My husband passed away on 11-16-06. We tried for 2 years to get our health insurance carrier to approve gastric bypass. His primary care doctor and his heart doctor both said he was going to die if he didn\’t have the surgery. He suffered from congestive heart failure, diabetes, high cholesterol, high blood pressure, sleep apnea, COPD and emphesyma. I think at the very least, insurers should have to approve payment of the surgery if the patient\’s doctor says they will die if they don\’t lose weight. My husband hadn\’t worked for years so obviously we couldn\’t pay for the surgery ourselves. I work and pay for health insurance through my employer and am very bitter that I was still unable to save my husbands life by providing him the health care that he needed. I think it\’s a shame that the health care providers are allowed to say \”no\” to treatment that physicians have recommended.
1. Having a doctor tell you to lose weight and telling you to have the surgery are two very different things. Should we be paying for poor eating habits?
2. The many side effects and hazards of the surgery are as bad or worse than the effects of NOT having it done. My neighbor died from the surgery.
Sounds like getting on a good diet and exercise program is the way to go if you can.
I can\’t beleive people would expect insurance companies to pay for their years of overeating and overindulging, but then again, insurance companies pay for many different types of surgeries-i.e. heart surgery for people who have abused their health for years. So why not gastric bypass???
Call me callous, but I have a hard time finding sympathy for those who allow themselves to get the point where a doctor tells them lose weight or die! And I say allow because a very small percentage of the population has a \”glandular problem\” that, despite all they do, they cannot manage their weight. The rest of those people CHOOSE a poor diet, they CHOOSE not to exercise, they CHOOSE to ignore the numerous warnings their doctors gave as their weight ballooned to 300, 400, 500 lbs. You don\’t go from healthy to morbidly obese overnight. And now you want me to pay (through higher ins. premiums) for your gastric bypass surgery because you are lazy and show no self discipline?!?!?!
Sorry, no sympathy for you or the smokers who ignore the warnings and get lung cancer.
Interesting comments from the gallery. We all acknowledge that weight gain is easy and taking it off and keeping it off is very hard. There is a point of no return for many people and in these situations of morbidly obese the aches and pains of just moving can become untolerable to them. Bypass surgery for most is just the kickoff effort to turn their life around. These are extreme but many conditions of complex interactions that spiral downwards unless weight loss program addresses and is required for gastric bypass to include psycho-social and dietary counciling for the individual and all their significant others. I doubt that the success rate is low for those that do not accept a program appoach to self preservation and weight loss.
WLS is one of the more unusual medical treatments in that it\’s long term success is dependant more on patient behavior than other surgical procedures. About 30% to 40% of WLS post-ops eventually regain enough weight to again re-qualify for the procedure. Maybe these legislative bills should include provision for recapturing funds from the patients who, after five years, have a BMI of 40 with no co-morbidities or a BMI of 35 with co-morbidities. This open ended blank check for people who fail to use their \”tool\” has to stop. It\’s essentially insurance fraud to have an insurer pay $20k to $40k for a \”tool\” that you choose to not use properly.
After reading some of your comments I feel the need to put in my two cents worth. I\’m 47 years old and have had a weight problem since childhood. Although I tend to be a big eater its mainly healthy foods, fruits, vegetables, baked fish, and chicken. Not sweets and lots of red meat that most would assume to cause this weight problem. No doctor is going to tell you to have this surgery unless you have already failed several exercise programs and diets. I have sleep apnea, take two different perscriptions to control my cholesterol, have a family history of heart disease and a degenerative lower back. These conditions are caused by being overweight, except for the degenerative lower back which is aggravated by the extra weight and limits my exercise to walking and swimming. The lapband procedure has a cost of a little over $14000, but my insurance does not cover it. Yet they do cover my other health problems, sleep apnea($3000 yearly machine and supplies) Two perscriptions ($500 yearly) Chiropractor ($1500 yearly). After three years The surgery would have paid for itself. I believe if it were to become mandatory they would find out it saves them money in the long term.
To the the poor ignorant soul who wrote \”Are you kidding me\” you are truly an ignorant person. I\’m 39 yo and morbidly obese in the process of trying to have the gastric banding done. Ask me how I \”got this way.\” I had always been thin until I was 23 yo and started having back problems. I\’m 39 now and have had chronic pain for 15yrs and over that 15yr period I gained over 100lbs. It wasn\’t because I was lazy! I am in constant pain. I went to the gym on a regular basis but had to take 2 tylenol #4\’s just to walk into the gym and more when I got home. I pity you and your ignorance about obese people.
Nope, still don\’t see it. I know of many people who haven\’t exercised a day in their lives yet somehow managed not to gain weight. It\’s a simple formula. Calories in vs. calories expended. If you are putting on weight, even over a 15, reduce your caloric intake! And are you telling me your doctor didn\’t give you many warning signs? Which you ignored? My doctor told me I needed to lose some weight. And for some odd reason, I considered him an expert in the field of health, took his advice to heart and lost weight. Hmmm… Funny how that works. Quit whinning and making me pay for your laziness!
If you\’re so perfect why did your doctor have to tell you to lose weight, or were you to lazy to get on a scale yourself. My guess is that you\’re young and still have your health. Well I have news for you, not many are able to stay slim and healthy all through life. If your doctor already had to tell you to lose weight, there is a good chance you will have weight problems in the future. Once you have fat cells they just shrink when you lose weight, they don\’t go away. So you may be in are shoes in ten years or so.
