Question:
Can you tell me what you think about this please...

My hmo denied me wls, saying refer to the policy, which says exactly "...gastric banding and intestinal gastric bypass surgeries for treating obesity are not covered benefits." Okay, now, my three physicians and I are seeking a VBG. My question is, in all the research I've done, I've seen "gastric banding" as a procedure in and of itself, similar, yes, but DIFFERENT from the VBG. We specifically requested a VBG, and the denial letter said "request for gastric banding, denied." Do you think I have something worth arguing about here? Or am I just clinging to false hope? Yes, I plan on appealing (as many times as it takes!), but I'd like some input as to what you all think. Thanks!    — [Anonymous] (posted on September 28, 2000)

September 29, 2000
My opinion is that it is their intention NOT to cover any weight loss surgeries. Whether or not you could win on a technicality, such as morbid obesity vs. plain old obesity, is anybody's guess. How much time and money will you spend on appealing or fighting this? Why not look for alternative funding sources? I always suggest that people look into a home equity loan for funds. Best wishes!
   — Cindy H.

September 29, 2000
You all have valid points. I wrote to Terri today as I was having problems posting..hopefully this will work now. I'm not suggesting that we (the almighty excluded ones)just go out and mortagage a home or ask for a loan...I think if most had that option, they would do it...some simply cannot! What I suggest is to follow Terri's advice and fight them to the very end. Then, if they won't pay...DON'T GIVE UP! Thats where I am...my surgeon and Walt Lindstrom tell me BCBS have an iron clad exclusion against WLS and I have little chance to fight them &%$#*&%^&'s! Sooooo, my surgeon will charge me 3000. for the Open R-N-Y. I have saved enough (raising three kids also) to pay that. My hospital will not deny my entry and I plan to set up a payment plan with them. They also have programs as I have learned many do to either reduce or forgive a portion of the costs based on your income and ability to pay. A friend of mine who just had it done paid the surgeon and this same hospital forgave 100% of the bill. That won't always happen, but I only suggest that you explore EVERY angle you can without giving up. Until we educate our legislatures, etc to prohibit WLS exclusions, we need to be resourceful and do what it takes to have the procedure. Worry about the rest when your post-op and healthy! Best of Luck!
   — Timothy M.

September 29, 2000
I ALSO THINK THE BEST THING YOU CAN DO IS FIGHT IT. ACCORDING TO THE NATIONAL INSTITUTE OF HEALTH "MORBID OBESITY IS A DISEASE". MY INSURANCE COVERS IF YOU ARE DIAGNOSED MORBIDLY OBESE. THEY ARE THE KEY WORDS!
   — smul3