Right off the bat I want to express that for me this is not about the politics and I think this article is very even handed. I thought this was an interesting perspective that many of use can appreciate from an insurance and weightloss surgery perspective.

That said...http://www.huffingtonpost.com/don-mcnay/who-will-be-the-best-pres_b_9257982.html

Thoughts?

pam

Huh... that's something I honestly never thought of. I am lucky and have fantastic insurance so I was covered but I know a lot of people aren't as fortunate. A good friend of mine applied to have surgery but her insurance denied her - which is ludicrous because she was even heavier than me.

I think people are starting to finally understand that sustained, dramatic weight loss isn't possible without medical intervention. I don't honestly know which presidential candidate would be better for the obese population... I know Michelle Obama was all about getting kids healthy and making school lunches healthier. Curious to see what others have to say about this!

Interesting article. I was lucky to have insurance that covered it. I would've had to go to Mexico in order to afford it if I had to pay on my own.

Insurance companies can and do pay for obesity related complications but not for the surgery to cure it. It's maddening.

I also am blessed to have incredible insurance. I think I paid the remainder of my deductible for last year (about $6.00 for my surgery!) I only have $100 deductible per year. I also had to pay my copays, but otherwise Everything has been paid. Now I can also get reimbursed from my flex account to pay for my supplements!

I heard a story recently about a friend of a friend who had WLS a number of years ago. She eventually developed what sounded like some kind of strangulated hernia. She ended up the hospital for more than 2 months in ICU a bunch of that and the insurance refused to pay for any of it because she basically "voided her warranty" when she had weightloss surgery! They said it was all related to the surgery so they didn't have to pay! I couldn't understand how the insurance could do that until I read the article!

pam

Maybe they can dig up President Taft?

I foresee the insurance picture changing over time. I'm in CA, and coverage for bariatric surgery here is the norm, not the exception. I've worked in managed care for twenty years. Twenty years ago, nobody asked for, or got bariatric surgery. Ten years ago, it was rare. Today, it's routine. My PCP views weight loss surgery as "definitive treatment for obesity". That would have been a radical statement five or ten years ago.

I have no patience for managed care nor government involvement in personal choice. All I see with ObamaCare is the compassion of the IRS with the efficiency of the Post Office and sky rocketing prices. This system is an absolute train wreck waiting to happen. I switched to a defined benefit plan that only kicks in for catastrophic events over $5000 ($182 a month). So I make my own decisions, get big cash upfront discounts from my doctor because they don't have to file any paperwork and wait on receivables. Since I don't have any lingering health issues since the weight loss I found many niche health service providers who do testing at significantly cheaper rates. Had my surgery done in Mexico. So there are many options than expecting an answer from Washington DC.

@@OKCPirate

I am so glad you found what worked for you both with your insurance and surgery. Mexico would not have been an option for me. I'm thankful for both of us being able to have options and choose the options that worked best for both of us.

@@2goldengirl

You make great points and I think they are a key to this article. This is largely about obesity being a medical issue and surgery being a tool to aid in getting a handle on it. Education and understanding are keys to that. There are too many people/doctors/insurance analysts who still feel that all fat people are lazy and surgery is the easy way out.

I think also its interesting that WLS became a pre-existing condition for so many people, like the author, and gave insurance an excuse to not cover any thing they saw as a complication. It makes me even more thankful for the great insurance that I have through work.

pam

There are too many people/doctors/insurance analysts who still feel that all fat people are lazy and surgery is the easy way out.

I think also its interesting that WLS became a pre-existing condition for so many people, like the author, and gave insurance an excuse to not cover any thing they saw as a complication. It makes me even more thankful for the great insurance that I have through work.

pam

Just a clarification. Insurance adjusters aren't the ones who make any decisions about whether anything is covered. Any health plan that is accredited by either of the two major national accrediting bodies or is licensed by Medicare has to have physicians and pharmacists making coverage decisions according to evidence-based clinical criteria.

Employers who purchase insurance can (depending on the state and the health plan) purchase insurance for their insureds that excludes specific procedures, but if the State in which the coverage is sold requires a set of basic benefits, those basic benefits can't be excluded. Just as an example, many policies here in CA used to exclude coverage for infertility treatment. That isn't the case any longer, because companies that didn't provide it couldn't compete for qualified candidates for employment without it. Companies wanted to exclude it because it raised the cost of coverage for every single insured for that company, and they wanted to keep premium costs down so that neither they nor their employees were paying for coverage that a very small percentage of people needed to use.

States can, and do, mandate benefits, but what proved to be the case here in CA is that for every mandated benefit, there is an incremental increase in costs both for premiums for the purchaser/consumer, and for the insurer to prove compliance with the mandate.

One of the provisions of the ACA is to eliminate the "pre-existing condition" penalty in terms of someone's eligibility to become insured. I can only speak for the situation here in CA, but here, if you go out of plan for surgery of any kind, whether you see a local plastic surgeon or a cardiologist in Morocco, and you need care for complications, you're covered for those complications. It's the law.

Edited February 18, 201610 yr by 2goldengirl

@@2goldengirl Thanks for the clarifications. That makes a lot of sense. I am fortunate to work at a large university so my insurance in "reasonable" for what I pay and has fantastic coverage. I am glad to hear that ACA has covered those complications now.

pam

My story: Have wanted/needed WLS for at least the last ten years. I'm self-employed, so on hubby's employer-based insurance plan which expressly, 100% EXCLUDES/PROHIBITS any kind of WLS from coverage "even in cases of imminent death" -- exact quote I got from insurance company. Finally, the ACA (Obamacare) happened - I'm in AZ and we are one of the 23 states that must cover WLS if you purchase a plan on the Exchange. Last year, I went off hubby's plan, purchased my own plan - we make too much $$ for any subsidies, but that was fine because between the $$ we saved from me not being on hubby's plan versus what my plan cost, it was about $300/month difference - yes, a lot, but fortunately, was do-able for us. I had bypass surgery last January (2015) and have lost nearly 130 lbs (plus, I'd lost 50 the previous two years on a medically-supervised program; well, actually, I'd lost 100 but as soon as I went off the STUPIDLY STRICT, IMPOSSIBLE TO DO FOR VERY LONG medically-supervised program, I gained 50 of the 100 lbs I'd lost back, but at least I kept 50 of those off before I had surgery. So in the last 3 years, I've lost approx 180 lbs - well, 230 if you count the "other" 50 of the 100 I lost and then regained before surgery. Anyway, not to make this too complicated, but WLS saved my life! And if I hadn't had access to the ACA, we could never have afforded the $50K or so surgery and hospitalization costs. So, all I can say for me, is thank God for Pres. Obama and all the legislators who supported the ACA!!

@della street

I am so excited for you. I know the ACA can be a hot button issue on both sides, but I am so thankful for all the good things that have happened for people under ACA. Congrats on your losses, all of your losses - before, during, and after!

best,

pam