SandeeD

Hello everyone! My story is a looooooonnnnngggg one, but I'll cut to the chase. I've been with Horizon BCBS of NJ since April 2013 (it's an individual plan that I pay for myself). It's bare bones and only covers well care stuff but no pre-existing conditions. Fast forward to now, I was able to get the bulk of my pre-op testing done with my insurance covering it. I just have a few more things to square away the first week of January. Because of the pre-existing condition clause, this plan will not cover my sleeve surgery until I've been in the plan for one year (April 2014). In the meantime, because of the new health care laws, Horizon sent me a letter stating that my current plan is being canceled as of the one year anniversary date in April 2014 (they're phasing out this plan because it does not abide by the new healthcare laws). So, what all of this means is that I will need to switch insurance plans before applying for approval for the sleeve surgery. Again, I'll be done with all of my pre-op requirements the first week in January 2014, but I need to have my new insurance in place before submitting. MY QUESTION IS, HAS ANYONE HERE SWITCHED INSURANCE PLANS (WITH THE SAME COMPANY), OR SWITCHED INSURANCE PLANS (USING A DIFFERENT COMPANY) AND HAVE BEEN SUCCESSFUL GETTING APPROVED??? WILL THE INSURANCE COMPANY PENALIZE ME BECAUSE THE POLICY IS SO NEW??? (IT'S NOT MY FAULT THE INSURANCE LAWS HAVE CHANGED). WILL THEY MAKE ME WAIT? (THEY CAN'T TURN DOWN PRE-EXISTING CONDITIONS ANYMORE, RIGHT?). ANY INSIGHT (BASED ON EXPERIENCE) WOULD BE GREATLY APPRECIATED!!!! THANKS A MILLION!!!

Stephannie, I teared up while reading this...CONGRATULATIONS!!!! I'm so happy for you and I can't to fee the same way:)

Thanks Proudgrammy and Patty. It hurts my heart to see my 70 year old mother get around better than I can, I just want to be able to keep up and give back that handicap placard.

Thank Seagirl! I sometimes get very depressed because I feel like I'm the only person in the world who is going through this. Thank you for letting me know that I'm not alone and that there is HOPE and a light at the end of the tunnel.

I have had chronic lower back and neck pain for a good solid 10+ years that has gotten more severe with time. This is the MAIN reason that I made the decision to have weight loss surgery. I have been to numerous doctors who have ruled out MS, Miosthena Gravis, Lyme Disease, neurological disorders, degenerative disc, slipped disc, etc. The condition that I was finally diagnosed with a few years ago that made some kind of sense to me was spinal nerve damage. Whose nerves wouldn't be damaged it they were carrying around 230 (give or take a few) on a 5'2" frame??? I literally live in pain. Walking is a mind over matter thing, as my legs are so weak that I must be careful of falling (if I step on a pebble, it could knock me off balance). I cannot go shopping unless I have something to hold on to (i.e. shopping cart). Sitting down and getting up from a chair is a chore at best. You get the picture? After all of these years of frustration, dealing with doctors, being diagnosed and mis-diagnosed, really with no one pinpointing what the real problem is, I came across a physical therapist online, Rick Olderman. He made the following statement and described EXACTLY what's going on with my body. "Weight loss can help relieve back pain, especially if you carry weight in your tummy area. This is because, when the waist becomes large, it creates a drag on the spine, pulling it forward into an excessively arched position (increased spinal extension). This arching contributes to spinal compression affecting the vertebrae, disks, and nerve roots exiting the spine. Losing weight, especially when it comes off the stomach, reduces the excessive extension of the spine and unloads these tissues thereby reducing pain. Increased weight also contributes to back pain because the leg muscles, not being strong enough to carry the body, become over worked. This leads to walking with extended or locked knees instead of using leg muscles. Locked knees contribute to tilting the pelvis forward. The spine then arches backward to offset this tilt, again leading to excessive spinal compression and pain. As you lose weight, the legs are more able to carry your weight and spend more time using their muscles--not locking the knees. This allows the pelvis to resume its natural position thereby allowing the spine to also return to a normal curve with less pain." FINALLY, I now know that I'm not going crazy. Everyone (family and friends) constantly putting their two cents in and telling me I need to do this or that, and even looking at me side eyed like there's nothing wrong with me and I'm just being dramatic. In addition to spinal issues, I also have other co-morbidities - high blood pressure, sleep apnea, high cholesterol, asthma and acid reflux. I am more determined than ever to see this process through because losing the excess weight is the first steps for me to get my life back - feel better and become more active. Anyone else dealing with back or joint issues and can feel my pain (literally)?

