Question:
Has anyone out there in WLS land....
denied surgery because of age??? I am 23 years old. I called my insurance co in FEB to see if this procedure was covered. The rep said that its a covered procedure just as long as I have a letter of medical necessity and 100lbs overweight. Now....13 days before surgery...they had told me I am too young to have this done, and that I need 4 years of a medically supervised diet. The age requirement is 25. Am I too young to know the research? Am I too young to make a healthy change in my life? Am I too young to LIVE??? The surgeons office is dumbfounded---they never delt with a denial like this before. Also, I have been "medically supervised" for years on end throughout my childhood. My Doctor died a while ago, and my files are gone. I have searched high and low for them. So what now? I am going to write an appeal letter. So is my PCP, so is my surgeon. Do I have an age discrimination case here? — hrussinko (posted on April 23, 2002)
April 23, 2002
I'm sorry to hear that. What insurance do you have? I am 22 years old and
have AETNA and in the process of going through insurance, they just sent
out my information. I have never heard of 23 being too young, usually the
age requirement is 18, atleast to operate. In your appeal letter, mention
that you may be young, but if you wait longer you WILL GET heart disease
and diabetes and high blood pressure (if u dont already) There is no
reason you should be denied this because you are 23! goodluck to you!!
— Lezlie Y.
April 23, 2002
Very interesting. I have heard of people being denied because they were
not yet 18, but you're 23!!! I had the surgery at 28 (got approved at 27)
and am SOOO glad I did it while I was still young and had lots of life to
live. Yes, I feel that you are dealing with age discrimination. The
insurance company obviously wants you to suffer as a fat person for a few
years longer. I would definitely appeal their decision and try to get some
solid reasons for their age requirement. If they don't have any good
reason for the "age 25" requirement, then I would sue for age
discrimination.
— Terissa R.
April 23, 2002
Just FYI, I started my whole process at 23... had my surgery at 24. I hae
never heard of 23 being too young.. I've even heard of people under 18
who've had it... Good luck in your journey! It's worth every step of the
fight!
— Elizabeth D.
April 23, 2002
I haven't had your problem, but I want to encourage you to fight this. I
am only 26 and I look at this surgery as a way to get to live a healthy
life. I have arthritis and slightly high blood pressure now, if I had to
wait two more years, my doctor said that I'd be having back surgery as well
and probably other problems. Don't give up. Make sure this policy was in
writing BEFORE you were approved and make them eat it. Good luck!
— cjabates
April 23, 2002
My insurance is Great West PPO...what is funny about it is
their website onehealthplan.com (or something like that)
has a search on diffrent health related issues when I
did a search for OBESITY...it actually mentioned surgery
and the diffrent types available(nothing about age!!!)
I am a adult. I pay my own bills. I make my own decisions.
This is my decision, and I have researched it for about 2
years so my age doesnt make me any dumber (hehe). I am a
fighter...they chose the wrong girl to pick on. Im sick of
people telling me what I cant do. I already paid 500 out of
pocket that im NOT getting back. I guess you can tell im
ANGRY. :-( and just plain upset :-(
— hrussinko
April 23, 2002
Heather, I don't know about the age thing, but I know Sue at
mygastricbypass.com has some excellent letters you might want to look over
:) DC
— DonnaCarol
April 23, 2002
Sorry, but that is complete BS. I am 23 now, but was approved for surgery
when I was still 22. Also, my angel Heather just turned 19 and she is
approved for surgery as well. Keep bugging them, cause that is a load of
crap.
— Jennifer Y.
April 23, 2002
Hi, I am 22 also, and on the verge of getting a date. My insurance
approved it very quickly, no problems. I personally think why should they
have you wait a few more years when you will probably be heavier, have more
comorbidities, and overall be costing them more money? Makes no sense!
Good luck on busting through that wall!
— Maggie C.
April 23, 2002
That is a bunch of whoha. I am 22 and post op as of this January. I would
definately pursue some action. Best of luck!
— Paula Prichard
April 23, 2002
I would fight them and ask for them to show you in writing their policy and
what generally accepted medical practise they are basing that policy on.
Definately appeal, but if they deny you a second time, I would contact
Walter Lindstrom of the obesitylaw.com. He got me approved and his fee was
only $350. Well worth every cent. I wish I had know about WLS back when I
was in my 20's. So they wouldn't have been such a negative experience,
always on a diet and getting bigger and bigger.
Good luck and don't give up. That is what the insurance company wants you
to do, so keep fighting.
— Dell H.
April 23, 2002
DO NOT GIVE UP! I only wish I had had this done when I was 23 not 35. The
issue of sagging skin would not be a problem and I would have led a
healthier happier life. Write your appeal. Contact a Lawyer if you have but
just DONT GIVE UP!
— swtnsxy0219
April 24, 2002
Hi again...thanks for all the support here, and all of those
who have emailed me. :-)
Today my wonderful co-worker contacted her friend who is the
health insurance administrator for the company I work for.
Right away she contacted the sales rep for Great West, and
as soon as she just mentioned the age of "25" she knew what
surgery was being denied!!! What the sales rep said, is that
it is a standard guidline they follow for ALL Great West
policies-but she will help us have it approved. "No Promises"
But, my company is quite angry because of the game the ins co
is playing. Hopefully, it will get resolved quickly!!!!
Ill update in a few days!!!
— hrussinko
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