Question:
What do you think?

I have insruance (for 2 months)(The Mega life and health insurance company) that has a specific exclusion. The exclusion states "weight loss or modification, or complications arising therefrom, or procedures resulting therefrom, or for surgical treatment of obesity, including wiring of the teeth, and all forms of surgery preformed for the purpose of weight loss or modification" I am 5'11" 380lbs (BMI 53) and have bad knees, depression, as well as extreme sever sleep apnea (102.7 per hour). I am leaning toward the surgery, however everyone in my family (Wife, parents, etc.) are totally against it. I am considering self paying for the surgery, (have applied and approved for the money)if I have to do so. My questions are: Has anyone delt with the Mega life and health insurance company? Should I go ahead and schedule and have the surgery or wait till the insurance company (hopefully)approves it? Is the surgery reversable? How long would I be off or unable to work. I work at home on online. Has anyone tired/used Spirulina after their surgery? Sorry this is so long.    — Robert B. (posted on November 3, 2002)

November 3, 2002
I too have Mega Life, and they will not pay for the surgery. I was a self-pay, and even now (about 6 weeks out) they are giving me trouble regarding other medical claims. I say it is no harm trying to get it approved if you can. I had lap rny, and I was told that although mechanically it is reversible, a surgeon (mine) would not do it unless you have serious problems FROM having the surgery that will not be fixed without a revision. I was out of school for 3 weeks. I felt good at 2 weeks, but was tired and still sore. If you sit all day, you can probably work sooner than that. Good luck.
   — Jen D.

November 3, 2002
Robert, it is always worth the try. It doesn't state <i>morbid</i> obesity. My exclusion (different insurance company) sounded similar to yours, but I was approved because I am morbidly obese. You can't go by what others with that insurance necessarily say unless it is the same company, same state and same employer. All you can do is contact them to make sure. I definitely suggest that you make sure you are approved before scheduling a surgery date. Most surgeons and hospitals will not even do so unless they have that approval letter in their hands. But no matter what- FIGHT! Don't give up! Good luck to you Sweetie!....Karen (lap rny 9/20/02- down 56 pounds)
   — karmiausnic

November 3, 2002
I presume you are on a c or bi pap and know the consequences of severe sleep apnea. I have been on c-pap 6 years- and my pulmonary/sleep study finally decided to refer me to wls as I coulf not keep the weight off.(bmi was 51). Now 10 months later and 106 lbs off (slow loser some think) I still use c-pap at a lower setting and my astha meds are cut way down. My insurance covered it- but I have met people that took a loan on their home or used credit cards - etc to get this life saving treatment. You and your surgeon can go for the insurance - and appeal if necessry. If you should think waiting a few months (or a year or two?) if not worth the stress - I say go for it and if you get any flak from other people - do what you can to relieve their "suffering" but do this for YOURSELF. You deserve it.
   — charlene M.