A Little Venting Music, Please

[Christabel 0]

I have over six months to wait to get my sleeve according to current insurance and employer standards. Six months of "dieting" to prove to them that I can be successful in following a "program" that I will need to follow the rest of my life once I have the sleeve.

But if my BMI drops below 35 once during this period, I am denied the surgery.

To top it all off, at this point it has to go to a physician review board to see if I'm even bad enough off to qualify for the surgery after the six month time period is up since my insurance doesn't recognize the sleeve as anything other than experimental. If the review board OKs it I'm good. If not, more hoops.

It's as if they and my employer are trying to see how many road blocks they can put up to see just exactly how far I'm willing to go to get this particular surgery. If the insurance requires a three-month diet, the employer tacks on another three months for good measure. If there's a psych eval required, the employer tacks on another 400 question eval to fill out and return.

Well I'm here to tell you folks, I am one stubborn individual. I can take all they can throw at me, because it means that much to me to be at a healthy weight without all the problems I have now. And if I have to jump through hoops from now until surgery, I guess I'll be the most proficient hoop-jumper there ever was.

But I'll need support. Can I count on you? If I need to vent about another hoop or rule or reg or eval or whatever, do I have your permission to do that here?

Because honey, it's gonna be a LONG six months...

[cajun 46]

I'll do some venting for you. This is a lot of CRAP.

Do they treat people with gallstones, or appendicitis like this, before they allow them surgery? Morbid obesity can be just as life threatening even though it is a more chronic threat. This just burns me up. It's one reason I was glad my insurance did not cover my VSG, so I just paid for it myself, as soon as I decided that's what I wanted. People complain and moan and groan that a new health plan in this country will end up allowing the insurance companies to control what procedures doctors can order for their patients...well folks, we are already there and have been for quite some time!!! AND IT IS KILLING PEOPLE.

THERE YOU ARE. I AM TICKED OFF FOR YOU!!!!

So come here and rant and rave all you want, anytime!

[Stacy160 201]

What pisses ME off is that even though obesity is officially recognized as a disease, it can still be left out of insurance coverage. Little discrimination going on there, ya think?

And yep... for you, it's the insurance company's way of beating the heck out of you until you roll over and give up. Be prepared for them to issue a denial or two after your six months... but just keep appealing!! And good luck!

[FireFly 0]

I was actually relieved when my insurance denied the sleeve. No hoops. I had already jumped some hoops for the band before I changed my mind and was soooo frustrated. Now I am free do what needs to be done.

I'll do some venting for you. This is a lot of CRAP.

Do they treat people with gallstones, or appendicitis like this, before they allow them surgery? Morbid obesity can be just as life threatening even though it is a more chronic threat. This just burns me up. It's one reason I was glad my insurance did not cover my VSG, so I just paid for it myself, as soon as I decided that's what I wanted. People complain and moan and groan that a new health plan in this country will end up allowing the insurance companies to control what procedures doctors can order for their patients...well folks, we are already there and have been for quite some time!!! AND IT IS KILLING PEOPLE.

THERE YOU ARE. I AM TICKED OFF FOR YOU!!!!

So come here and rant and rave all you want, anytime!

[deedee 5]

I love your attitude! Come and vent away whenever you need to.

[Tiffykins 672]

Vent away, that's what we're here for. . .

I honestly get so frustrated with all the insurance denials I hear about. I've read about people layering clothing, and strapping ankle weights on under their jeans just so they could meet the weight requirements. RIDICULOUS the hoops people have to jump through.

[Deb 0]

I had to do a psych eval and 6 months of counseling and 6 months of a diet under a dr's supervision. That was fun because I could not lose any wt and qualify either. When I went to the Dr to weigh, I wore the heaviest clothes I could find and had my pockets loaded. I have heard of people putting rolls of quarters in their bra too. Part of it is the ins co is hoping you will give up. Keep it up...you'll get there.

[Lee 19]

Don't Give UP!!! I am so pissed off for you. It should be illegal for your employer to have any say in this process. I haven't even told my boss what surgery I'm having. I simply said I was having a procedure and would be out sick for a week, then working from home for a week. In California, he can't even ask me what the procedure is. I love my State.

You hang in there and vent away. We'll all listen. Just let us know what you need support wise to keep up the good fight.

Can you call in sick a lot because you're too exhausted from being fat to get out of bed?

[Bob_350lbs 105]

You are so right, vent away...what I don't understand is don't they see how much obesity is going to cost them in the long run? With 2/3 of the population obese, it is only going to get worse, eventually ending up with diabetes, hypertension, heart disease, asthma exacerbations, degenerative joint disease, tons of expensive medications, surgeries like coronary artery bypass, knee replacments, etc...HELLO!! And, the number of people applying for social security disability is only going to increase, creating a significant burden on society. As obesity increases, so do all the co-morbidities. Claimant's with a BMI of 40 places a significant burden and starts to compromise the weight bearing joints, such as the knees. Today's obese children will grow up sicker and sicker, eventally on a plethora of medications, reduced ability to function, and early disability, directly related to obesity. Next to smoking, there is nothing worse for your health..Okay...I know I vented a lot too...but this is a huge issue with me too.

Edited February 3, 2010 by Steph_123

[Lookinupin2010 0]

I just don't get it....the nations 2nd leading cause of preventable death, and the very tool that we need to help us and they make you jump through hoops like this. I AM very concerned about what will happen with our healthcare in the future. I am hoping to have this done BEFORE the 'change' comes.

Hang in there...I love your spirit....

[thinoneday 445]

I have over six months to wait to get my sleeve according to current insurance and employer standards. Six months of "dieting" to prove to them that I can be successful in following a "program" that I will need to follow the rest of my life once I have the sleeve.

But if my BMI drops below 35 once during this period, I am denied the surgery.

To top it all off, at this point it has to go to a physician review board to see if I'm even bad enough off to qualify for the surgery after the six month time period is up since my insurance doesn't recognize the sleeve as anything other than experimental. If the review board OKs it I'm good. If not, more hoops.

It's as if they and my employer are trying to see how many road blocks they can put up to see just exactly how far I'm willing to go to get this particular surgery. If the insurance requires a three-month diet, the employer tacks on another three months for good measure. If there's a psych eval required, the employer tacks on another 400 question eval to fill out and return.

Well I'm here to tell you folks, I am one stubborn individual. I can take all they can throw at me, because it means that much to me to be at a healthy weight without all the problems I have now. And if I have to jump through hoops from now until surgery, I guess I'll be the most proficient hoop-jumper there ever was.

But I'll need support. Can I count on you? If I need to vent about another hoop or rule or reg or eval or whatever, do I have your permission to do that here?

Because honey, it's gonna be a LONG six months...

Eeeeek . . . insurance sucks big time! This is exactly why I did self pay, you show the money you get surgery when YOUR ready, not the insurance company. . . i took out a loan for the whole amount at 3.7% and have never looked back. . . could you consider that and show that stupid insurance company you don't need them?

[AJW 18]

/ Frankly, I'm an ARIES and 6 months of waiting/weighting would drive me completely crazy. I'd just do again what I already did: go to Mexico and PAY FOR IT myself.

Dr. Aceves is the best, no waiting and sooo much cheaper than in the States. Just my opinion; everyone has to find their own way on this path.