Letter to Human Resources (long)

[ArcusX 216]

Today I'm sending the following letter off to the VP of HR and CC'ing the CEO. Hopefully you will never need to do anything similar, but in case you do, feel free to purger me. Enjoy!

Dear <VP of HR>:

My name is John and I have been with <my company> for a little over two years. I love working for <my company>. The people I work with are all second to none. We have a fantastic team here, and I wouldn’t trade it for anything. I’ve been married for 14 years and I have two boys, ages 7 and 9. I’m a Den Leader and Committee Member in my children’s Cub Scout Pack. Unfortunately, before the kids came along – in fact just after I married – I broke my foot and was in a cast for a long time – nearly 18 months. During that time, and the months that followed, I gained around 60 pounds, and have managed to slowly put on another 40 over the past 12 years. Now I’m what you would call Morbidly Obese. Worse, over the past 6 years I have also developed Type 2 Diabetes, Obstructive sleep Apnea and Gastroesophageal Reflux Disease (Acid Reflux). The diabetes and sleep apnea are serious conditions with potentially life threatening affects on the body. Besides the medical issues, it’s difficult to do things with my kids; it’s not fun staking a tent with 100 pounds of belly in your way.

My weight was floating at around 290 pounds, which at 5’11” tall put my BMI over 40. When I saw my doctor in the fall and knowing that my weight was the main reason for all of my medical issues, I asked if he thought I was a candidate for some form of Weight Loss Surgery. You see, I’ve been with him for a while, and he’s always advised me to go the way of “eat less, move more.” Not in so many words, but that’s a good summary. This time he considered the thought and said he would refer me to someone he knew.

I started down the road of research, attended a seminar, and following the seminar had a consultation with a bariatric surgeon. I was told that insurance had been verified, and since the first week of October, I have gone through all of the steps – and incurred the costs – needed to prepare for surgery. I’ve had an EGD and gallbladder ultrasound, a chest x-ray, a psychological evaluation and worked with a nutritionist for three months. I even lost about 25 pounds by the time all of my documentation was submitted to Cigna for approval, only to find that bariatric surgery of any kind is specifically excluded from my coverage.

When I confirmed this finding with HR, I asked why bariatric surgery is excluded, this was the answer I got: “We don't cover it due to the other complications that can arise from this particular surgery which in turn can cause higher claims.”

I have found it difficult to understand this policy. Research shows that bariatric surgery resolves – not just improves, but resolves – Type 2 Diabetes in 83% of cases, Sleep Apnea in 74-98% of cases, and GERD in 72-98% of cases. I would like to think that the decision to omit bariatric surgeries was made so many years ago and that the data has improved so much since then, if it were to be reconsidered and reevaluated today, <my company> might add this service to the benefits covered by the medical insurance offerings.

The information below will illustrate that there is a cost associated with NOT offering bariatric surgery as a treatment option. Diabetes alone costs <company name> and its employees an estimated $2.6 Million annually. I have spent many hours gathering this information, and I hope that you at least take the few minutes it will take to read through the information herein:

Obesity is one of the greatest public health and economic threats facing the United States. Approximately 72 million Americans are obese and, according to the American Society for Metabolic & Bariatric Surgery (ASMBS), about 18 million have morbid obesity (roughly 6% of the population). Obese individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including Type 2 diabetes, heart disease and cancer. The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion, double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018.

Co-morbidities associated with obesity:

The evidence is overwhelming on the association of obesity to a number of medical conditions. These include: insulin resistance, glucose intolerance, diabetes mellitus (specific statistics for this co-morbidity provided below), hypertension, dyslipidemia (high cholesterol), sleep apnea, arthritis, hyperuricemia (gout), gall bladder disease, and certain types of cancer. The independent association of obesity seems also clearly established for coronary artery disease, heart failure, cardiac arrhythmia, stroke, and menstrual irregularities. http://www.ncbi.nlm....pubmed/10593535

Diabetes Statistics:

Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes. <my company> having some 4,800 employees, statistically, 398 of them have diabetes.

