Submitted Stories on Surgery and Insurance Coverage
Story #1
My family desperately needs your help! Blue Cross Blue Shield of IL is discriminating against my husband because of his obesity diagnosis. My husband, Jeff, has suffered from obesity since the age of 8. His father died suddenly at the age of 42 related to obesity. In Jan. 2004 Jeff was diagnosed with diabetes and severe sleep apnea which requires him to use a mini-respiratory when sleeping to keep his oxygen levels normal.
Despite strict dieting and exercising all of his life, Jeff has never been able to reach a healthy weight. Our Primary Care Physician has recommended that Jeff undergo gastric bypass surgery to save his life. The insurance company has used very stall tactic to delay this life saving surgery.
First we received a letter of approval. Three weeks prior to his surgery date we found out that this "approval" was only for the hospital stay, not the surgery. The insurance company claimed that they sent us a letter requesting a detailed account of every diet that Jeff has ever been on. We wrote the letter and faxed it to them that same day.
I continued to call every couple of days to check the status and was told that they still didn't have an answer for me. One week prior to his scheduled surgery date the insurance company told me that they had sent another letter requesting more information. This was now the second letter they have claimed to have sent that we NEVER received.
I asked the insurance rep what else they could possibly need and was told, "We need proof that a doctor has been managing his diet plans since the age of 8." WHAT??! I asked to speak with a supervisor. I was told that they needed a supervisor "request" 48 hours ahead of time.
My husband's scheduled surgery has now been canceled. All of the pre-op testing has been completed. Arrangements have been made for us to be off work and for our 2 young children to be in camp for the week. All for nothing! I still have not received that call back from a supervisor! So tomorrow we will be shopping for a lawyer to help save my husband's life.
The really sad part of all of this is that I'm a Hospice RN that has dedicated my life to enhancing the lives of others and I may not be able to save my husband! No one should be denied a life saving treatment! I'm sure that we are not the only persons experiencing this type of discrimination.
Story #2
Hello, I am 31 years old, 5'10' and weigh close to 400 pounds, and have struggled with obesity since I started school. I am from Calvert City, KY. I am currently fighting my insurance company for a referral to a bariatric surgeon. I have already been turned down once but I will not stop.
I am diabetic, have arthritis, polycystic ovarian disease and several other health conditions. I am fighting for the Gastric Bypass surgery. My obesity is definitely hereditary; my mom and dad are not small. The next generation back is not small either. My grandmother on my dad's side was 6 feet tall and 300 pounds and my dad was 6 feet and 250 pounds. My mom is 5'6" and weighs about 170 to180 pounds. I need any ideas that someone might have to help me to convince my insurance that it is necessary, not cosmetic.
Story #3
I am currently 29 years old. I have been overweight my entire life. I think I was six when the doctors first wanted to put me on a diet.
My nickname in middle school and part of high school was Beluga. I say part of high school because I moved and once I started at a new high school and losing a bit of weight, I never was called that again by my peers. I still remember that though so apparently the scars remain.
Throughout my life I yo yo dieted until I topped out at 348 pounds. As my last hope I had RNY gastric bypass surgery. I say last hope because I was quickly approaching being unable to walk.
I was tired all the time, breathless upon the least little exertion. I couldn't stand for long periods of time without my ankles wanting to break. I didn't experience menstruation. I was infertile. I was insulin resistant. I was afraid of dying. Then I had surgery.
Within a year I lost over 90% of my excess weight. I became more energetic. I didn't get winded as quickly. Thirteen months after surgery, I got pregnant and went on to deliver a healthy baby. Somewhere along the line I got noticed.
When I was heavy I would try to blend into my surroundings (which is hard to do when you are normally the largest in the room) but I was lucky in that I had friends and met a man who became a devoted and loving husband. (He still is -- lucky me).
But I got noticed by not just those around me but by a group doing a documentary for MSNBC called The Last Chance? They interviewed me about the surgery, my success and having a baby. They listened to me. And I started realizing that I had something to say.
I was lucky in that my insurance covered my surgery but there are those who are not so lucky. So I spearheaded a drive in the state of Ohio to mandate coverage of morbid obesity treatment so that every insurance company who writes a policy in Ohio would be required to cover treatment of morbid obesity before someone else dies because of it.
I started talking to the press. The local paper published a few stories. The local television station got involved when I told them about a friend of mine who needed surgery or she would die. The AP got involved and ran a story that went national. I started getting phone calls. Not about me but about the surgery and morbid obesity. About people that are dying. And I am trying to do something about it.
