RE: Feeling depressed and need some support

November 24, 2001

Hi ann,

Not sure if this will help, but I have BC/BS from PA. The plan is called

Select Blue.

I elected to have my surgery out of network, but I can do a self-refer with

my plan. Its only and 80/20 coverage though. Daryl, who handles the

insurance approvals at Mt Sinai got my approval in one day. I had called

the insurance company myself prior to that and once I got a very helpful

person who told me that if I met all the qualifications for obesity, that it

should be covered. Obesity itself is not a covered medical reason, but the

surgery was covered if I was pre-qualified. Even though Daryl had me

sweating, becaue he did not even try for approval until 2 weeks before

surgery, he was able to do it quickly.

Sheri

lap/open DS 9/28/01

Dr Herron

Mt Sinai NYC

November 24, 2001

ann,

Take your life off hold and go forward on the assumption it will happen. I

had my consult, and my surgery date without knowing if I was going to be

covered. I went forward on faith. I had a couple moments of panic, but all

ended well. I am going to have to pay some out of pocket expenses, but I was

ready to have to beg borrow or steal (not really) to get whatever money I

needed for this surgery.

Hugs,

Sheri

November 24, 2001

I don't know what's wrong with me, but maybe all of my research and

preparing for consult over the last several months has made me weary. I

just so despondent over my loaming battle with my insurance carrier (BC/BS)

for approval for the DS surgery. I really do appreciate that everyone's

needs are different, but I really resent that an insurance carrier dictate

what type of procedure they will cover to treat my super obesity. I

strongly feel that decision should be made jointly by the patient and their

surgeon (provided, of course that the surgeon is a qualified and licensed

professional.) By limiting coverage to the RNY, I feel like I am being

punished. Being forced to endure a life with eating habits that most so

called " normal " people would find totally unnecessary and unacceptable does

make me feel like their attitude is I should suffer for letting myself get

so big and out of control. I just want to eat like a normal healthy person

does, is that so wrong? If a procedure exists which would allow that and

still result in my losing a substantial percentage of my excess weight,

shouldn't that be a viable option? I do understand that there are people

who for their own reasons might choose such as restrictive option, but it's

not for me. I already feel like a giant looser. I don't understand how at

my weight I can still be very hungry most of the time. I'm not an ignorant

person, but I've been struggling with my weight for over 20 years. I can't

really believe that anyone would think that another individual would

purposely chose to weigh close to 400 pounds. It's not just a matter of

" putting the fork down. " There is definitely something different about how

my body reacts to food. Medical science still does not yet have the

definitive answer. But WLS options are a very viable tool in the interim.

To me, it feels like the insurer is saying, " All right, we'll help you, but

there's a price. " You can never pass yourself off as normal at a social

gathering, business luncheon or party. " You'll always have to remember what

you did to yourself. Now go have your 1/2 cup of chewed up food or face the

consequences. " I feel bad enough about myself already without having to

deal with that, especially when there is an alternative!

It feels good to vent. I'm starting to feel a little bit better already.

Does anyone know if anyone has ever been successful in getting BC/BS to

cover the BPD/DS when their policy excludes it? I'm so into getting my self

geared up and prepared, I guess these feelings are all just a part of the

process.

Thanks for being there to share this with me.

ann

----------------------------------------------------------------------

November 24, 2001

Sheri,

I have Blue Care Elect Preferred and I too can self-refer. They also told

me surgery was covered if I pre-qualify, but then sent me some type of

document called Medical and Surgery Management of Obesity that said gastric

bypass surgery was covered but then listed the BPD/DS as not covered as it

has ... " not been scientifically proven to result in improved net health

outcomes for obese patients. " Interesting enough, the doctor that I will be

using is in network, so if I can get around this it should be covered at

100%. It is good to know that BC/BS of PA did cover surgery, that gives me

hope.

Again, thanks so much for responding. I feel like my life is on hold and I

can't wait to move forward.

Sincerely,

ann

Re: Feeling depressed and need some support