100 lb. Club - You know you live in bizarro world when…




Heather
12-08-2005, 12:13 AM
You WANT the doctor to tell the insurance company you are morbidly obese, rather than merely “obese,” because the insurance company doesn’t pay for treatment for mere obesity.

What kind of screwed up system is that??!


kaplods
12-08-2005, 12:53 AM
Yeah, but you know what is even more bizarre? People wanting WLS with less than 40 lbs to lose, and doctors willing to do the surgery on them.

Colleen

happydaisy
12-08-2005, 01:01 AM
I know Colleen! I'm so glad you mentioned that because I've seen people, even on this site that weight less and/or have less to lose saying they want weight loss surgery which amazes me. And scares me a little, I have to admit.


DishyFishy
12-08-2005, 02:28 AM
You WANT the doctor to tell the insurance company you are morbidly obese, rather than merely “obese,” because the insurance company doesn’t pay for treatment for mere obesity.I guess it would suck to be only just on the wrong side of the cut-off point.
Yeah, but you know what is even more bizarre? People wanting WLS with less than 40 lbs to lose, and doctors willing to do the surgery on them.There are still a great many misguided people who believe WLS is an easy way out. If they do get to have it, I reckon they're in for quite a shock.

Jen415
12-08-2005, 10:22 AM
What's even MORE bizarre.....people GAINING weight to make the cut-off!!!!!

teahoney
12-08-2005, 10:52 AM
What's even MORE bizarre.....people GAINING weight to make the cut-off!!!!!

I've never heard of that one but it doesn't surprise me.

Heather
12-08-2005, 11:35 AM
Oh my, I never thought of that either.

The issue I had is that I went for a weigh in and discussion about weight loss back in september, I think I weighed in at 278 or something on the docs scale. Insurance didn't cover it because she wrote down "obesity" not "morbid obesity".... I just want that visit covered.

I never realized all these other issues are out there. Does insurance generally only cover WLS if you are morbidly obese?

howie6267
12-08-2005, 12:58 PM
Well the cut off is supposed to be 100 over weight but many doctors fudge that. Plus there are the people who will gain that extra weight just to meet that goal. It just sickens me to see how some doctors are so quick to push that on there patients. I'm all for the surgery if you truly need it. I just think the guidelines should be a bit more stringent. Myself I don't even think it should be considered unless you are 200 lbs over weight. Even then I'm not sure if it's someone like me who was pretty healthy and able to get around. It just so drastic.

newfiedarling
12-08-2005, 01:32 PM
I just think the guidelines should be a bit more stringent. Myself I don't even think it should be considered unless you are 200 lbs over weight. Even then I'm not sure if it's someone like me who was pretty healthy and able to get around. It just so drastic.

I'm all for surgery for people that really don't have any other alternatives and that have done the research and contemplated the pros and cons. But I agree with with Howie, if you're able to do - do. It is indeed a very drastic procedure that I think too many people view as a cosmetic surgery and a quick fix, which is so far from the truth.

~Dee

lucky
12-08-2005, 02:18 PM
One thing I've always thought was weird is that most insurance companies will cover removing excess skin if you've had WLS but not if you've lost the weight on your own. WTF? I mean, is it any more medically necessary one way or the other? Don't get me wrong, I'm glad it is covered for WLS patients. I just don't understand why someone who qualifies for the surgery but opts to lose weight on their own wouldn't have the same opportunity to have their claim paid.

howie6267
12-08-2005, 02:28 PM
It really does suck but I think they have fallen for the same miss conception of a lot of people who have the surgery. And that is you can't gain it back which is not true. So they think someone who has the surgery is not going to gain the weight back so what they are paying is not going to be a problem in the future. Where if you lose it on your own it could be.

barbygirl43
12-08-2005, 03:35 PM
That does suck to be just on the middle of it. Had you went to your doctor a couple of months ago it wouldn't have been a problem.

Jawsmom--you are so right on that. We can only hope one of these days that will change. It's like you get punished for saving them $25,000 and doing it the old fashioned way. sheesh.

boiaby
12-08-2005, 05:26 PM
One thing I've always thought was weird is that most insurance companies will cover removing excess skin if you've had WLS but not if you've lost the weight on your own. WTF? I mean, is it any more medically necessary one way or the other? Don't get me wrong, I'm glad it is covered for WLS patients. I just don't understand why someone who qualifies for the surgery but opts to lose weight on their own wouldn't have the same opportunity to have their claim paid.

Don't even get me started on that one! Even though it's not an option for me since I don't have medical insurance, this still infuriates me.:mad: Who ever sets these ridiculous rules just needs a good swift kick in the rear, then they should be made to pay for their own surgery to remove said foot from rectum.:devil: Sorry, feeling a little resentful today!:D

Beverly

Heather
12-08-2005, 06:04 PM
Well, I was never considering surgery... just really going for a weigh in and find out about nutritionist, healthy weight loss etc. At that time especially, I think I would qualify as "morbidly obese" but it seems funny that I'm hoping that's the diagnosis.

But I think you have all answered the question as to why a diagnosis of "obesity" doesn't get covered, even for that kind of visit -- insurance companies don't want to pay for more surgeries (though I agree it should be a last resort!)

jiffypop
12-11-2005, 03:38 PM
i know a woman who qualified for wls by loading up her pockets with rolls of QUARTERS. after eating herself up another 20 or so pounds. and after losing a lot of weight, she's eaten herself right back up there.

as for the plastic surgery issue, it's truly bizarre. but it follows the general policy about approving plastic surgery if the need for it is the result of another surgical procedure. doesn't make sense, but that's the reason i've heard.

DishyFishy
12-11-2005, 05:25 PM
as for the plastic surgery issue, it's truly bizarre. but it follows the general policy about approving plastic surgery if the need for it is the result of another surgical procedure. doesn't make sense, but that's the reason i've heard.That doesn't make sense to me either. It isn't the WLS that results in loose skin, it's the big reduction in weight that's the cause. The patient still has to put in the work to get there. WLS is merely something that's designed to aid someone in their quest to shift weight. Well, so is a healthy diet and regular exercise, without the operation.