Re: Digest Number 1561

[Guest guest]

I just celebrated my first anniversary, Aug. 7th. I am oh so happy. I lost

a little over 80 pounds before surgery, from 400 to 313. Then since surgery

with Dr Tennewitz in Melbourne, Florida, I have lost to 175 and hope to get

to 163 and stop.

This is my first post with this group and I hope to change the subject from

Calcium to Insurance Lobbying. (I do take 1500 mg a day of calcium citrate

from GNC on the recommendations of both my surgeon and orthopedic doctor) and

I split them up because they are too big to swallow.)

It concerns me that insurance companies appear to be trying to make it

more difficult for people to get this life-saving surgery. Perhaps we

should all be lobbying our legislators in a proactive stance to ensure this

surgery remains viable for people, who can afford it the least. We all have

stories to share, and so we should share them with those who make the laws.

(So many times, we are put on the low end of any salary range if we are able

to work at all and if we have insurance what we do not need is an exclusion.)

My e-mail and the responses I got follow. I am open to any suggestions

for lobbying.

Ms. Elliott:

Thank you for your recent e-mail message concerning insurer's coverage of

gastric bypass surgery. Unfortunately, Florida law does not prohibit

insurance companies from excluding coverage for this particular procedure.

To date, United Healthcare is the only insurer that has specifically excluded

coverage for gastric bypass surgery.

The Department's legal staff is currently researching the possibility of

preventing carriers from imposing this type of limitation, but several HMOs

have already challenged the Department's position. More specifically, we are

concerned with insurers' limitation of this procedure when it is medically

necessary.

Without statutory authority to uphold our position of disapproving this

exclusion, the Department will continue to be met with resistance by

insurance companies.

I appreciate the time you took to relay your concerns on this issue. Based

on your feedback, we will continue to monitor coverage changes requested by

insurers, including coverage of gastric bypass surgery.

If you would like more information or if I can be of further assistance, you

can contact me directly at .

Sincerely,

Lorna J. Noren, CPM, PAHM, MCP

Insurance Specialist III

Florida Department of Insurance

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Dear Ms. Elliot:

Thank you for your recent email to the Agency for Health Care Administration

regarding coverage for weight loss surgery. The Agency forwarded your email

to the Statewide Provider and Subscriber Assistance Program for a response.

I would like to take this opportunity to congratulate you and wish you

continued good luck with your newfound good health. It is always a pleasure

to hear about a successful outcome to a medical problem.

We understand the concern you expressed over the health plans excluding

weight loss surgery from their covered benefits. However, health plans are

private businesses, and the decision they make to include or exclude

benefits from their coverage is a private business decision. Unfortunately,

there is nothing we can do through regulation to alter this situation, as

The State of Florida only has the authority to regulate those benefits

mandated by statute. Only your state legislators have the power to amend

the statute to require additional benefits.

I would encourage you to contact your state legislators and share your story

of the importance and benefits of of weight loss surgery and how it changed

your life. Only through Florida constituents, you and other concerned

voters, can a voice be given to successfully address the changing needs of

Florida's health care.

Thank you for taking the time to share your uplifting story and your

concerns for the needs of others who could benefit from this treatment. If

you have further health care issues, please contact the Agency at

1-.

Sincerely,

Elaine Eddy

Medical Health Care Analyst

Statewide Provider and Subscriber Assistance Program

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Email: bemyavon@...

Comments: I had weight loss surgery last August. I lost 80 pounds on my own

from 400 pounds to 313 pounds over a year and a half. Then since surgery a

year ago I have lost down to 178 pounds. I had a multitude of health

problems, many of which were obesity related, my doctors are astounded, they

cannot believe the difference and say so. It has been a life changing thing

for me to good health.

Please don't close up this option for people who have been fat all their

lives because of genetics and could not solve it on their own. Both my

grandmothers (grand and great-grand died from heart attacks related to

overweight. My uncle weighs 500 pounds. My whole family is overweight, I was

destined to die young like my grandmothers (I am 50).

We already didn't get the jobs we wanted, the careers we wanted, the chances

we wanted, no matter how smart we were; we were seen as fat and lazy and not

taking

care of ourselves when really morbid obesity is every bit as lethal a

disease as cancer or leukemia, or Huntington's, or Crohn's , or a host of

others. So, please, don't look at it as just a cosmetic fix.

Yes, there are failures, people who say they will follow doctors orders and

don't, but, oh, for every failure there are ten more who are grateful to God

every day of

their lives that they were given a second chance and don't intend to blow

it.

I probably have saved my insurance company a great deal of money in the

long run because I wont be sick to death for years from diabetes, high blood

pressure, even mental illness, chronic arthritis, and other debilatations

that were slowly but surely sapping me, not because of my lack of will power

but because I had a disease that surgery could help me with -- not do for me

totally but help me with.

And I grabbed on to it like the sinking man (woman) that I was, and now my

ship is afloat again, and the sun is shining in Florida!!! I am even looking

at getting a job which I havent been able to work in 10 years. -- Marika

Elliott, 1555 Vega Ave. Merritt Island, FL 32953