I am still waging the battle in Ohio. When hearings are held on Senate
Bill 162 I plan to be there. I plan to force the state to take heed. I plan to do something.
I don't plan to try to blend in ever again. As if at 348 pounds I was actually succeeding at blending in. Rather I plan to speak out -- continue speaking out.
I am going to law school in the fall (on full tuition scholarship) and plan to continue leading the fight against discrimination of the obese. I plan to work to make sure that the bill in Ohio passes and continue helping others appeal to their insurance companies.
I plan to make a difference. Okay corny I know this sounds. But it is also honest. I can do it. And so can anyone else if they try. I encourage you to try. If I can lose the weight and keep it off, I can do anything. And I plan to prove it.
Rogers, Ohio
Lost over 90% of excess and maintaining
Gained a beautiful daughter on 8/9/00
Story #4
Compared to the guy who can't get his insurance company to pay for heart surgery, I realize I don't have much to complain about. But today something happened that surprised me.
I recently left my job, and am trying to find a new one. Since I'd like to have health insurance in the meantime, I applied for coverage with Blue
Cross Blue Shield (BCBS). Today I received a letter from Blue Cross that said they would be unable to offer me coverage "until my weight stabilizes."
I am a 30-year-old woman who doesn't smoke and drinks maybe three or four beers in a month. I am 5' 5" and I weigh 230 pounds. I know I'm overweight, but it surprised me that I'm so heavy I can't get insurance.
And it's not like I'm asking for the best plan in the world. Basically, I'd be paying BCBS $105 a month. In return, once I've spent $1,000 on medical care, then they'd pay 90% of any other medical bills I might have. No mental health coverage, not much in the way of prescription coverage.
Really, I just wanted to have something in place in case I get cancer or something really catastrophic.
Anyway, that's my story. I live in Fernandina Beach, Florida.
Thanks for listening.
Story #5
Non-compliant. That is the new word I find applied in my direction lately. Before fat, lazy, undisciplined were more the words I was used to, this new one has given me some new thoughts on being morbidly obese.
I am 54 years old, female, and I live in Lodi, California. I am a registered nurse. I am also a wife, a mother, a diabetic, and hypertensive. Fat has always been part of my life, my mom and her family were obese, my brother too, I have not always been obese but I have always felt I was.
Currently I am a medical review nurse. I review cases for medical necessity. I feel I am working to help people get the treatment they need at good cost savings when possible.
One of the procedures we review for is Gastric Bypass Surgery. I consider this a rather difficult review because we have specific criteria, but actually if you have a BMI over 40 and one or two significant comorbidities the surgery is generally deemed medically necessary and the procedure is approved.
Now, I have begun the process of applying for gastric bypass surgery. My BMI is 48, I have had diabetes for 24 years, on insulin for about 14 years. I have been significantly hypertensive for 27 years. I have worsening osteoarthritis in my knees and ankles. I have other minor problems but those listed are the worst. My mom died at 64 of renal failure, and heart failure due to diabetes, obesity and hypertension. I am fast approaching that age.
I have had the same primary care physician for 10 years. I have trusted her and considered her a friend and a good doctor. She has always encouraged me to lose weight and exercise and there have been times when I have been able to do so, but generally, I do not exercise and for the past few years, I do not try as hard to diet as I have in the past. Before I would wake up most mornings determined to diet, but by evening usually, I had FAILED. Each day I failed.
Now as I ask help to have a surgery I feel is my absolute last chance, I find my doctor is reluctant to support me because "YOU ARE NON-COMPLIANT, YOU KNOW."
The program that my medical group recommends will not even let you talk to a surgeon until you have lost 10%. If I could loose 10%, I would not need surgery, I could loose more than 10%.
These restrictions and my doctor's comments demonstrate to me that they do not have a clue how to deal with morbidly obese people. I have thought long and hard about this surgery and absolutely feel it is my last chance. Now with all the added obstacles placed in my way I may end up giving up.
I know I am a failure. I know it every day. I know I am non-compliant, I need help, but instead it is judgment and restrictions, something I see every day. I am very disappointed in my doctor, but I guess after 10 years of telling me what I should do (nothing I don't tell myself by the way) I guess she knows I can only fail again and why spend her medical group's precious share of money on a failure. (what a baby!!)
Anyway, this is how I feel today-I needed to whine a while, thank you for giving me a place to vent. I do think some of what I am saying is valid. I do feel my doctor feels I am a bother to care for when I am always non-compliant. It makes me not want to go back. I agree of course, I am gross and slow and
Why don't I just loose weight???
