can't find any insurances to help! - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

rrrocky · 12-20-2005, 09:49 AM

Hello, my name is Rocky. I'm 20 years old and 320 pounds. I guess I have the same story as a lot of people here, I've tried all the diets I could, I went to weight watchers and even had a supervised diet by my doctor. Nothing has worked. I'm a compulsive over eater.

This past year I've been in therapy and I've started taking antidepressants because I've gotten to the point where I don't want to leave my house. I took them for 3 months and felt no different, so I stopped taking them. I quit school my second year in college with a 4.0 GPA, and my insurance company (Aetna PPO- I'm on my grandfather's plan from his job) said that they will not cover gastric bypass surgery at all. I called two times, and they said that they won't cover it under any circumstance, and that was their final word, and that there is nothing that I could do.

My mother had the surgery and her life has only improved for the better, her insurance company was United Health Care. She lost her job right after her surgery, so she couldn't add me to her plan. So I decided that I wanted to do something about it, and I got my own job and I found out that they offered insurace through United Heath Care! So I worked for the past 3 months, making myself go to work despite my feelings of depression and suicide because I kept telling myself that all I needed was to work for 3 months before I would be eligile to sign up for insurance.

Yesterday I got the paperwork and quickly read the plans to see what they offered. Under "exceptions" for both plans my job offered, obesity surgery of any kind, including surgery for morbid obesity is not covered!

I am so depressed now that I didn't even go to work today.

Isn't there anything I can do? I haven't cashed any of my paychecks because I wanted to save all my money for any type of deductible I would have to pay for the surgery I wanted to get.

So now I'm thinking about just looking for my own insurance plan that is not offered by any job, and signing up for it so that I could get the surgery. Is there anything wrong with this idea? Can anyone suggest insurances that have approved you? Am I just not being aggressive enough with my current insurance? Even though it's stated on their form that it's not covered, and they tell me, is it still possible to MAKE THEM change their decision? Can anyone offer any help at all? I'm 20 and I want to live outside of my house.

Jtcox88 · 12-20-2005, 12:21 PM

I'm sorry that you are in so much despair. Unfortunaltely I can't help with the insurance info. However, I think that you should definatley check with your insurance re: theropy. I know, I know, this sound dumb, but a pych. clearance is one of the requirements of surgery. Find a good theropist. One who actually cares about YOU. I think that once you get your life on the upswing the surgery and the insurance approval will be a breeze. I also believe that we all have had moments of hopelessness. That's what turned us on to surgery!

Good luck and don't give up!

Dave · 12-20-2005, 12:34 PM

I don’t want to offend you but I think your problems go much deeper than your weight. When I was your age I weight at least what you do if not a little more. It didn’t keep me from working or enjoying my many hobbies. The extra weight just makes things more difficult because there is more of you to move around. It’s hard on your body and makes you think less of yourself but it shouldn’t keep you from living life. You should still be very mobile at your age and weight. I am now 360 lbs and I still work on cars, work on my house, help friend roof houses. It isn’t easy but I am able to do it. I’m not saying that you don’t need bypass surgery but I think you need counseling first to find out why you are depressed. My brother has depression and he thought losing weight would fix all the problems in his life. He lost over 100 lbs on his own jumping between weight watchers and Atkins. After he lost all the weight he found his problems were still there and he didn’t feel any better about himself. Now he is convinced if he could only get a girlfriend that all of his problems would go away. They won’t. There will just be more problems. Anyway, good luck with insurance. I think signing up for your own private plan is a good idea.

momronda2k · 12-20-2005, 02:08 PM

Rocky, I think you need to look at Aetna again. I had a situation where I was covered under Blue Shield but only until the end of the year, due to my husbands company changing insurance carriers. Aetna is very difficult to get the insurance approval through, but you must keep trying. First I would go to your primary care providor and have them do a referral for Gastric Bypass. When you go to your PCP make sure to have all your records of attempted weight loss ready, especially including the Doctor supervised diet you were on. I do know that Aetna REQUIRES you to have proof of a Doctor supervised diet. Maybe you do not meet their requirements for the duration. Keep trying Rocky, don't take no for an answer. I was told on October 25 by my surgeons office when I went for my consult that there would be no way to have the surgery done before the end of the year under my Blue Cross plan because I still had a majority of my testing to do. I was devestated, went home that night, and the next day I woke up and said "I will not accept that answer, I can do this." I went and had all my testing done that same day, blood work, EKG. I had my surgery on Nov 28. Just a little over a month later. Please don't give up. Make it happen. Do insurance research if you plan on switching, because most insurance companies will have an pre-existing exclusion clause if you are going to be applying on your own. Good luck, and keep us posted.

coptergirl · 12-20-2005, 02:42 PM

Quote:

Originally Posted by momronda2k

Rocky, I think you need to look at Aetna again. I had a situation where I was covered under Blue Shield but only until the end of the year, due to my husbands company changing insurance carriers. Aetna is very difficult to get the insurance approval through, but you must keep trying. First I would go to your primary care providor and have them do a referral for Gastric Bypass. When you go to your PCP make sure to have all your records of attempted weight loss ready, especially including the Doctor supervised diet you were on. I do know that Aetna REQUIRES you to have proof of a Doctor supervised diet. Maybe you do not meet their requirements for the duration. Keep trying Rocky, don't take no for an answer. I was told on October 25 by my surgeons office when I went for my consult that there would be no way to have the surgery done before the end of the year under my Blue Cross plan because I still had a majority of my testing to do. I was devestated, went home that night, and the next day I woke up and said "I will not accept that answer, I can do this." I went and had all my testing done that same day, blood work, EKG. I had my surgery on Nov 28. Just a little over a month later. Please don't give up. Make it happen. Do insurance research if you plan on switching, because most insurance companies will have an pre-existing exclusion clause if you are going to be applying on your own. Good luck, and keep us posted.

