Two steps back...

I know I am not the only person to go through the rollercoaster ride with insurance, but I am just starting to feel the pain of it. I am feeling very down. Insurance has decided that my medically supervised weight loss was too long ago and they want me to do another 6 months before even considering my coverage...and that coverage would be a mazimum of 50% for Dr. Hodges. Also found out that Dr. Horbostel and Dr. Scott are "out of area" for me because of the distance and they can't guarantee me that would be paid for at all. I have been praying and crying and praying some more and I still feel lost. I have done everything right and have everything completed for pre-op and now they throw this roadblock at me. I feel like I have 2 options at this point: 1.) Go ahead with the surgery and pay out of pocket. It would be difficult and I would have to make some HUGE budget reallocations, but nothing that isn't impossible. 2.) Wait the 6 months doing the Dr. supervised and still not have a guarantee of approval (or employment - my insurance is through my employer). I know you can't provide medical advice on the board, but I need some guidance. My husband and I are a wonderful team, but even we are exhausted about this. God Bless you for reading this, Leah

Leah, I'm so sorry this is happening to you. You're such a sweet, caring, optimistic person so I know you'll get past this but darn it is hard. I can't actually advise you because, like you, I worry that I'll finish my six months and they'll still say NO at the insurance or that the insurance will change after the first of the year or something awful. I am going to try to push for approval before the end of the year to protect against that happening but who knows if it will work. Fortunately for me MedPay, Missouri State's insurance administrator, is right here in Springfield so I'm not dealing with some huge far away entity but it still worries me. I do work hard four days a week at the gym and have four lecture classes a month, and at least two appointments with MD or Exercise Physiologist, not to mention the New Images meetings once a month so I'm investing a lot of time in this process. I have to say that if I did not have the support of my boss and co-worker I don't think I could do all this required preparation. I have to miss work for at least 1-2 hours a week. That being said, pieces are falling in place in other ways. My DH went to see his PCP, who's a neighbor, yesterday and told him I was planning to have WLS and his Dr. said his sister had had the surgery and did great and thought it was wonderful. So that helped DH feel even more comfortable about it. I certainly will be praying for wisdom for you and your DH. I know you'll figure out what's right for you. Hugs and love Lana

Hi Leah and Lana, I just wanted you BOTH to know NOT to give up~ I started my journey almost a year ago. I went through 4 appeals processes, several doctors appointments, pysch evals, lab work etc and just to find out that my old insurance NEVER would pay. It was listed as an exclusion on my policy. I have a lot of friends from this site that needed the 6 month supervised diet and were approved, or if they were denied, got more and more documentation and sent in an appeal. I now have different insurance and am going to my consult on August 29th in Columbia with Dr. Fearing, who is with Dr. Scott and associates. Please just know that no matter HOW bad you feel about the wait time....try and stay positive or else the time will go by MUCH slower and you will feel stressed out a lot. I am speaking from experience here and I know it sucks, but there are so many wonderful people here to talk to who understand. Also remember, delays dont always mean denials. Leah, does your employer have the option of denying the surgery to you? What is written in your actual policy? I worked for insurance and hospital for 13 years specializing in this field and I would review your manual and see if the employer is a self funded company or not.... I will keep BOTH of you in my prayers and hope that you will find the way in which you need to go and that your time flies by so quickly, that this will seem like yesterday. PRAYERS TO ALL, janet

Leah don't give up I have Great West also and I got approved . I think I told you that in an email, but I have since been approved. What length of time did they tell you your six months had to fall within? They told me within last 3 years and when I first sent in my medical records which listed everything and I mean everything they denied me because they just wanted a simple paragraph showing I had 6 months surpevised diet within last 3 years. I know all policies are different but I just wanted you to know there is hope. Even if you have to wait 6 months the time will fly by and you could be ready for surgery by Feb or March.. I started my process in Dec, and finally have surgery date in Oct. but that is not all .....my husband lost his job same day I was approved so now I have to pay for insurance out of pocket , but still cheaper then paying for surgery. Decide in your head that this will happen for you and it makes you willing to go the distance. I am not about to give up after 8 months of persistance. Hang in and there and don't give up girl. Jane