[gettinghealthy]

I'm sorry that this is long-ish. Thanks in advance for taking the time to read it.

I've been trying to do everything in my power to get the money together to have gastric bypass via private pay. Somehow, someday I will do it. As the case has been for the last 20 years, I'm also still dieting and exercising. I have a 40 BMI and many comorbidities. I also pay for the best health insurance plan that my employer is capable of obtaining from BCBS of AL.

Sometimes, when I tell people that my policy has an exclusion they tell me it is my employers fault that it isn't included. I've checked very carefully, it's not my employers fault. BCBS of AL has exclusions on ALL of their policies for small businesses and for individuals. This makes me so upset.

Sour grapes on my behalf? Maybe. But, honestly- they are willing to pay for all of my obesity related illnesses and for the open heart surgery that I will probably need in 5 years but ALL Bariatric services are excluded? Even though my PCP, my endocrinologist and my cardiologist all agree I should have the surgery and would be willing to write letters on my behalf, bariatric surgery is simply not an option? Really? Not even with a 6 month diet? No way? No how??? Nope, No way.

I know that there are many of you out there that have found yourselves in the same shoes as me. Is there truly NOTHING we can do about it? Is it really right that health insurance companies are allowed to deny us a potentially life saving and/or life extending surgery? This isn't a nose job. If my MDs that do not benefit financially from the surgery (endo & cardio) say I need the surgery... their are not considered? Nope

Type "Bob Clegg Bariatric New Hampshire" into google. He's a senator and you and I are not... I get that. He was able to make change in his state. There has to be a way that we can be allowed to have a chance to have the care that we deserve.

I'm nobody. I'm a morbidly obese, single parent, hard working, health insurance policy holding, computer savvy, diabetic woman that currently costs my insurance company approximately 3000 dollars per month due to obesity related illness. If I had the surgery I would save my health insurance company a lot of money.

I'm not a politician and I've never been one to take on a cause but, I feel like I'm being harmed by this exclusion and I feel that I'm being discriminated against.

What about some of you? Does anyone here have any thoughts or ideas about how I (or we) can try to bring about change? I'm not expecting any miracles, I'm not so idealistic as to think that I could change what a huge company is doing to deny me the chance to be well. But, I just feel like if all of us walk away and sulk about what they do to us nothing will ever change for anyone. We may be obese and society may not "like" us but we deserve for our health insurance companies to fulfill their obligation to care for our health.

Seriously, I am wide open to ideas and willing to investigate but, I'm not sure where to start. Maybe you know where to start but don't have the time? Tell me where to start. Please.

Feel free to PM if you're uncomfortable commenting publicly. Or reach me on my blog.

Thanks for reading.

[SummerBreeze]

I can relate to all your saying , I was under same situation other than i did have a good insurance, they covered everything and I was there eight days , but I have to tell you my Surgeon told me before hand that the insurance company didnt care if i died or lived, he says tht sounds crude but its TRUE...For the life of me I dont get how they want to spend all the money on medicines inlcluding insulin and deny an operation to make all those expenses go away...Have you had a surgeon and his staff try to get the claim thru for you ? They know more than your other drs on how to get around things , but sounds like you have done alot of studying on it all already...Write your Senator, all of them ! I did that on a personal situation with family member and I was amazed how I got emails and phone calls and things started moving forward fast...all depends how hungry you Senators are for your votes I think lol...I wish you good luck ,I wish there was a simple answer for you , but unfortunately there is not...Hugs , Annie

[mj2903]

We also have BCBSAL but my husband works for one of their companies. How is the exclusion worded? Is there an exception for medically necessary?(This is what our policy says). If so, you can go into the website to look at the physician requirements at BCBSAL.org/providers/policies/draft/053.pdf. It is under surgical treatment of morbid obesity in the drafts section if the path doesn't work. Then you can see what is expected.


Hope this helps and you find you do have some coverage.

Melinda

[johnms]

I live in New Hampshire and it is law that it must be covered under insurance in this state. I was lucky and mine was covered before this happened.

[yvonneiam]

My husband works for a company that carries BCBSAL and I read his policy online several times along with phone calls. There were no exclusions in his policy but I did have to follow the requirements to the "T" literally!!! I had to get a letter of necessity from my PCP, follow a six month supervised diet by a doctor that had to be documented every visit,could not miss a visit or I'd have to start all over again and had to have 3 yrs. prior medical papers from PCP. It was nerve racking to say the least and honestly did not think I would get approved but I did. I wish you the best of luck through this ordeal and I pray they will approve you. Don't let up on them contact them daily and please don't give up!

[Adeledave]

I'm sorry to hear about your difficulties. Like Johnms, I am also from NH. I work for a small company (About 35 employees), and we have Anthem BC/BS. My surgery was also covered. As Johnms mentioned, I believe it is the law in NH that insurance companies must cover it. I guess we were really very lucky!

[DocSanae]

Welcome to the board, thank you for joining us.
I am sorry to hear of the problems you are having with your insurance, and I sure hope you will be able to find a way.
(((((HUGS))))) May your journey go well.

[mangomelon]

Does your job have a flexible benefit plan? Its where you have money taken out of your check pre-tax to pay for medical expensses? I think the max is $5000/year so I know it won't cover the whole thing, but its definately a help.

Good luck!

[MylesMom]

I also have BCBS OF ALABAMA. I went to there website and typed in the search forum, gastric bypass and followed through with the steps it directed me to do. I'm totally not understanding why they are turning you down? I would assume that the policies each of us in Alabama have are the same criteria for Gastric. I seen the surgeon, went six months to my PCP, and got my three years of vital signs/weight. The insurance lady with my surgeons office sent it and within three days I was approved! TO MY GREAT SURPRISE...where abouts in Alabama are you located? thought maybe I could give you a referral and see if switching doctors/office might help. A lot of times it boils down to what the PCPvisits/vital records indicate. Seems like I read that letters, would not be suitalbe for coverage.

[MsVickie]

Honey the thing you said it not being the employers fault is true its not there fault. You stated its a small business. If your company buys the rider to have it placed on the policy then yes it would pay. That is what your missing here. BSBS do have policys that will pay for the surgery. They have thousands of different policys out there. They are written so each company can afford. Dependent on how large the company is and what type coverage they are looking for.

I have worked jobs that have delt with insurance companys and know how all this works. Small companys have choices but with the cost of insurance they dont have the choices of larger ones. For them to make the choice to put a rider on to pay for one person or even two to have a life saving surgery for everyone to pay for is not a cost saving measure for them...... Which is understandable. The new healthcare that has be placed in the US Im axiuoius to see if it will cover it. Im not holding my breath on it.