Mom is right, Rocky - most private insurance contracts have the pre-existing exclusion clause. You've done the supervised diets and have made pleas to your doctor so this is a documented fact. Some will say no flat out, and some will hike the price up on you...and the prices for private insurance is ridiculous! Keep trying with Aetna. Go to your PCP and have him write you a letter, then go to your surgeon and get copies of your medical results and letters written on your befalf already, and get a hold of a supervisor at Aetna to see if there is anything that can be done - do not take no for an answer! Take control of your own health and persue this until it happens! We are behind you, and you will be in my prayers...

Baron Patrick · 12-20-2005, 02:54 PM

rrocky!

Never Give Up! Keep fighting for what you have every right to have!

In regard to your depression - don't stop taking them! If they're not doing you any good, go back to the doc. There are other types that can be used. Remember one thing - depression is NOT a mental illness, it is a physical condition. I've been on anti-depressants for years, and believe me, if not for them, I would not be here today. If you've been taking them for a while then stop, you will have what's called a "crash", and your depression will only get worse.

So, PLEASE, get back to the doctor about your depression.

Now, as far as weight loss surgery, some insurance companies seem to want to fight you every inch of the way. They will put up "road blocks" and "barriers" hoping to wear you down and go away. When I called my insurance, they told me they DO NOT cover gastric bypass surgery. I called back about two months later and asked if they cover the LapBand surgery, and they said yes. It's all in how and what you ask. If you ask a generic question, you will get a generic answer.

You may also want your grand-dad to check with his HR and find out if they can establish a rider or something on the insurance coverage that will be to yours (and other's employeess) benefit.

I honestly feel you need to get your depression checked on and stabilized. In your frame of mind, I doubt a doctor will approve you for the surgery. I'm very glad your here, there are a lot of incredible people here who are ready to help and support you. Keep sticking around, it's a great place to be!

brookscn · 12-20-2005, 05:55 PM

Rocky:
A couple of things....first of all, you have a right to be disappointed about the insurance situation. But, being depressed about it is only going to make you retreat more, and what you really need to do here is GET ANGRY and start figuring out a way to make that surgery happen. Get your own insurance, if you have to - you can check the Blue Cross website to see how much individual insurance costs for you (or any of the major insurance websites), but please be sure that you understand all of their exclusions.

As far as not taking your meds - you should not just drop anti-depressant medicine cold turkey. That's what they do to laboratory rats that they're testing the medicine on. You have to wean yourself off anti-depressants. So, you need to contact your doctor, and figure out where you stand with that medicine, and get yourself back on it. I'm thinking that once you are back on your medicine, you'll feel better and get what's needed within you to make your surgery happen. Besides, you need to be in sound mind in order to make the decision to undergo major, life-altering surgery.

You're a 20 year old, you're a grown up, and it's time for you to take control of your life. Please don't throw it all away - I think a lot of the folks on this board would give their eye teeth to be back in their 20s again! And, you've made a decision that has taken many people (myself included) decades to realize - we have a weight situation that we cannot possibly control.

Good luck to you - keep on plugging away - good things happen to good people, go win one for the Gipper....Sorry, one cliche too many, but they seemed appropriate. Keep us updated on your progress.

Happy holidays.
Carolyn

fatnomore67 · 12-20-2005, 08:26 PM

Might I suggest, if you can afford it, quit thte job and go back to school full time. Most colleges have insurance for the full time students and it may cover you. Worse case you only get an education. With a 4.0 GPA you are only hurting yourself by not going back.

Matthew
Open GB 5/11/05
416/281/199

exit88 · 12-20-2005, 10:39 PM

No insurance company is going to sell an individual policy to someone heavy enough to qualify for weight loss surgery. I get my insurance through the California Major Risk Medical Insurance Program (MRMIP) http://www.mrmib.ca.gov/MRMIB/MRMIP.html . You should check to see if your state has a similar program.

LizardQueen · 12-21-2005, 12:23 AM

You poor Dear! Sending you a big hug! Now, get back on the anti depressants ASAP. Go to work and have a life. Don't center your whole world on having wls. If you can't get insurance to cover it, have you considered paying out of pocket? It's a BIG debt to get into but it is possible. Also, you need to schedule an appt. to see your PCP and ask for a referral to a surgeon and go to a consult. Good luck and let us know!
This won't fix everything in your life. You'll have to work on some stuff on your own!