Change in policy! - Page 3 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

supersexysprite · 06-07-2009, 01:18 PM

Insurance ahhhhhhh nice topic.

I'm all about gettin some more jeans, and shoring up your strength for the fight. It is a war to get to "Yes" It sucks, but, it is worth it all when you gain control of your health.

Insurance companies have been selling air for a long time. Now we have a technology that works in over 90% of the case studies, rids the patient of co-morbids and serves the patient's external family and friends as well as far as peace of mind. This isn't about getting wolf whistles at Home Depot. Well maybe a little bit.

If I were Joy, I'd be pissed.

Joy, I have a thought. If you posted your size, I'm sure there are some of us nice ladies that could send you some freebies that would otherwise be going to a local charitable organization. Just a thought.

Sprite

katzz87 · 06-07-2009, 10:28 PM

Quote:

Originally Posted by Native2u

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.

I'll get flamed for this...but I had been working with doctors, nutritionist, exercise regimen for YEARS trying to lose (and keep off weight)...so luckily I had everything documented and from the first time I saw the WLS doctor till surgery was 3-4 months it was that long only because I changed from lap-band to gastric bypass. Does that make my journey any less difficult? I had diabetes, high cholestorel, high blood pressure, among other issues that I fought for years and years.

My insurance told me flat out that it was up to my doctors facility if my surgery was approved. As long as my doctor approved, the insurance company had no "approval" in the process. I realize that all insurances are different...but that was how it worked for me.

I felt the Jersey's comment was actually pretty supportive if you would get past the first sentence.

And no....I didn't take this personally.

Native2u · 06-08-2009, 06:29 AM

Quote:

Originally Posted by katzz87

I'll get flamed for this...but I had been working with doctors, nutritionist, exercise regimen for YEARS trying to lose (and keep off weight)...so luckily I had everything documented and from the first time I saw the WLS doctor till surgery was 3-4 months it was that long only because I changed from lap-band to gastric bypass. Does that make my journey any less difficult? I had diabetes, high cholestorel, high blood pressure, among other issues that I fought for years and years.

I also had fought WL for YEARS and had been working with Doctors, Nutritionists, Personal Trainers and just about every WL Clinic we have around us. So, I had YEARS of documentation also. I ALSO had HB, and then during 3-4 months into fighting with the insurance company for WLS, my Doctor had me tested for Diabetes (cause it runs so high in our family) and it came back that my sugars were close to 200 (so Diabetes was positive), then I had to do a Glucose Tolerance Test (A1C) and that test showed that I had been Diabetic for the last 3 months. Still my Insurance Company denied me.

My insurance told me flat out that it was up to my doctors facility if my surgery was approved. As long as my doctor approved, the insurance company had no "approval" in the process. I realize that all insurances are different...but that was how it worked for me.

You are one of the lucky ones. Really lucky. I wish that at that point, I had your insurance company.

I felt the Jersey's comment was actually pretty supportive if you would get past the first sentence.

I did read the whole post and if it was supportive, I didn't get that out of what I read.

And no....I didn't take this personally.

Thank you!

katzz87 · 06-08-2009, 10:57 AM

Quote:

Originally Posted by Native2u

Thank you!

You're welcome.

lillylaroo · 06-08-2009, 11:08 AM

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.

Both of you STOP! For Christ sake this is someone's thread and they are down in the dumps. We don't need to turn this into a debate session. Just listen to Joy's troubles and provide ADVICE not OPINION. Please. Some of us are getting sick of this. Start a thread where you all can debate about whatever. I surely don't want to post and have it turn out like this. PLEASE with sincerity.

lillylaroo · 06-08-2009, 11:12 AM

Joy, I am sorry for your situation. I don't know what advice to offer. I don't know what I would do in your situation. I might try with my PCP first and see if he can show that you have been on a diet for at least 9 months. Doctors can be kind like that.

As for pants. PM me with what size you wear. I have some nice jeans that I may be able to send you if your the right size. I had surgery last Tuesday so I am most likely not going to need them.

deputymauldin · 06-08-2009, 11:39 AM

I am sorry for what you are going through. I know how you feel. Let us know what happens when you talk to your doctor.
I have a million pairs of jeans and I would be willing to send them off tomorrow. I can't wear jeans to work anymore so they just sit in my closet. PM me

jerseygrl684 · 06-08-2009, 11:54 AM

Joy-

Do you have a local thrift store? Before wls i would never be caught dead in one, however I found my fav pair of express jeans in there for $6!

If you have to wait an extra 6 months, i promise it will FLY by. Trust me, 2 yrs has flown by so quickly.

mistymee · 06-08-2009, 12:20 PM

Quote:

Originally Posted by katzz87

I'll get flamed for this...but I had been working with doctors, nutritionist, exercise regimen for YEARS trying to lose (and keep off weight)...so luckily I had everything documented and from the first time I saw the WLS doctor till surgery was 3-4 months it was that long only because I changed from lap-band to gastric bypass. Does that make my journey any less difficult? I had diabetes, high cholestorel, high blood pressure, among other issues that I fought for years and years.

My insurance told me flat out that it was up to my doctors facility if my surgery was approved. As long as my doctor approved, the insurance company had no "approval" in the process. I realize that all insurances are different...but that was how it worked for me.

I felt the Jersey's comment was actually pretty supportive if you would get past the first sentence.

And no....I didn't take this personally.

I can't imagine you getting flamed for your post...

My situation was almost exactly like yours, right down to the time frame, which was less than 2 months from my visit with the PCP through all the 'hoops' to a surgery date, which was then pushed out to just less than 4 months from beginning to end (because I blew out my knee and couldn't get to my preop tests)

And honestly, it seems people are seeing stuff in posts that just aren't there due to past issues between them. (This has happened to me as well) It's annoying to have every word you write be taken wrong or to have negative connotations attached to them even when you don't intend for there to be any.

Moving on..to the OP, have you checked to see if these new requirements affect everyone regardless of how far into the process you are? That would be my first thing to do.

Secondly.. though it is understandable how damn frustrating this must be, in the grand scheme of things three additional months really is nothing.. it'll fly by before you know it. So if you have to do three months.. then do it.. it'll be worth the hoop jumping and the wait, in the end.

Kimberly76 · 06-08-2009, 12:20 PM

Joy,

Might I suggest you call your insurance company back and speak to another agent? From my own personal experience, I would call one day and get an answer, and then call another day speak to a different person and get a different answer for the same question... It got to the point I wanted to speak to a supervisor. I called about a week before Surgery was to happen, and I actually had a woman tell me that My University of Michigan insurance (BC/BS) was not accepted there and that I would have to have my Surgery in Flint. I can't tell you how livid I was... Hung up the phone after saying thank you, and called and talked to another person and told the insurance company who I spoke to and what had happened. yeah, try again, please!

Best wishes that's not the case.