New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.

Morbidity and Mortality of Diabetes

575]· In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.

Complications of Diabetes

Heart disease and stroke

025]· In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.

025]· In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.

025]· Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.

025]· The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

025]· In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension.

Blindness

025]· Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.

025]· In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss.

Kidney disease

025]· Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.

025]· In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States.

025]· In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.

Nervous system disease (Neuropathy)

025]· About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

025]· More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.

025]· In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.

Cost of Diabetes

575]· $174 billion: Total costs of diagnosed diabetes in the United States in 2007. That’s $6744 per person who has diabetes per year. $2,684,186 for the 389 <my company> employees per year

575]· $116 billion for direct medical costs

575]· $58 billion for indirect costs (disability, work loss, premature mortality)

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.

Bariatric surgery is the only reliable treatment that offers sustained, long-term weight loss. This results in cure or improvement in almost all of the obesity-associated diseases and translates into reduction in the relative risk of death or increased longevity of the operated morbidly obese population. Since the treatment of obesity-associated conditions is very costly, bariatric surgery also results in significant reductions in healthcare costs with a return on investment of 3 years. It is not just weight loss, it is health gain. http://www.ncbi.nlm....pubmed/19440652

The treatment of obesity and related comorbidities are significant financial burdens and sources of resource expenditure. This study was conducted in order to assess the impact of weight-reduction surgery on health-related costs. Patients having undergone bariatric surgery had significant reductions in mean percent initial excess weight loss (67.1%, P <0.001) and in percent change in initial body mass index (34.6%, P <0.001). Bariatric surgery patients had higher total costs for hospitalizations (per 1,000 patients) in the first year following cohort inception (surgery cohort = CDN 12,461,938 dollars; control cohort = CDN 3,609,680 dollars). At 5 years after cohort inception, average cumulative costs for operated patients were CDN 19,516,667 dollars versus CDN 25,264,608 dollars, for an absolute difference of almost CDN 6,000,000 dollars per 1,000 patients. Conslusion: Weight-reduction surgery in morbidly obese patients produces effective weight loss and decreases long-term direct health-care costs. The initial costs of surgery can be amortized over 3.5 years. http://www.ncbi.nlm....pubmed/15329183

Bariatric Surgery As Treatment For Obesity And Therefore Other Co-Moridities

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. In the United States, about 200,000 adults have metabolic/bariatric surgery each year. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent. The 30-day mortality rate for sleeve gastrectomy was 0.08 percent, while the rate for gastric bypass was 0.14 percent and 0.03 percent for gastric banding. These mortality and complication rates are lower than those typically associated with gallbladder or hip replacement surgery.

One study published in 2010 in the Journal of the Society of Laparoendoscopic Surgeons by the Surgeons Group of Baton Rouge, following the groups first 100 consecutive Laparoscopic Sleeve Gastrectomy, a relatively newer procedure included the following results: The percentage of excess body weight loss at the 3- and 6-month marks was 34.2% and 49.1%, respectively. Comorbidities were also improved at the 3- and 6-month marks. Hypertension resolved in 38%, hyperlipidemia resolved in 19%, and diabetes in 46%. Complication rate during the first 6 months was 10%. Major complications included 2 patients with postoperative bleeding, 2 patients with acute renal failure from dehydration, and 1 postoperative bleeding patient who developed a gastric fistula. No surgical reintervention was required for any complication. Conclusion: Our technique is a safe method that is easily reproducible and does not require any modification. Laparoscopic sleeve gastrectomy is an excellent surgical option with a low complication rate. http://www.ncbi.nlm....les/PMC3083039/