Thanks a lot. I've made the decision that if I don't hear something within the next two weeks, I'm just going to purchase new insurance and take the hit. I can't wait longer to have this surgery, my well being depends on it.

I'm going to wait it out as long as I can (keeping my current plan that ends on 4/1/13). If I don't get an answer on the subsidy by March, I'm going to have to purchase something on my own.

Apparently the plans prior to 2014 are what they are, they are not making changes to them. Basically, they getting rid of the "old" plans prior to the health change laws and replacing them with "new" expensive plans that have to cover more stuff.

I had to appeal their denial for a subsidy because I DO qualify for it! (I make under $40,000 a year). I submitted my appeal over two weeks ago, heard nothing. I called and no one knows anything...appeals department is in a different location, we have no phone number for them, blah, blah, blah...the runaround! I have insurance right now but it doesn't cover bariatric surgery until I'm on the plan for year (which won't be until April 2014), AND, they're canceling that policy as of April 2014 because it doesn't abide by the new health insurance laws. To top it off, if I decide to purchase insurance outside of the Marketplace I then forfeit my subsidy (IF I get it). I called to get the status and they are now telling me it will take 90 days to get their decision. I AM BEYOND FRUSTRATED RIGHT NOW!!!!!!! I want them to just tell me something so I can move on either way!!!!!!

No, I pay for my own insurance. Regardless of which Amerihealth plan it is, if the plan covers bariatric surgery, I can't imagine that the there would be different requirements since all of the "plans" are Amerihealth, right???

I'm going to have to switch insurance companies before 1/1/14 and I'm leaning towards Amerihealth. I know that they cover bariatric surgery, but does anyone know what the full list of requirements are before submitting for approval? Thanks in advance!

Loveafterwls, you give me hope! I have severe back problems and just walking from my front door to my car in the driveway is becoming a chore, forget putting the trash cans to the curb. My right knee is starting to give me trouble lately. This surgery can't happen soon enough!

If I were closer I'd be there for you lickity split! I'm in NJ.

Where do you live imgood?

Can someone post the link? I can't find it on YouTube.

You're welcome:) I love this site too! Great support and info. for anything you need.

Hbeasely Although I know in my heart of hearts my family doesn't want me to have the surgery, they still support me in my decision. I know how you feel not being able to move the way you want to. Stand strong in your decision, and your husband will surely come around especially when he begins to see the benefits of the surgery. Remember, the fear is in not knowing. Be sure to educate him as much as possible about the process.

Thanks guys, this really puts my mind at ease. One of the reasons I love this site, so much great information!

Ladymendoza, I've been reading that a lot of people had to pay they're deductible and other fees upfront before their surgery, was that the case for you at Virtua and with your doctor? I'm getting nervous because I have insurance, don't have a load of cash.

Dr. Boynton, you?

Anybody using a doctor from the South Jersey Surgical Group in Lumberton?

There is no way I would be able to get that machine if I had to pay over $300 for it. My current finances will not allow it. When I first started searching online for one, I'm not gonna lie, I lost it! The prices were crazy! Then I found this site secondwindcpap.com. In the about us section you could tell that they genuinely cared. I called and I was still in tears. The woman was so nice and patient. I told her the type of machine I needed and she hooked me up.

Linda, girl, those mighty wings are the devil! Stay away from McDonald's!

I sure do wish I was poor poor pitiful you:)

I had my sleep study a week ago and the doctor called me today to inform me that I do indeed have mild sleep apnea. She wants me on the cpap machine before she'll clear me for surgery. Well, insurance doesn't cover anything on that, so there goes Christmas! I found a great website with a gently used one that will meet my needs for $284, approved by my doctor (tubing and mask included).