Six Months Out - Full Body Picture

Saturday, December 24, 2011

Insurance Company Requirements for WLS and a Rant, sorry.

A recent thread on VST made me write the following:

A young woman is researching WLS and is attempting to find out what her insurance company requires that she do before they will pay for the procedure she chooses. Her words, paraphrased, were that she was doing all of these appointments and requirements, but she doesn't feel like she's doing enough. IMO, she's already jumping through enough hoops, but I'm not the insurance company.

I can see what the next requirement will be: Stand on your head for six months! :)  The insurance companies already make bariatric patients stand on their heads for six months to several years to get this surgery. I was self-pay, but I read the horror stories about extended diets and insurance plans changing halfway through. People have had to do long term nutrition, dietitian, and psyche consults. Then, when you think you're almost there, they change the rules!

IMO, it's a bunch of baloney (except the psyche consults). The insurance company is going to benefit by paying for your ONE bariatric surgery, instead of paying for multiple operations later to help you keep breathing, or keep your heart beating, or to remove obesity-related cancers. 

I'd like to see it is insurance companies treated cancer patients this way. "Oh, you've got stage 1 breast cancer? Well, now you have to follow this specific diet for six months and see if it resolves itself. Oh, and while you're doing that, you have to talk to a nutritionist monthly, for which you'll pay out of pocket..."  People would be up in ARMS.

I need to join the Obesity Coalition. They are working to change the way fat people are treated in this country, both by the medical community and by the political machine. IF we obese/fat/big/large/whatever name people gathered our voices together, we'd be the biggest voting block in the world. I read a statistic the other day that says that 60% SIXTY PERCENT of Adult Americans are overweight. Maybe they all aren't obese, but they are all overweight. Now, that's a HUGE group of people (no pun intended).

Why haven't we joined together to force insurance companies to start paying for WLS without the insance hoop-jumping?  Esteemed medical professionals have stated that being 100 pounds overweight is like having an advanced cancer. It's not something that most people can cure on their own, nor can they just "eat less". By the time you are 100 pounds overweight, which I was, and many WLS patients are on the day of surgery, the co-morbidities are literally making it impossible (okay, extremely difficult) for the obese person to stop the cycle!

100 pounds overweight means that your heart and lungs do not work as efficiently as your smaller peers. It means that you often have diabetes, asthma, sleep apnea, arthritis symptoms, and a score of other ailments.  So, the obese person (100 pounds qualifies) cannot work out effectively without putting undue stress on the heart and lungs. That person has to stop and use his inhaler and make sure he's adjusting his insulin dose to compensate for the exercise, all while he's exhausted and dealing with pain from sore joints due to arthritis.

So, insurance companies are, IMO, being penny wise and pound foolish. WLS should be available as a first option in the obesity fight. Once you reach 100 pounds over the recommended weight, the insurance should be BEGGING the obese person to get the surgery. Losing that 100 pounds reduces the risk of tons of medical complications, which, in turn, saves the insurance company money. It shouldn't be a question of can I qualify for WLS. It should be a question of how soon they can convince you to have it done!

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