In the March 26, 2012 issue of the New England Journal of Medicine, Schauer et a published “Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes.” In this randomized controlled trial, the efficacy of intensive medical diabetes management alone versus laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes was performed. The results were enlightening. In this specific population, the sleeve gastrectomy outcomes were equivalent to Roux-en-Y gastric bypass, a CMS covered surgical benefit. At the end of the one-year trial, hemoglobin A1C was 7.5 for intensive medical diabetes management, 6.4 for Roux-en-Y gastric bypass, and 6.6 for sleeve gastrectomy. As expected, weight loss outcomes had similar results namely, an end-point BMI (kg/m2) of 34.4 for intensive medical diabetes management, 26.8 for Roux-en-Y gastric bypass, and 27.2 for sleeve gastrectomy. Of note, when examining serious adverse events requiring hospitalizations, intensive medical diabetes management (non surgical treatment) and sleeve gastrectomy (bariatric surgery) hospitalizations were equivalent! (9 vs. 8 %, respectively). This trial was published in the New England Journal of Medicine, which leads all general medical journals in its impact factor. There is no question that this trial is of the highest methodological quality and should be part of the External Technology Assessment of the proposed decision memo.

In the April 16, 2012 issue of the Archives of Surgery, Leonetti and colleagues published Obesity, Type 2 Diabetes Mellitus, and Other Comorbidities: A Prospective Cohort Study of Laparoscopic Sleeve Gastrectomy (LSG) vs. Medical Treatment. From trial initiation to trial end at 18 months, the medical treatment control group gained weight (BMI, 39 to 39.8 kg/m2) and saw modest declines in Fasting Plasma Glucose (FPG) (183 to 150 mg/dL). In contradistinction, the LSG group saw substantial declines in both weight, BMI 41.3 to 28.3 kg/m2) and FPG (166 to 97 mg/dL) (note that 100-150 is considered “pre-diabetic,” and below 100 is “normal”). Cardiac risk factor assessment showed consistent superiority of Laparoscopic Sleeve Gastrectomy over medical therapy particularly for Triglycerides, mg/dl (LSG, 169 to 97; Medical, 199 to 173). http://asmbs.org/201...verage-decision

Since February 21, 2006, the Centers for Medicaid and Medicare Services (CMS) have covered Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. Also, effective June 27, 2012, Laparoscopic Sleeve Gastrectomy has been added to the list for National Coverage Determination (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (100.1). http://alturl.com/wnbko

I urge you to consider adding bariatric surgery to the list of covered services to <my company> medical insurance offerings by leaving you to ponder the following: How many morbidly obese senior citizens do you know? How many do you even see? I’d be willing to bet the number is zero – I know that I don’t know any – because obesity has been proven to shorten a person’s life expectancy.

Sincerely,

[920amy 409]

John,

I feel your pain. I also went through all of the hoops and hassle, incurred many out of pocket expenses trying to work with a bariatric surgeon. My husbands insurance changed over to a Cigna plan in the middle of my process, and I, like you, found out the hard way at the end that Cigna does not cover bariatric surgery in any form. I was undeterred though. I ended up going to Mexico. I did self pay, my cost was $4,750. If I would have self paid here in the states, it would have been $16,000. That would not have covered any hospital stay either. I know self pay in Mexico isn't always an option for everyone, but I want to say good for you for writing this letter, and where there's a will, there's a way!! Don't get discouraged! You will find a way!! Good luck!

[TakeCareGirl 161]

Great letter! I hope you can get the policy changed!

[kyllfalcon 768]

I am a Human Resources professional, the Senior Vice President of Human Resources in a large mulit-bank holding company. I have been sleeved. I am in charge of our benefits programs. Our insurance did and does not cover bariatric surgery of any kind, like yours. I, too, think it should. I of course because of my position did not push to get it covered in time for my surgery because it would appear to be self-serving.

And now that I have been sleeved, and have been successful at losing the weight and improving my health, I want and need to push to get the door opened for others. I do so totally appreciate what you are doing and agree with your strategy and your supporting facts.

Would you mind if I borrow some of your verbiage and facts?