Story #6
Hi there. I am a 30 year-old woman with 2 beautiful, pretty healthy children and I should be the happiest woman in the world. I am not. I have a problem. I am morbidly obese. Geez, I hate that word. It just makes my skin crawl.
I have always been an obese child and have continued to be one as an adult. The real problem is that I have an 11 year-old son that is also following in my footsteps and I want to change that before it goes too far with him. I suffer enough without having to worry about my son doing the exact same thing.
To be "fat" as a child is the worse thing in the world. It is so emotionally damaging that [you] don't really live a "normal" childhood. I was always made fun of by children and ADULTS. This caused me to rebel and have a terrible time in school.
I was the most insecure person in the world and still am. I never thought that I would get married. I started dating a guy and thought I was in love with him when deep down, I thought he would be the only guy in the world to marry me, so I married at the age of 18.
I had my 1st son when I was 19. I am divorced now and am raising my 2 sons. I don't work, I couldn't. I am in pain too much and therefore, I would not be able to hold down a full time job.
I have a chronic fatigue syndrome called Fibromyalgia. The calves of my legs feel like I have "charley horses" in them constantly. I sleep about 3 to 6 hours a night (6 being if I have a really good night sleeping). I have developed High Blood Pressure, High Cholesterol not to mention the constant back pain, the constant neck pain that I go through every day of my life.
I am on so many medications to try and control this chronic fatigue syndrome that it is hard to keep up with all of them. I have extra skin hanging that sometimes gets heat rash or yeast infections between the layers. I feel like I am walking on my bare feet bones sometimes. Carrying around this weight is a lot for your feet, legs and back. My knees hurt all the time. I fall all the time and always land on my knees, therefore, I have bursitis on my right knee.
I have an awful time with my monthly periods. Sometimes I have periods every 2 weeks. And I never stop like normal. My periods usually last 10-14 days. This itself is enough to drive a person crazy. My periods are very heavy, sometimes to the point that I have to lie down because I feel dizzy and am bleeding very heavy. The doctor that delivered my last son suspects that I might have Endometriosis. But I am a "high risk" for surgery because of my weight that I can't have the surgery that is required to find out if I have this problem with my uterus.
I don't know who is reading this or if anyone will. But I want you to stop for a minute, put yourself in my shoes. Try to imagine being an adult that weighs 390 lbs. and this is nothing. I have weighed up to more than 420 lbs. I have 2 children. I can't sit around like I feel like. I have to be up cleaning, cooking, chasing the kids, helping with the homework and running to the kids games and school events.
I mean, I don't want you to think that I am feeling sorry for myself. I just want all this pain and emotional scars to go away. I want to stop hurting all the time. I want to stop hearing people laugh at me. I want people to stop saying, "But you have such a pretty face!" (I HATE THAT) and I really want to be able to go out and play with my sons like a normal mom can. But most of all, I want to be the REAL me. I want to go to college and get my RN Nursing Degree. I want to work on the Labor/Delivery Floor. I want to be happy. Isn't it time for me to be happy for once?
Yes, I have tried all of those diets, the diet pills and even one period in my life I tried the throwing up/gagging myself theory. That last theory ended shortly there after when my hair started falling out. I have been that low in my life, that I would stoop to such a stupid thing.
I have a really good Doctor. He is trying to help me so that I can become that person that he knows that I need to be. After many months of trying this medicine and that medicine, we both have agreed that if I lost weight, it would be a big, big difference in my health, emotional and physical.
He has put me on a waiting list to have the gastric bypass surgery done. The only thing is that I have Medicaid. I have to be on a waiting list that is until the end of this year. I feel so betrayed.
If I had insurance, the situation would be different. I feel like I am on death row. My health problems can kill me. High blood pressure can make me have a heart attack or a stroke. I have a chance of developing female cancer, because I have had mild dysplasia cells found during a routine pap smear and possibly have bleeding in the lining of my uterus that may develop into uterine cancer if not found.
But I can't have the surgery because of my weight. If someone had cancer, would they tell them that they would have to be put on a waiting list for the necessary chemotherapy that is often needed.
I know that it isn't like this and I halfway understand, but I am just frustrated. I need to loose weight so bad. Not for only my kids sake, but for mine too. If I feel like this at 30, what am I going to feel like at 60? Will I be alive that long?
Thanks for taking the time to listen to me. Hope someone reads this
hahaha
felt good just saying it all though. Have a nice day!
Muncie, Indiana