[MsVickie]

Im newer to these forums. I have been accepted with open arms. I have to thank everyone for that. I have said a few times I have reseached this surgery for over 6 years. Back during that time insurance companys paid for it.

The problems started about 3 years ago almost 4 now. The companys seen such a high rate of people going after this surgery. So what they did the sneaky litte devils was when an employer renewed there policy or even switched there policys they excluded WLS. Nope its not mentoned they took somthing out. I keep the insurance records for the company I work for. They have these little prints at the bottom of the policys stating....we have to right to change this thing any time we want without disclosing this to the policy holders.

We as real people wanting this surgery see it as a way to become healthy. They see it as robbing there pockets. They would rather you go see your family Dr. that has precribed you several medications for a arrange of problems every three months and have test and studies done than to have this paid for and probally in a years time you have cured most of the ailments.


Now set back and look at what you have to prove to the insurance company before your even considered.


I have read you have to keep food logs, including that whiff of meatballs you got while grocery shopping, steps you take in a day, wearing one of them peds things. How many times have you sought help, AKA (how many times have you agreed with your Dr your fat and need to lose some weight). AKA (How many pamplets did you take home.) AKA (How many did you actually open)
Cant laugh here because that is what there asking you. How many times have you tried to diet, what kinda of diets, Jenny Criag, Weight Watchers, Nutrisystem etc... One thought I was funny when i wrote the Rice diet, The cabbage diet. What? These are real diets.

How many diets have you been on. Does this count the ones we done for one day until something emotional come up and threw us right back into the swing of things?

The one I truly love the most..... Do you have documentation that you have been, heres the word (obese) for atleast 5 years. Now .... that is a tough one. Think about it. How many of us have let the same Dr. fuss at us every 3-6 months or yearly about our weight and put up with it. How many times have you ever told a coworker or a friend yep went to see a Dr the other day. He or she didnt say anything about my weight.


I had Anthem insurance. Its the same as Blue Cross Blue Shield. When I looked into this 6 years ago they paid for it. As long as i was 100 lbs overweight. So 3 years ago when I decided to have it done.....I called them up,,,,same policy mind ya.... and they said....NOPE sorry the company you work for insurance policy renewed in Dec. The current policy you have now dont cover it not longer. MMM I was shocked. Now the lady I spoke with wanted me off the phone as soon as she said May I help you? I hung up stewed about it a bit and said ok this is not right. I called back. A angel anwered the phone and told me what happened. She stated they had the right to pull anything off the policy they wanted to yearly. And did not have to notify us of the change.


So what do you do? Cry? YES. I wonder how many tears have been cried because of the same exact thing. Its sad. .. I wrote my congressmen. He did tell me certian states were trying to pass laws that made it illegal to withhold that benefit from a policy. So the insurance companies the little devils made a fast change.... They decided they would put what they call a rider on the poilcy which will cost more and eveyone not just the people seeking the WLS eveyone would have to pay for it. Yes even little Betsy 3 decks down with a body to die for. Now you know that is not gonna happen. It would be up the the empolyers to ask for it to begin with. If you think about it that part isnt really fair. BUT... its not fair im paying for maturnity benefits either when I can have no more kids.

If anyones employer is like mine there not gonna ask for the rider to be placed. Its called the bottom line


Now im very fourtunate. I was married on Jan 6th 2006. My husband is covered by Tricare. Now what do you think was the first thing I looked at? Yep the monday after my wedding I called them up and asked. They cover the gastic but not the band. Hey im excited. I didnt want the band ...have you ever seen one much less held on in your hands?

As for my new insurance Tricare is a goverment insurance policy for the Armed Services for you those of you that dont know what Tricare is.

My hubby is retired Air Force. So i got to digging around some about other goverment employees insurance. Seems the Federal Goverment has not tried to take that benefit away and all goverment policys pay for it to be done.


I work in a medial office as a nurse. I also call insurance companys daily getting approval for surgerys etc... I find most people dont know what type of insurance they have much less what type of benefits they have. The companies you work for will buy them because because they got a great rate and give you a card take money out of your check and good luck.


