Starting the Process, Need Your Prayers!

Hello Missouri Board. As you all know I had my WLS 8-17-06, and I believe it's the best thing I have ever done for myself. This post is about my DH. He has diabetes really bad, has a real hard time controlling his blood sugar. We have talked about him getting the WLS for as long as I had wanted it. We had contacted his insurance company in the past (he has United Healthcare) about covering the surgery and they said that they did not cover it, so we gave up. Well we have never stopped praying for God to intervene and show us what to do . Today when we went for our walk, I was out walking my husband, that's the first time that has ever happened. And again we starting wishing he could get the WLS and I told him I was going to call his insurance company and talk to someone who could tell me what we could do to possibly get this covered. When I called them I asked them about the coverage again and they started telling me it wouldn't cover it and I said what exactly does it say? She said "It will not cover surgery to take care of obesity. I said "What's it say about having the surgery if you have medical comorbities, like Diabetes?" She said "That in that case we could go see the surgeon and have them send in a "Predetermation of Services" and that it would probably get denied. Then have the doctor send in an appeal. She even gave me a fax number to send stuff in instead of mailing it so the process will get started faster. I know this is a long post but I said all that to say this. PLEASE PRAY THAT MY HUSBAND CAN GET APPROVAL FOR SURGERY!!!!! His health is not getting any better at this point and he has tried so hard to lose weight. But every diabetes medication he is on has a side effect of weight gain. His PCP told him with diabetes and being over age 50 it was pretty much impossible for him to lose weight on his own. So I leave this in God's hands and covet all your prayers. Thank you so very much and God Bless, Love Brenda

Brenda I am new to the boards but have been reading posts tonight. I am in school and don't get in here very often. I will be praying for you and your family. I hope that your husband can get approval for WLSit sounds like this is a serious matter. I hope you will stay on top of things and not give up until he gets the prcedure. Good luck and God bless, Michelle

Brenda, I will keep you both in my prayers. I was at a seminar tonite with Dr. Hornbostel. Maybe you should consider taking him to a seminar and starting the paperwork and let them help.That way they will know how to file and if there are any loop holes they can use. Also you will have all the foot work done when he does get approved. JULIA

Praying that your husband is accepted as a surgery patient, so you can work together to build a new and better life. Barb S

Brenda, If you need help preparing.....I think it's good to go at them with both barrels loaded so they KNOW from the start you are ready to FIGHT, there are many appela letters on OH from others who've had this battle. Ask around, I'd send a personal letter describing the medical reasons along with the first request. I'm told they dfon't want to hear why you WANT if but rather why you NEED it, the life and death issues, the medical expenses that are bound to keep adding up ifg he doesn't lose this weight, all the other methods he's tried, what he does now as far as working out etc. Prayers for you! YOU CAN DO THIS! Tami

Brenda I think I remember them talking about a lawyer that would help with insurance, call dr. Hornbostels office...and ask, I dont think I missunderstood....vesta

Thanks to all you guys for your support and prayers! Vesta - we contacted that lawyer and were told they couldn't help us, but thank you for caring. Thanks again. Brenda

Brenda... As the other poster's have stated... be prepared and then some. If you go into this process with as much "ammo" as you can put together it is going to make it much easier on you, not to mentions easier emotionally as well. I fought the insurance companies for years and got denied time and time again. I was finally able to win the battle after my DH's employer offered insurance that MIGHT cover it with medical necessity proven. Prior to that, all of our previous insurance policies didn't even offer it with medical necessity so it was futile to fight against them (even though I tried!).... I got EVERYTHING that I could think of. They wanted 2-3 years of diet history. I gave them my entire life from my teen years through adulthood. They wanted medical records. I GAVE THEM MEDICAL RECORDS. They wanted letters from my PCP. I not only got the letters but they were incredibly specific and chock full of the medical need. They wanted Co-morbids... I gave them to them along with ALL the ones that my family suffered through ... the same ones that I was BEGINNING to have myself. I sat down and researched normal healthy weight loss per the NDIH website. EVEN if I could of lost weight at the rate that is acceptable and HEALTHY per the government standards it would be too little too late. Basically my commorbids would outpace any normal healthy weight loss that I could of hoped to have. Therefore it was AN EMERGENT situation that I was approved. I gained their approval and thank the Lord I did... it has made a world of difference in my life. I will be thinking of you and sending prayers your way. Let me know if there is anything that I can do to help. My insurance company that I found was United Healthcare.... Pixielf~