Change in policy! - Page 2 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Tess · 06-07-2009, 11:31 AM

That is just so wrong Jersey....Yeah its OK that thousands of people will suffer because the insurance company thinks its becoming to common to help them?

I wonder how many people will wind up dead because they suffer from depression because they are close to three hundred lbs and because they have no (What the insurance says) co-morbidities and refused help and for the same reason you got help.
A little selfish don't you think. Heartless too. With support like this people might as well post on a "Lazy Fat people suck and need to work out and not suck our insurance companies dry) forum

Its costing them!! thats the only reason the BMI will be moved up. We ought to be storming Congress not defending the insurance companies if we care at all. People who suffer the same thing (Obesity)we all do need help. Its sad it really is. I guess no ones going to listen until thousand die and same one Finlay realizes depression is a Co-morbidity and people are dieing every day

katzz87 · 06-07-2009, 11:38 AM

Quote:

Originally Posted by jerseygrl684

They are doing it because WLS is becoming WAYYYYYY too common. I don't blame them. Smart move on their part.

Joy- i wish you the best, get all you can get... present it to them... worst case... you wait another 6 months. Trust me, i would have rather been bumped back another 6 months than live another 6 yrs like this. You will be so knowledgable at wls, you will go in like a pro!

Keep us updated.

I agree with jerseygrl; another 6 months in the scheme of life isn't too long. I know it's disappointing, but just another hurdle to cross.

The insurance may have bumped up the BMI requirement, but if someone has several co-morbidities they'd more than likely drop their BMI requirement.

Native2u · 06-07-2009, 12:00 PM

Quote:

Originally Posted by katzz87

I agree with jerseygrl; another 6 months in the scheme of life isn't too long. I know it's disappointing, but just another hurdle to cross.

The insurance may have bumped up the BMI requirement, but if someone has several co-morbidities they'd more than likely drop their BMI requirement.

Cathy,

Please don't take this like I'm attacking you...I'm not.

Did you have to fight for your insurance company for over a YEAR for them to pay for your WLS....even though, you qualified? I sure did! I had to hire an Attorney to fight this for me (more $ out of my pocket). I'm telling you, it wasn't fun!! I had to jump though SO many hoops, even though I qualified in the beginning.....and I kept getting letters of denial.

Don't think for a second that an insurance company will even drop their BMI requirement, just because a person has several co-morbidities....it just doesn't happen. Insurance Companies don't work like that.

Insurance Companies want our money ever single month, but when we need them for a life saving surgery (WLS), something that will pro-long our lives and make us healthy again...they have NO interest in helping, even IF you meet THEIR criteria for surgery.

jerseygrl684 · 06-07-2009, 12:11 PM

Quote:

Originally Posted by Native2u

So...I have a couple of questions for you Jersey.

So, you'd be OK with the a denial from your insurance company if you didn't qualify? Or better yet, you were in the middle of your diet with you doctor and your insurance company just "out of the blue" raised the qualifications for WLS?

You'd be OK with this??

Hello, I made a general statement. Call off the dogs for about 2 mins of your life please.

No, I wasnt happy when my insurance company put me through hell to get all my requirements, then denied me, then tacked on 6 months of dietary requirements. Guess what though, they are an insurance company... they can do it.

I'm not a doctor, nor do i play one on tv, but there are some of us here who were not in medical danger to die in the next year. Therefore it wasnt a necessity, it was something we felt we needed to lose the weight to help the co-morbidities. If I didn't qualify through my insurance company and didn't win my appeals, I would have probably tried to fund it myself or wait. I haven't been in that position, so I don't know.

But, WLS is becoming way more common nowadays... not that it is a quick fix, but it went from something so taboo about 5 yrs ago, to something so widely talked about and even advertised on a billboard. I don't blame the insurance companies for making their bmi requirement higher, they are tryin to save themselves money too.

jerseygrl684 · 06-07-2009, 12:14 PM

Im selfish and heartless now?

This is one of the nicest posts I have written lately, and you managed to actually turn it on me?

You need to step back, stop taking it personally... and see it from the other side.

Native2u · 06-07-2009, 12:26 PM

Quote:

Originally Posted by jerseygrl684

Hello, I made a general statement. Call off the dogs for about 2 mins of your life please.

First of all Jersey....I don't have "dogs".

Quote:

Originally Posted by jerseygrl684

No, I wasnt happy when my insurance company put me through hell to get all my requirements, then denied me, then tacked on 6 months of dietary requirements. Guess what though, they are an insurance company... they can do it.

Yes, they can. But were you NOT upset about their decisions?

Quote:

Originally Posted by jerseygrl684

I'm not a doctor, nor do i play one on tv, but there are some of us here who were not in medical danger to die in the next year. Therefore it wasnt a necessity, it was something we felt we needed to lose the weight to help the co-morbidities. If I didn't qualify through my insurance company and didn't win my appeals, I would have probably tried to fund it myself or wait. I haven't been in that position, so I don't know.

