[Cassey1989]

Hello My name is Cassey I am 21 5'6" and 330 pounds and am trying to get a gastric bypass my journey started...well since birth.

I have always been big even in kindergarten. People assume that because you are big you must eat lots of junk and a lot of it. I don't know in all cases but in my case its not true. I have been on one diet from the next since I was 10 years old. I have seen numerous nutritionists and doctors saying there was nothing wrong with me I just needed to exercise and eat right. My parents put me on weight watchers 3 times i have tried atkins, diet pills, and shakes. Have tried everything and I lose some weight but never enough and then I gain that back plus more. No matter how much work i put into it or how hard i tried or how much i exercised it never worked.

At 15 my doctor suggested weight loss surgery but my dad refused. Then at 17 I had to have my gull-bladder out and again a different doctor told my dad I should have weight loss surgery and he refused. I have been at or over 200 pounds since I was 13. Now at 21 I embarrassingly weigh 330 pounds. Thankfully my dad has finally agreed to the surgery due to the fact that we lost my mom to cancer 3 years ago and he now sees that he could lose me if we don't do something. He said he will even cover any co pays but unfortunately doesn't have the money for the whole surgery.

we have insurance through cigna so we thought they would cover it but the insurance is through my dads work and any kind of weight loss surgery is excluded...

So im wondering what we do now is there anyway around it if its excluded from our plan our insurance tells us there isn't. They will pay if i have a heat attack they will pay for diabetes medicine when i become diabetic but why wont they pay for a surgery that will stop those things from happening

there just has to be something we can do I have come this far... I want my chance to be healthy and normal.

I go to my doctors this Thursday but i stumbled upon this site and thought I would post and see if anyone has any ideas or advice seeing as most of you have been through this before anything will help thanks!

[SummerBreeze]

Welcome to our family hunny...I am happy for you that your dad is going to support you now in having WLS...Only thing I can offer is you surgeons office can get the ball rolling if anyone can, they will do all the researching for you and write all the the right things to help you..good luck and dont give up



annie~

[Cassey1989]

Thank you for your kind words I hope your right I'm praying it works out but I'm so scared I didn't know that excluding something that could save someone was even possible...i know knowing everything you can doing all the research is good but i'm wishing I didn't know about the exclusion...

I'm hoping my surgeon can get around it or know what to do cause I dont think its right to let me die when there is something that can help me...

any ways I will keep you updated I dont plan on going down without a fight

[mj2903]

Do you know how the exclusion is worded? My husbands policy also excludes surgery for the purpose of weight loss, however it is covered if the BMI is over 40 for the past 3 years or if the BMI is over 35 and there are co-morbidities that existed for the same 3 years. When the conditions of BMI and BMI + co-morbidities are met it is considered a medical necessity.

Each insurance company and policy is different with their requirements and their exclusions.

Good luck, your surgeons office should be able to help. Also, a new year is coming up and the policy may change for 2011.

[DocSanae]

Welcome to the board, thank you for joining us.
(((((HUGS))))) May your journey go well.

As mj2903 says, confirm the exact working of the exclusion first, good luck with finding that loophole in your insurance.

[judijo]

I think patience is the key. Keep an open communication with your doctor regarding your weight, so it is continually mentioned in your medical chart. This way, when your insurance changes or their exclusion policy changes, you will be good to go. Insurance companies will not approve any WLS without documentation of weight loss efforts already tried.

Hang in there...keep posting and reading. Information is key.

[MsVickie]

Hi there thank you for comming to this site for help.

Cigna has thousands of polices out there. Some cover some dont. It boils down to how the policy like the other post here said. Its gonna depend on how the policy is written. It used to be they all covered it if they could produce enough medical information to support the surgery. Now alot of companys have to buy what they call riders to attach to the policys to cover the surgery itself. Its up the the companys it self to purchase the riders for the employees or offer the employees different types of policys to choose from.

So have your father or your self even make the call and ask if does in fact have an exclusion stating it will not pay for WLS at all. Some policys have that now. Then ask your dad if they offer more than one policy at work. If so have him ask the human resorce people what type of policys they have and when he can change and if they allow the surgery with the other policys the has the choice to have. Some companies dont give you a choice but I notice now alot do.

I wish I could help you more on this....... but this is how insurance companys are getting around this now. And for the record I do agree with you on the part of if you have a heart attack they would pay for it or get diabetes they would pay for medication or drs visits and it would be alot cheaper in the long run for them to just pay for the surgery but they dont seem to see it that way. I do know there are certian states in the USA that have a state law that prohibits insurance companys from denying you from being covered for the surgery. See if your state has that law . I do wish you the best of luck.

Cigna is a good insurance company. But like I said they have thousands of different types of policys and they are all written differently so there is no way any of us can tell exactly what kind you have. You would have to call them yourself . If you do make sure you get the persons name you speak with and ask specific questions.

Like does my policy cover WLS surgery of any kind?

Even if it is Dr recommed because of Co morbiditys?

Those are key questions.

Good luck and update us on this as you know.