Wednesday, October 22, 2008


So we called today and my Insurance group plan will not cover Bariactric Surgery. Not only will they not cover it, but they will not cover any damage you might incur if you have the surgery and there were complications. My Insurance will not pay for, nor support, any surgical efforts to control weight.

Want to know what is wrong with this picture? I live in a state that ranks in the top of the nation for adult obesity. And according to my State Health Department, I live in the region that has the highest levels of adult obesity. The State Health Department claims that obesity is the number one potential threat to people in my state and will soon replace tobacco as the top preventable cause of death.

The Health Department, like my Insurance Company, and my doctor, all tell you that you are fat. Fat is bad. Fat is killing you. You are fat because you are lazy and make poor (stupid) eating choices. They might tell you this as they are eating donuts in front of you. They all tell you to jump on one form of diet or another and begin an exercise program. But what they fail to tell you is that 90% of all diet and exercise attempts fail within two years. 90%!!!!!

So while these professionals are telling you that you are fat and lazy and stupid they are also telling you that your only hope is to engage in an program that is statistically doomed to failure. Oh, did I mention depression and suicide are real high in problems in this state too?

If you can get doctors to talk about it, where price is not an issue, they will tell you the only statistically effective way to lose large amounts of weight (we are talking for people that are termed morbidly obese.. not those that want cosmetic changes) the best safest way is Bariatric Surgery. More specifically, lap band.

But my Insurance wont pay for that procedure. My Insurance even says that if I decide to take out a loan and pay for the procedure myself and there is a problem, they will not cover me. My insurance provider, to whom my employer pays over $325 per month (and over $325 for my wife and I pay well over $325 out of my pocket for my children) says the only way to lose weight is in a process doomed to a 90% failure rate.

Now let's look at my current medical condition. I am type II diabetic. I call it the "fat ass" kind, because it is weight related. My mother, who has already lost one foot and has spent a good chunk of the past three years in a hospital is also Type II diabetic, as was her mother before her, who died due to complications of diabetes. I have high blood pressure, which doctors say is a symptom of weight. I have elevated triglycerides and take a cholesterol drug (Lipitor) due to the Diabetes which is due to weight. I have chronic back pain (medicated) my doctor says is due to weight. I may be developing sleep apnea due to... wait for it.... weight.

Dude something is wrong here! Way wrong! All of my medical problems could be cleared up, my quality of life could greatly improve, I can possibly stop a generational disease from killing me.... but not only is it not covered by MY insurance.... that same company says they wont even cover me if there were complications should I decide to pay for the procedure myself! Which then makes the procedure an unacceptable financial risk.

I have a medical condition. The recommended treatment has a 90% failure rate. I am denied realistic medical care even though I have other wise excellent insurance. This is unacceptable.

Where the hell is Alan Shore when you need him?


Lisa said...

I don't know who Alan Shore is.. but you know.. what your insurance company is doing verges on violating the ADA (American with Disabilities Act).

I'm on my way, ever so slowly, to getting my lapband. Since it has been over a year since my ins. approved me, we have to get reapproved.. but hopefully that won't take long.

I also found a great place to monitor what you're eating.. it's called I started using it yesterday and it's fantastic. And I haven't even gone to the paid side yet.. lol

Hang in there my friend, we'll see you through.

Avitable said...

Are you sure that it's not permitted? Many insurance companies allow it if it is deemed medically necessary, but they say that otherwise, bariatric surgery is not covered.

Medical necessity is not a hard burden to overcome, either. I'd go to their website and search for "lap band" and see what comes up.

Email me if you want to talk more about this.

Anonymous said...

(Ugh, Blogger ate my comment.)

I've wondered before if there is a way to buy risk insurance against complications from elective procedures. When my wife got laser eye surgery, there was some level of risk of blindness. I thought she ought to be able to buy risk insurance against this so that in the unlikely even that it happened, she would at least have a large amount of cash to help deal with the situation.

More specifically for your situation, I wonder if there is statistical data showing that the risk of future health problems is lowered after bariatric surgery. If so, then it would just come down to straight-forward math for the insurance company, though they would likely also factor in the chance that you wouldn't be insured by them in the future.

Cris said...

Lisa: Alan Shore is one of the Lawyer dudes on Boston Legal. Thanks for all your help!

Adam: Yes we checked yesterday. I think the college negotiated it out of the group policy

Ren: That's a good idea. Is it offered? Seems wrong to have to buy additional insurance when my family alone puts $12,000 a year in Blue Cross's pockets.

Anonymous said...

I don't know if it's offered - couldn't find anything via google. It wouldn't really be the same as general medical insurance as it would target a specific occurrence and be a one-time coverage. More of a hedge against an unlikely negative result, though I suppose that's what insurance is supposed to be in the first place.