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My husband passed away on 11-16-06. We tried for 2 years to get our health insurance carrier to approve gastric bypass. His primary care doctor and his heart doctor both said he was going to die if he didn\’t have the surgery. He suffered from congestive heart failure, diabetes, high cholesterol, high blood pressure, sleep apnea, COPD and emphesyma. I think at the very least, insurers should have to approve payment of the surgery if the patient\’s doctor says they will die if they don\’t lose weight. My husband hadn\’t worked for years so obviously we couldn\’t pay for the surgery ourselves. I work and pay for health insurance through my employer and am very bitter that I was still unable to save my husbands life by providing him the health care that he needed. I think it\’s a shame that the health care providers are allowed to say \”no\” to treatment that physicians have recommended.
1. Having a doctor tell you to lose weight and telling you to have the surgery are two very different things. Should we be paying for poor eating habits?
2. The many side effects and hazards of the surgery are as bad or worse than the effects of NOT having it done. My neighbor died from the surgery.
Sounds like getting on a good diet and exercise program is the way to go if you can.
I can\’t beleive people would expect insurance companies to pay for their years of overeating and overindulging, but then again, insurance companies pay for many different types of surgeries-i.e. heart surgery for people who have abused their health for years. So why not gastric bypass???
Call me callous, but I have a hard time finding sympathy for those who allow themselves to get the point where a doctor tells them lose weight or die! And I say allow because a very small percentage of the population has a \”glandular problem\” that, despite all they do, they cannot manage their weight. The rest of those people CHOOSE a poor diet, they CHOOSE not to exercise, they CHOOSE to ignore the numerous warnings their doctors gave as their weight ballooned to 300, 400, 500 lbs. You don\’t go from healthy to morbidly obese overnight. And now you want me to pay (through higher ins. premiums) for your gastric bypass surgery because you are lazy and show no self discipline?!?!?!
Sorry, no sympathy for you or the smokers who ignore the warnings and get lung cancer.
Interesting comments from the gallery. We all acknowledge that weight gain is easy and taking it off and keeping it off is very hard. There is a point of no return for many people and in these situations of morbidly obese the aches and pains of just moving can become untolerable to them. Bypass surgery for most is just the kickoff effort to turn their life around. These are extreme but many conditions of complex interactions that spiral downwards unless weight loss program addresses and is required for gastric bypass to include psycho-social and dietary counciling for the individual and all their significant others. I doubt that the success rate is low for those that do not accept a program appoach to self preservation and weight loss.
WLS is one of the more unusual medical treatments in that it\’s long term success is dependant more on patient behavior than other surgical procedures. About 30% to 40% of WLS post-ops eventually regain enough weight to again re-qualify for the procedure. Maybe these legislative bills should include provision for recapturing funds from the patients who, after five years, have a BMI of 40 with no co-morbidities or a BMI of 35 with co-morbidities. This open ended blank check for people who fail to use their \”tool\” has to stop. It\’s essentially insurance fraud to have an insurer pay $20k to $40k for a \”tool\” that you choose to not use properly.
After reading some of your comments I feel the need to put in my two cents worth. I\’m 47 years old and have had a weight problem since childhood. Although I tend to be a big eater its mainly healthy foods, fruits, vegetables, baked fish, and chicken. Not sweets and lots of red meat that most would assume to cause this weight problem. No doctor is going to tell you to have this surgery unless you have already failed several exercise programs and diets. I have sleep apnea, take two different perscriptions to control my cholesterol, have a family history of heart disease and a degenerative lower back. These conditions are caused by being overweight, except for the degenerative lower back which is aggravated by the extra weight and limits my exercise to walking and swimming. The lapband procedure has a cost of a little over $14000, but my insurance does not cover it. Yet they do cover my other health problems, sleep apnea($3000 yearly machine and supplies) Two perscriptions ($500 yearly) Chiropractor ($1500 yearly). After three years The surgery would have paid for itself. I believe if it were to become mandatory they would find out it saves them money in the long term.
To the the poor ignorant soul who wrote \”Are you kidding me\” you are truly an ignorant person. I\’m 39 yo and morbidly obese in the process of trying to have the gastric banding done. Ask me how I \”got this way.\” I had always been thin until I was 23 yo and started having back problems. I\’m 39 now and have had chronic pain for 15yrs and over that 15yr period I gained over 100lbs. It wasn\’t because I was lazy! I am in constant pain. I went to the gym on a regular basis but had to take 2 tylenol #4\’s just to walk into the gym and more when I got home. I pity you and your ignorance about obese people.
Nope, still don\’t see it. I know of many people who haven\’t exercised a day in their lives yet somehow managed not to gain weight. It\’s a simple formula. Calories in vs. calories expended. If you are putting on weight, even over a 15, reduce your caloric intake! And are you telling me your doctor didn\’t give you many warning signs? Which you ignored? My doctor told me I needed to lose some weight. And for some odd reason, I considered him an expert in the field of health, took his advice to heart and lost weight. Hmmm… Funny how that works. Quit whinning and making me pay for your laziness!
If you\’re so perfect why did your doctor have to tell you to lose weight, or were you to lazy to get on a scale yourself. My guess is that you\’re young and still have your health. Well I have news for you, not many are able to stay slim and healthy all through life. If your doctor already had to tell you to lose weight, there is a good chance you will have weight problems in the future. Once you have fat cells they just shrink when you lose weight, they don\’t go away. So you may be in are shoes in ten years or so.