Question:
~Just Wondering~

Hi All, Well I need to get all this out, and well Most of it is what we all have felt once or twice in our life.When do we decide to give up...I Am a very aggressive woman by nature, and I really dont like someone telling what I can and cannot do. Especially after I Feel I have paid my "dues" In life. I work hard, try to be a good human being, and pay taxes, have insurance, and even buckle up *Smiles*. After dealing with insurance companies, doctors, and lawyers that dont seem to care, im wondering to myself, ok when do I give up. I was so angry today when i called my insurance company to find out where the appeal I sent 4 weeks ago was. They said they hadnt been able to find it, and the operator(Nellie)was so cold and rude, Told me that I should look in my policy that the exclusion was there, and I was wasting my time and theirs. I was so mad, I Asked to talk to the supervisor who tried to calm me down. He said he would try to find out about my appeal, but also told me that I really should be using the appeal process to tie up the insurance, that they stand behind the exclusion and do not make changes, and i was basically wasting my time. Oh boy, by the time I Got off the phone all I did was cry. I was so mad, so hurt, and So well Didnt know what to do. So I called a lawyer who I Am meeting with to help me try to determine at this point where I should go and what I should do. I have to fight my PCP for a letter, and a recommendation, Ive had to argue with the surgeon cuz it seemd to me at the time that they were ignoring me after I Got denied the first time..I Feel like all im doing is fighting, and yet every time I think I Should just walk away and "Settle For being this way", I Get mad and write another letter to a public official. And yet in the back of my mind I wonder..What good Can I Really DO??? Does one person really make a difference...*Sigh* Im sorry for going on and on, but I Really am at my wits end now..I Just want to scream, and ask why NO one cares If I Live or die...Just wanted someone to know how i felt if you were feeling the same way too........    — Ann A. (posted on March 24, 2000)

March 24, 2000
Ann, I know you've gone through hell already, but please do NOT give up. This is your life you're trying to save. If your PCP and surgeon aren't cooperative, find others who are. If no appeal is good enough, switch to another insurance carrier. Yes, it means waiting longer and starting over, but if all else fails, it'll be worth it in the end when you finally get the surgery you need to live. In the meantime, keep the appeals process in motion. I know one person and have read of others who were turned down again and again, until they reached the final appeals board review, where they go to present their case in person. It's harder for some people to say no to your face, once they've seen you and heard you speak. You become more than a policy number then. So hang in there, get help from an attorney and don't give up!
   — Duffy H.

March 24, 2000
Please!!! Never give up. Someone told me that friends are angels who lift us to our feet when our wings have trouble remembering how to fly. PLEASE!!! Never give up. My wings are old and not very strong...still I have hope that an angel will help me to my feet (for I cannot stand) and I cannot remember how to fly...(for I have never been thin) We are out here. We are behind you. We don't need pitty. We need changes. ~.~
   — [Anonymous]

March 24, 2000
Ann, After reading your post, I felt that I had a responsibility to at least tell you my story. Similiar to yours but with a happy ending/NEW BEGINNING! It all started with trying to obtain health insurance. I was turned down by 2 companies. Then a friend told me about TennCare, I didn't even think that I could even apply. But I did and I was accepted. I then went to my pcp, who told me that to lose weight I should quit eating! I was told by my pcp, my obgyn, my ear, nose, throat dr., & even my surgeon that "TennCare WILL NOT, HAS NEVER, & WILL NEVER PAY FOR WLS!!!" I was told NO, everywhere I turned. But thanks to this site, I learned of others who fought before me, and won. I included the knowledge of that with specific names in all 3 appeal letters. BlueCare (my mco) still refused to pay but TennCare asked for letters from any doctors stating medical necessity, which I provided, and I was approved! I am scheduled 3/31/2000. I started the process last June, I had to fire my first pcp, argue with my second pcp, write letters,ect., you can read all the tiring details under my peer site (TN) if you wish. My point is that persistance pays! I wish you the best...don't ever give up on what you want & deserve!
   — Janice K.

March 25, 2000
Ann, your post brought tears to my eyes. It reminded me of my fight with my Gramma's insurance company to get a life-saving treatment for her, which they kept denying for one bullsh*t reason after another. I fought for six months... and when it was finally approved (through legal arbitration), it was too late. My gramma died a month later. Your post brought back the memories of all that rage and frustration and helplessness -- I truly do understand where you're coming from. I want to echo the encouragement of the other folks here: DO NOT GIVE UP. Keep looking for alternatives (is there a Vocational Rehab program in your state? What about Medicaid/Medicare -- could your family get by without your income for a couple of months so you could quit your job and get the surgery through this? What about a change in insurance? Will your employer advocate for you? A second mortgage and self-pay? There's a surgeon in Spain who does the BPD/DS for about $10,000 - is that something you'd be interested in?) There are endless options, and there's a solution on the other side of one of them, I promise. You just need to sift through them until you find it. Don't give up, sweetie! And if I can be of assistance in your insurance fight, let me know. I have a few nasty tricks up my sleeve... *evil grin*
   — Kim H.

March 25, 2000
Ann, Please don't give up. You deserve more and some way some how the solution will come. Keep fighting for your right to live. I will keep you in my thoughts and I hope soon the answer you are seeking arrives and you can be on your way to a new life.
   — Rebecca D.

April 29, 2000
Hi Ann, Your story could be mine too. I am so sorry your going through this. I have been denied 3 times. Just this month my PCP told me she would nt write a letter of recomendation for because she didn't believe in WLS. Well needles to say I cried too. I ahve been at this since June of 99. I'm just now where you are. Stalled and not knowing where to turn. I have to find a new PCP.A WLS friendly on before I start this whole thing again. I hope you do the same. All the feelings you listed are so true. The frustration!! Even the anger with your surgeon. I feel ythe same way at times. Like he just doesn't want to help. I have another surgeon but he is very far away.And I have thought this is never gonna happen. But we can't give up. I have driven my family nuts for the past year I've been so obsessed with this. I can't quit. Neither can you. It truly is our only hope. Hang in there. Feel free to e-mail me privately if you like.My heart is really with you.
   — Jennifer M.

July 12, 2000
Hi Ann, I too am in the waiting game but at the very beginning. I am waiting on the first response from my insurance company to my surgeons office (two days away). One of the things that I found out is that the Human Resources at the employer is one of the places that could pull strings for you. They are part of the make-up of the insurance policies. Give them a good talking to and see what they can do. I have read on these sites that some people have even gotten their Human Resousce to CHANGE the policy to allow WLS after it being listed as not covered~~`GOOD LUCK~~~Keep your chin up~~~~
   — Violet K.

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