So, you would have been good without surgery, even though you qualified for surgery..without your insurance company paying? To have t pay for WLS out-of-pocket, is a lot of money to come up with. But when you qualify with your insurance company and you have met all THEIR requirements, they should pay for your surgery. You pay your monthly payments to your insurance company...don't you?

Quote:

Originally Posted by jerseygrl684

But, WLS is becoming way more common nowadays... not that it is a quick fix, but it went from something so taboo about 5 yrs ago, to something so widely talked about and even advertised on a billboard. I don't blame the insurance companies for making their bmi requirement higher, they are tryin to save themselves money too.

It is common, I agree. But in the long run the insurance companies are going to SAVE money by paying for WLS (if their requirements are met). Come on, they are going to SAVE a lot of money on all of the Pharmaceuticals as well as surgeries/heart attacks and more that WLS could prevented in the beginning.

Lynette · 06-07-2009, 12:31 PM

Quote:

Originally Posted by jerseygrl684

I don't blame the insurance companies for making their bmi requirement higher, they are tryin to save themselves money too.

Exactly and there is a big difference between being able to step back and make a practical observation from a financial point of view for the stability of a corporation versus what someone would like for themselves on a personal level.

These insurance companies have actuaries and financial analysts who are obviously starting to crunch the numbers and figure it is cheaper to let fat people stay fat than to pay for a surgery that can have a high failure rate

jerseygrl684 · 06-07-2009, 12:35 PM

Quote:

Originally Posted by Native2u

First of all Jersey....I don't have "dogs".

Yes, they can. But were you NOT upset about their decisions?

So, you would have been good without surgery, even though you qualified for surgery..without your insurance company paying? To have t pay for WLS out-of-pocket, is a lot of money to come up with. But when you qualify with your insurance company and you have met all THEIR requirements, they should pay for your surgery. You pay your monthly payments to your insurance company...don't you?

It is common, I agree. But in the long run the insurance companies are going to SAVE money by paying for WLS (if their requirements are met). Come on, they are going to SAVE a lot of money on all of the Pharmaceuticals as well as surgeries/heart attacks and more that WLS could prevented in the beginning.

Yes I was upset, but this was the insurance company I had and it was their requirements. I can qualify for plastic surgery and be a great candidate, but doesnt mean that an ins company has to cover me if they don't deem it medically necessary. Does that make it right? ABSOLUTELY NOT. If you want a better insurance policy, pay out of pocket for another one. Its a shitty option, but its the only one we have nowadays.

Did my ins company make out in the long run? Ha, right now according to them NO. I had 3 subsequent surgeries last year at the age of 24. I don't think they made out IN THE LONG RUN with me. They probably thought, okay we paid for her wls, but now look at the crap shes got.

Insurance companies arent fair, and joy shouldnt have to go through it, but if she does.. its ONLY another 6 months. She's gonna look back on this is 3 yrs and be like THAT WAS SO EASY.

jerseygrl684 · 06-07-2009, 12:37 PM

Quote:

Originally Posted by Lynette

Exactly and there is a big difference between being able to step back and make a practical observation from a financial point of view for the stability of a corporation versus what someone would like for themselves on a personal level.

These insurance companies have actuaries and financial analysts who are obviously starting to crunch the numbers and figure it is cheaper to let fat people stay fat than to pay for a surgery that can have a high failure rate

EXACTLY, I would like new boobs, batwings gone, and my sharpeis thighs gone... but im almost 100000% sure my insurance would rather me be an ugly thin girl than do that. It isn't fair, but you have to step back and put yourselves in their shoes. The rate of failure or gaining weight back is very high. It sucks, and it may not be us, but they cant make an exception for one and not others.

ragazzarosa · 06-07-2009, 01:03 PM

eh, you won't ever find me siding with an insurance company. If they existed to be not for profit, I would consider it. But as it is, they screw the patient (unless someone makes a stink) and they screw the doctors as well. For profit health insurance companies are a huge part of what is wrong with our current health care system. I've researched this issue too much and seen/talked/been related to too many of those in the medical profession (including people who work for big pharma companies). It's all about the money, not taking care of people. It's disappointing and that's not how one would hope that a thoroughly modern westernized society would treat those most in need of help.

Having said that, Joy, I think you should treat yourself to one more pair of jeans. You're going to be wearing them for a few months and you might get more use of them for a month or so after the surgery. I know you didn't want to, but one more pair does not mean that you are giving up!!!!

You can battle through this - I'm sorry they changed the requirements on you, honey. They're money grubbing b*stards. Don't ever forget that. It's war - and your health is the prize.