I intend also to point out to the powers above me (the Board of Directors) that we pay for treatment for other self-inflected conditions. Examples would be lung cancer from smoking, skin cancer from sun exposure, cirrhosis due to drinking, gunshot wounds to the head... well, you get the picture.

I made a pitch to the CEO but he did not permit me to put it before the Board, even though he knows I had the surgery and sees my success. I intend to retire in 1.5 years, so I will put it before the Board without his permission at next opportunity. What's he gonna do? Fire me? So what if he does? I'm on my way out the door anyway.

I have nothing to lose and everything to gain. It may be my last great hurrah!

Please, let me know how your plan works! I am very interested.

Good luck.

[NancyDec20 212]

I have blue cross blue shield..and had no trouble being approved.. HR was so helpful in that dept.. even helped with paper work.. so that was awesome..and even was behind me if my boss said no to FMLA.

[JackieV 246]

Great letter, towards the top the company name is still mentioned. I wanted to make you aware so you can edit if you chose to.

[ArcusX 216]

Great letter, towards the top the company name is still mentioned. I wanted to make you aware so you can edit if you chose to.

Thanks. Edited! Don't want to get into any trouble

[ArcusX 216]

Would you mind if I borrow some of your verbiage and facts?

Please do. I spent a lot of time looking for relevant and CURRENT statistical information. My reason for posting it here is maybe my time will be made more useful if others can benefit from it too.

[SeriouslyChange 319]

I had trouble securing a leave of absence to have my surgery. My human resources person was a huge hurdle every step of the way. Funny thing is: their insurance doesn't cover Bariatric surgery either. And they were amazed that mine does. And that's when the hurdles started. I had to have my surgeon write them a letter, after which I was told I was approved. I truly wonder what he said, because whatever it was, they changed their tune and gave me time off. I was told I was good to go... 2 days before surgery. I would have quit if they would have denied me time

[Butterthebean 8,146]

That's a great letter. I'm impressed with your fortitude. You're taking the right approach....showing how it helps their bottom line. Many times that's the only thing big business cares about.

[sramos89 260]

My insurance covered my surgery after my deductible. I work at a satellite office and don't see our HR people but once or twice a year. I made a point when I was at the office in January (4 months post op) to go to the HR office and tell all of them about my surgery and how it has changed my life, how loyal I felt to our organization and what a better job I have been doing because of my increased self esteem since my weight loss. I am sure they think I am a total nut, but I kinda got emotional talking about it. I told them the reason I wanted them to know all this is because I know every year they are faced with making cuts and changes and how important it was to not exclude bariatric surgery to save money. They all kinda looked surprised and happy, I don't think they get thanked very often but I wanted to ensure this amazing benefit was there for others, I would have never been able to have this without my insurance. I know how life changing it is.

[bethxxx 304]

Please let us know the response you get, I really hope they will cover you

[ArcusX 216]

Best case scenario, they'll cover it for re-enrollment in June. But at least I'll have said my peace. I'll not pursue it further with them. If they do not make changes, my choices are to either look for a new job, self pay, or not do surgery at all.

[AmandaRaeLeo 2,145]

Best case scenario' date=' they'll cover it for re-enrollment in June. But at least I'll have said my peace. I'll not pursue it further with them. If they do not make changes, my choices are to either look for a new job, self pay, or not do surgery at all.[/quote']

WLS is excluded and I campaigned to get it added. So far no luck. I'm headed to Mexico in March instead.

Amanda Rae

[NothingUpMySleeve 244]

Another HR professional here...my company uses Cigna and we do cover wls, although my bmi isn't quite there yet so I'm self-paying. Sometimes the barrier is not necessarily that the efficacy of the surgery is in doubt, it is the question of the likelihood of someone staying long enough that the ROI is likely to happen. This is when a tiered benefits structure rewarding longevity is great. Maybe you could propose this sort of approach to HR?