anyone who can give me any ideas. Debi    — Debi R. (posted on September 2, 2002)

September 2, 2002
Isn't your former employer large enough to have to offer COBRA in order to continue your insurance through them?! I would check into that one tomorrow AM! That would be the simplest and surest way to go about this. I feel terrible for you in having to deal with this. Also, what about getting on WA state medical? I'm not sure where you are but when I was looking into having surgery at Sacred Heart in Spokane, WA I found an awesome resource in their social workers who deal with trying to match up patients with possible funding. They would be able to tell you if they've ever had anyone on WA state medical have an RNY that was paid for by it. I THINK they told me that Medicaid DID pay for it, but that the state funded insurance program didn't. It would be worth a shot there, especially considering your medical situation and your limited income. Those would be my first choices if I were you. As it is that's a LOT to try and deal with. Do everything you can to make one of those work for you. I'm self pay and can tell you that $12 -15,000 cheapest (and praying for no complications) is a big chunk to come up with. I'd keep those worries for a last resort.
   — Shelly S.

September 2, 2002
Well maybe they HAVE never paid for it or maybe they have and they are just telling you that hoping to discourage you from it. DO not talke this lying down. Apply let them deny it appeal and then use Walter. You would be surprised how fast they turn around when they hear lawsuit. Also if and when you qualify for Medicare they sometimes pay. Be a big pain in their side. One more comment. Yeah getting basically gutted is a cosmetic procedure. My scar is goes from breastbone to bellybutton. I got that to improve my looks - YEAH RIGHT
   — snicklefritz

September 2, 2002
If all else fails, call or write the local tv stations in your area. Most have a "neighborhood angels" type of segment (they do here in Ft Lauderdale, FL) and they can possibly help hook you up with healthcare providers that would be willing to donate their time, etc in exchange for telling your story on an upcoming news segment. It's always heart-warming to see the community helping each other and those kind of stories and the people love them. Here they have done stories on maybe an old woman on social security that needs a new floor or a family that has no money to help buy their son a new wheelchair when his was stolen or broken, stories like that, and yes, one story was on a 700 lb man that needed gastric bypass surgery. Your's is a story waiting to be told! Go for it!
   — thumpiez

September 2, 2002
How about a dIFFERENT part time job? Home depot and Lowes have non physical jobs and approve WLS. I think we should organize a effort to get WLS covered by insurance BY LAW thruout the country. I am saddened by stories like this.
   — bob-haller

September 3, 2002
Debi- I am so sorry you are having such a rough time. Have you thought about applying for Medicaid? If you are in poverty level, you would most certainly qualify. Or how about Medicare? It sounds like you have a disability and would qualify for that too. I don't know about your state, but Medicaid paid for my surgery. It was a 6 month wait for authorization...but they covered it! I know Medicare is covering them too. Good Luck!
   — Shawnie S.