My advice to anyone no matter what type of insurance you have is to call your Insurance company and talk to them. Ask if you have the benefit. If so ask for what critera that needs to be met. If they tell you that you dont have the benefit ask why not. Buy Craigs book. I have not seen it but i doubt very seriously if a man who has fought for his right to be healthy would guide you wrong.


Yes you may be in for the fight of your life..... or should I say....The fight for YOUR life but it will be worth it. If all else fails let me know. I still have a few tricks up my sleeve that may help.

We all deserve this. Were not here because we need to lose a few pounds. We are here because we have the need to continue to live.

[beckamarie]

Vickie thank you so much for your input on this insurance mess. I am lucky enough to have tricare. But I am sure many people will benefit from your input

[fr1endly2]

YEAH insurance is a mess i went thru alot of hassles many many years back with infertility treatments not being covered.
SO i fully can relate....
with my weight loss surgery i was thankful
it went very smooth for me.....and i got the quick
approval...but i know its not that way for everyone.
I know in my husbands job we have choices for
our insurance they have a few options...of course
for the better i contribute more but its always
well worth it!
HUGS
what a beautiful writing!!!!

[laydiej]

I have 1199 National Benefit fund and they are giving me the worse time. I am so depressed at this time. They want me to wait another six months and try something else after I have already tried something for the last six years. Oh well I'll keep praying for a miracle

[armywife2aerial]

MsVickie this was a great post to start and as i have stated in a previose post i can not begin to thank you for the little bit of help that you have already givein me. when i was getting down and ready to give up. after i had call what felt like a million time trying to get answers and the insurace company not giveing me what i needed or talking to the rong person. you gave me the tools to call agen and ask and things are on the right path agen and im gunna get my DUCKS IN A ROW and nock there socks of lol

MY advice also is if you call your insurace company and the woman or man seems like (stail pop corn with out butter hang up becuse the movie is ganna be shitty) . IF they sound lost like they would be better of working in a coffie shop it's probly true. hang up call agen. so the moral of this is dont think every time you call your insurace company you are talking to the best person to deal with the issue at hand. keep trying till ya get the answer you want. Thanks to MsVickie i did this and it worked

[fr1endly2]

(((HUG))) laydiej!!!
im speechless on the problems your endureing!

[laydiej]

Thank you all for your words of encouragement. It is at times like these I wish I would hit the lotto and pay for it myself. Thanks Ms. Vickie.for your advice. You are absolutely right we need this to continue our life why dont insurances realize that.

[MsVickie]

LaydieJ: You dont need to give up on this fight. Im not familiar with you insurance company. Is this a pention fund of sorts? Let me know what steps you have taken thus far and what you know for fact from the insurance. I can try to help you from there. Remember.......

[Michelle]

MSVICKIE thanks for the post. It's nice to know you're not the only one, sometimes it feels like they are picking on you personally. In my case, Aetna keeps denying my Pre-Cert because they say I have not been at a BMI of 40 for 5 Years. Well, I have been overweight for 14 years, up and down. Is any person really going to try and stay at an overweight state there whole life... NO. They will try and try and try until they are successful and lose weight or reach this decision of surgery! I got a DR's note today with my weight record for the last 14 years from my OB. We will see what they say, there were 5 times I was over 40 BMI but not 5 years in a row. I just wish I knew what information I could send them to make them say APPROVED... WISH ME LUCK!

- Michelle

[laydiej]

Hi Ms. Vickie, My insurance is a unioun insurance. It is mostly for hospital and health care workers. Basically I gave them six years of documentation that I have tried to lose weight. I decided to have WLS in Dec. 2006 which is when I decided to stop with the diet yo yo. So I don't have six consecutive months for 2006 but I was also ill in 2006 with cellulitis of my leg which kept me bed bound. I could not visit my diet doctor often. The last documented visit was Dec 2006. So the insurance consultant for my surgeon feels that I should start a diet program again for another six months. I think that six years of constant dieting and being obese all my life should qualify. I have asthma, sleep apnea, swollen ankles, serious back pain, unable to walk up stairs without breathing heavy.I'm not completely giving up but I dont know what else to do I feel if I continue on for another six months of trying they still may deny me.My insurance is the worse. They do pay for WLS but they give you a hard time approving.The longer I wait the more my health is in danger.
LaydieJ