Letter to Human Resources (long)

[ArcusX 216]

Well, i've moved on to another employer, so THAT point is moot.

I posted here to help others. When I originally posted, the "Statistics" forum didn't exist, which is probably where this now belongs.

[feedyoureye 3,087]

Not that it makes any difference, but the research section has been on this site since 2009.

Thank you for posting this, I am sure it will make a difference for some one, and I really hope you can make the surgery happen for yourself, you will love it, and it will be so good for your family as well. Best of luck.

[Arts137 1,811]

Yes, an excellent summary. I too suggest that your letter ALSO be placed in Research and Statistics!!!

[feedyoureye 3,087]

Yes, an excellent summary. I too suggest that your letter ALSO be placed in Research and Statistics!!!

Arts, He put a link there already.

[Arts137 1,811]

Thanks Feeds!!!

[Georgia 2,908]

Alex moved the letter for me. Thanks!

[jajmj 40]

I have Cigna and they did cover my VSG. It's up to the COMPANY to choose if they will offer the coverage in their benefits package. I was with one company who didn't cover WLS or breast reduction then when the management changed - YEAH! WLS was covered 80/20 after a year of employment with the company and once you receive approval.

[JadedMage 39]

I love you Brother! I had the same problem with my health benefits until this year, my company finally got an insurance co that does pay for the operation. Of course i have to jump though 50 hoops, ah but it is worth it.

[bpbqueen 45]

This is an old thread but the information is still so relevant! My last employers insurance did not cover the surgery. So, I stayed with my previous employers insurance and paid for the COBRA payments out of pocket so that I could get the surgery covered in full because that insurance did cover it. I find their reasoning ridiculous and not well thought out at all. I love your letter!

[andreamy7 55]

Good for you for moving on from a company that does not cover bariatric. Employers elect their insurance so they can select a plan that includes that option. Please folks, understand that if you do have coverage, you DO NOT have to disclose to employer EVER what medical treatment you are having. I went so far as to have my PCP write me out because my employer at that time was VERY nosy and I knew whatever I turned in they would look up. However, it came from my PCP so nothing can be looked up, so I was really happy that the PCP did it for me. All you have to do is provide a note and say Drs orders, I am out for a week. Technically, they are not even supposed to ask anything beyind that after that in the State of Ca. You can choose to answer, but you have privacy rights and can simply say, I prefer not to discuss at this time or I am out for a week, having a procedure....it is not the employers business. Its yours. We probably all want a boss that is concerned, but a good boss that follows guidelines of privacy and respect should say....something like Thanks for letting me know, I do hope all is well and if I can help in any way, let me know. Keep in touch with us if you need more time and meantime lets get your area set up so that soandso can cover you while you are out. Then just move on. That is how a good boss should manage it and the employer cannot fire you, remove your position or change your role if the issue is a proven medical issue. Extended medical may have some limitations, read your Employee handbook for your company policy or inquire with HR if you think you have to use additional time. However, protect yourself and you do not have to discuss or disclose at any time what you are having done. Just make sure you get your note and thats it.

[CountryGirl5584 115]

It's not the ins company that decides what's covered it's your employer. I hope your letter changes their mind!

[NE_NevadaGrl 31]

My husbands company has Cigna and they not only cover WLS they have a plan add-on called surgery plus that will do the surgery at no cost to the insured (if annual deductible has been met) and will actually pay the insured $500 for travel expenses. I live in a rural area and my surgery will be done 220 miles away with the surgeon coming to our town every 2 weeks for pre/post op appointments.

That being said, there are hoops I have to jump through to be approved. I have met the BMI hoop and now have to complete 3-6 months of monthly doctor appointments. I am working hard to push for the 3 month deadline so that my surgery can be completed by the end of the year.

Our insurance also covers plastic surgery for "medical necessity." My husband works for a large, international gold mining company, so I'm guessing that is why we have better benefits.

[ar1kah12 3]

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 :

My name is John and I have been with for a little over two years. I love working for . 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, 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 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. 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 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 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,

I would like to know if you were successful with your new employer and have received the surgery?

Sincerely wondering how your journey is going?

[ArcusX 216]

Greetings Sleevers!

Well, I don't know if my former employer ever made any changes as a result of my letter. I left the company in July of 2013 and took a job with another company, that as it happens, DID cover bariatric surgery. In May, 2014 I had the RNY bypass surgery. My surgeon changed me from sleeve to bypass due to my GERD; according to him, sleeve makes GERD worse, which was contrary to everything I had read previous.

Today, I'm sitting at about 178 pounds, from my high of 290. My lowest was probably about 169. It was expensive having to buy new clothes all the time - especially for work. My sleep apnea went away within about 2 weeks of surgery. When i was done with the GERD meds i had to take post-op for 90 days, it was gone too. My A1C is now normal, as are all my other bloodwork. I'm feeling great and have no regrets.

Best

[Miss Mac 6,261]

Just FYI to comment #29, my sleeve cured my GERD, and I had some erosion of my esophagus.