[maryjo1975]

Today the final nail was put in the coffin of my quest for gastric bypass. I had held out hope a few months now but its over.

I called last week and made an appointment with the doctor who did my friend's surgery. I had been told that even though Aetna doesnt cover gastric bypass in Florida that this doctor would get it approved and he even talks about how wonderful Aetna is. So I made an appointment for Sept. 21st and I was going to his seminar this coming Tuesday that everyone has to go to before the surgery.

Well, the doctor called me Friday but I missed his call. I returned it but no one answered so I left a message. He obviously didnt get it because he called me today to make sure I had gotten his message.

Anyway, he asked where I worked and I told him. He then asked if I had called my insurance company to see if they cover it. I told him yes and that they had told me they dont unless there is a state mandate for it but I had been told by his former patients that he said it was the best to have and he could get it approved.

He basically told me that if they told me they dont cover it then there is nothing he can do. He said that if I worked for a bank, they would cover it then. I dont know why banks are special but...whatever. I work for a non-profit organization. We run group homes for developmentally disabled people. I am the house supervisor of one of the houses. He even suggested I quit my job and go to work for a bank for a few months, have the surgery, quit the bank and then go back to my job. I explained that that wouldnt work because my job would be gone fast and they wouldnt give it back. Besides, I wasnt going to quit my job because its a great job and I love it. He wanted to know if it was good enough financially. I told him no...it IS a non profit. He wanted to know because he thought maybe I could pay on a cash plan. Yeah...thats not going to happen. So then he said..and I cant believe he actually said this.."Another option is to find a husband with really good insurance."




I laughed. Out loud. Literally. I said that would be a GREAT idea!!!!! He said "Well, I am just trying to give you more options."

If I could find a husband at this point in time I wouldnt NEED the surgery! The whole point was to get gastric bypass, lose this weight I cant seem to lose to save my freaking life, and then hopefully find a man who might look at me twice!

I almost hung up on him.

He then said I should still come to his seminar on Tuesday because someone there could help me with other insurance companies and other options. Unless they can set me up on payment plan from now until eternity...it just isnt going to happen.

I am so upset. I got off the phone and just cried and cried. My best friend, who is the guy who had the surgery last November (and has lost about 120 pounds and looks amazing!!) and this doctor's former patient, is sleeping so I cant even tell him what happend yet.

I was really starting to look forward to this and think it was going to change my life.

But yeah, I have accepted that this just isnt going to happen for me but I am glad those of you who got it did and I hope it changes your lives. Good luck to you all.

[dixieladybug]

I am so sorry to hear this. I know if my insurance had not covered it I probably would not have been able to have it. I know at the group where I had mine they offer a really good cash price to anyone not having insurance. It might surprise you how much they can do it for. I know that it is so worth what ever you have to do even financing or something. I know things are tight now for me and everyone else I know but to me it was like this surgery saved my life so it would be worth whatever for me. Good luck don't give up yet until you have explored all your options.

[maryjo1975]

I dont know what other options are left? I cant pay for this out of pocket. I am not quiting a job I have been at for 3 years now where I am in a supervisor position, to try and get a job with a different insurance company. I have tried everything to lose weight and all I end up doing is gaining what I do lose back and then some.

Its hopeless.

[SarJen01]

I'm so sorry to hear that. I hope that maybe things will change (soon would be nice). Good luck.

[Kenyar]

does your insurance cover the band? thats another option...

im sorry this happend. to quote you "If I could find a husband at this point in time I wouldnt NEED the surgery! The whole point was to get gastric bypass, lose this weight I cant seem to lose to save my freaking life, and then hopefully find a man who might look at me twice!" --if this is truly the case then, and dont take this personally, you werent ready for this anyway. if you were counting on how you'd look post op solving your problems...um....you'd be even worse off.

things happen for a reason, now might not have been your time. hang in there. something will open up for you when the time is right.

[maryjo1975]

No. I was hoping to have a long and healthy life and watch my son grow up. I was hoping to have more energy and be more productive at work. I was hoping to be able to dress like normal people do and not have to shop at the plus size stores anymore. I was hoping to finally stop having to fight with diets, only to lose yet again, and then go through the feelings of failure and depression that only leads to more weight gain.

I have been on diets since I was in the 3rd grade. I am 33 years old now. Thats a looooong time to be on a diet and be more than 100 pounds overweight.

[klong]

I had the same thing happen to me five years ago. I believed that they could get it through my insurance to the point of getting all the work ups done. I was left $4000 worth of medical bills. I worked off the debt, and found a place through the surgeon's office called Care Credit. They financed most of my surgery in May. It might be worth looking into.

[decker1976]

Sorry about your insurance problems. Aetna can be a bear. My secondary insurance is Aetna, thank God I had BCBS Messa as primary. Our Aetna does cover WLS but you have to have been on a medically supervised weight loss program for 12 months, have medical documentation that WLS is medically necessary, & a bunch of other things. Is it possible that your Aetna has strict requirements you must meet before they'll approve or did you receive a flat out NO? I agree with KLong. You may want to find out how much WLS costs for the non-insured and also consider lenders such as Credit Care.

[maryjo1975]

Originally Posted by decker1976

Sorry about your insurance problems. Aetna can be a bear. My secondary insurance is Aetna, thank God I had BCBS Messa as primary. Our Aetna does cover WLS but you have to have been on a medically supervised weight loss program for 12 months, have medical documentation that WLS is medically necessary, & a bunch of other things. Is it possible that your Aetna has strict requirements you must meet before they'll approve or did you receive a flat out NO? I agree with KLong. You may want to find out how much WLS costs for the non-insured and also consider lenders such as Credit Care.

Yeah, I got a flat out no. Unless there is a state mandate for it and Florida does not have a state mandate for it. Thats what my insurance company said. One other doctor's office I called said if the insurance company told me they dont cover it then there is nothing else they could do. And today, again, THIS doctor told me Aetena wouldnt cover it.

When I told my friend who had used this doctor for the surgery he said that this doctor ALWAYS talked about how wonderful Aetna was. He even called him for me a few months ago and asked him about it and he said the same thing. He said in one of his seminars that it was so good that most patients that use it are left only owing a couple hundred dollars! I dont know what the deal is.

I wasnt aware you could get someone else to finance surgery. Can anyone give me more information about that. That IS one avenue I havent explored yet and I would definately be interested in looking into that.

[MsVickie]

Listen to me a moment ok? Companys change insurances alot. I dont know when yours is up to be redone but keep your fingers crossed they change insurance companys or.... when they renew the policy they attach the WLS rider. Dont ever give up on this. Ever. Honey you have to let your self be you before a man will let you be who you are. I kinda mistook your statment also until you just plainly typed it out to. I know that is a want after you get to losing weight. Anyone would think that for sure and need it to.

So.... hold on cross your fingers and hope they make some sort of change in your benefits.