nanahanna

Thanks Rene, I am going to need it! Hey, I got on disability the first try with lots of prayer and God's help...maybe He will come through again for me!

Hi porclndoll! Yes, I have diabetes, high blood pressure, some asthma (only seasonal), and psoriatic arthritis. I sent an email to one of the owners of the company my husband works for (they are self-insured and BCBS administers for them) and asked him why they don't pay for it, that I desperately need it and that my medical conditions (I spelled them all out)would be definitely improved and maybe even go away if I could lose the weight. He is an email buddy of mine and so I felt comfortable asking him. He wrote back and said that the company had been absorbing huge costs already instead of passing them along to employees (they did try to get the union to approve some changes but the union voted it down) and that our insurance is geared to helping pay for illnesses and injuries that are not in the insured person's control and not conditions. In other words he was saying the company thinks being overweight is something that the person can control. Hmphf! Oh well, I am going to go ahead and get my doctor to send the medical necessity letter and see what happens.

I was thin, painfully thin as a child and adolescent but more normal as a teen and until I was 41 years old. My dad came down with lung cancer. He, my mom, my sister and I were all smokers. When he was in the hospital getting chemotherapy we would go to the "family" room and smoke. Then 3 months before he died I decided I didn't want to die like that so I quit. That was 20 years ago this past November. I substituted food for cigarettes and that started the weight problems. I have struggled with it for 20 years, but now it is an addiction. I eat whether I am hungry or not. I eat just because I can. I eat late into the night. But, I would rather be fat than die with lung cancer. My mom died 4 years ago this Valentine's Day with emphysema, my sister (only sibling) died 10 months after my mother with lung cancer. Now ...if I don't get this weight off me I will die with diabetes, heart disease, hypertension or some other related disease! I have also had a dysfunctional marriage until the last few years when things have gotten some better, but I think that has been part of my problem....like Jack...that is the only part of my life that I could control...if you can call getting obese is control. I had wonderful childhood with wonderful parents...no obesity in anyone else in my family...I'm the lone duck (the one who waddles).

Sharon

ELEEBANA2, I am glad you were able to get it done! We certainly must have paid our dues at our ages!

Sharon

He said he would get back to me soon and that it was not an easy question to answer. I know he will get back to me...he always has when I have asked questions before. Maybe I can stir up some dialog among the powers that be on this subject! I will keep ya'll posted!

Sharon

Thanks dylansmom! I appreciate the welcome!

Jack, lol...you have a lot of wisdom to share with us...I am sure!

Sharon

That is wonderful! I hope she is doing well! Man, that makes me REALLY want to get it done! Did her Medicare pay for it?

Sharon

I will be 62 next September! It aint bad is it? I mean, my body may say I'm old but my brain says I am still young!

Sharon

Well that is wonderful! Keep me posted on how you do, ok? Who is doing yours and how much are you going to have to pay for it?

Sharon

Rene, I wrote him an email! I will keep you posted on what he says!

Sharon

Thanks Rene. I may have to do that. Funny thing one of the owners of the company is an email buddy of mine...I might approach him about it. LOL..that might be the end of the friendship! But it is ridiculous that they have spent no telling how much on me in Drs. appointments, lab work, meds, procedures etc. because of my diabetes, hypertension, arthritis and diverticulitis...they should look at that and realize in their thick skulls that if they would help us get this surgery, we probably wouldn't be that much expense to them ever again. I don't get it!

Sharon

Hi Roberta! I am 61. I hope to have it sometime this summer if I can get insurance approval...if not...then I will have to save up the money! Yipes! That might take a year or so! Good luck with getting your approval!

Sharon

Thanks! I hope things go well for your dad!

Sharon

Thanks Leah! What kind of insurance does your dad have? Is he trying to get Medicare to pay? I will have that in May and if my BCBS refuses I will try Medicare. Thanks for the encouragement!

Sharon

Hi There! Yep, that is me! I really need to lose some weight so I can enjoy gardening! LOL. How are you? Are you banded? If so, tell me about your experience and how hard it was to get approved or if you had to pay for it yourself.

Nanahanna (sharon)

Thanks Karen! I also forgot to mention that my husband's work place is self-insured and BCBS of MS administers it.

Sharon

I got a copy in the mail today and it says under Exclusions:

"Weight reduction programs or treatment for obesity including any surgery for morbid obesity or for removal of excess fat or skin following weight loss, regardless of Medical Necessity, or service at a health spa or similar facility".

So...do I still get my doctor to send a letter of Medical Necessity and try to fight it?

Thanks!

Sharon

I'm feeling a little better now that I know there are possibly some on here who are closer to my age! LOL.

Nanahanna (Sharon)

LOL. Most of ya'll that I have seen your age are youngsters! I am feeling a little old "up in here".

Nanahanna (Sharon)

That is what I was going to say dipic02! They may have wonderful surgeons but someone or something in the operating room is causing the infection. We have a problem at our local hospital here a few years ago. Everyone who had joint replacement surgery were getting staph infections. They tracked it down to a defective autoclave machine (the machine that sterilizes the instruments).

Nanahanna (Sharon)

Congratulations to your wife! I hope she continues to do well!

Nanahanna

(I hope to get a band sometime in the near future!)

Thanks Alexandra. I will get the ball rolling.

Nanahanna

Thanks Alexandra. Do you mean work closely with my personal doctor or do I go ahead and make and appointment with a surgeon? Is there anything I can do up front to get things going?

Nanahanna

Thanks Rene. I am thinking about doing a precertification to see what they say. I have to get my husband behind me on this though. He has rolled his eyes at me whenever I have mentioned any weight loss surgery before. He thinks I can do it on my own even though I havent been able to do it! If I can get some help paying for it...I am definitely doing it!

Nanahanna

Hi Dovie, I just got through reading the sticky at the top of the page titled "Just starting to explore options...help!!!" and it had lots of good info on appeals etc. with some copies of suggestions of how to write appeal letters. Check it out. I haven't even tried to get my insurance to pay yet as they say expressly they do not cover weight loss surgery or meds....but I may go that route and try to get them to pay. Good luck!

Nanahanna