Question:
Do you feel like all insurances should pay for WLS? IF so Why?
— sherri parker (posted on April 8, 2003)
April 7, 2003
Some states require it to be covered, I think it should be a federal law.
It should drop the unnecessary rules like 5 years of being MO, and long
diet requirements too.
— bob-haller
April 8, 2003
I think all insurances should cover wls because everyone should have the
option to have the surgery. It can save alot of lives and cheaper in the
long run. Example, if my cousin could of had the surgery when he was
younger, it would of helped with his diabetes, and in helping with his
diabetes he probably wouldnt of had to have a food amputated and some toes
on his other food amputated due to infection from diabetes.
I think that insurance companies could really benefit from wls as much as
the patients who have it. It could save them alot of money in the long run
because you lose more then weight, most people become more active and
healthier so the more healtier you are the less you need to go to the
doctors and the less you go to the hospital.
I think every mo person should have the option available to them whether
they take the option or not is a choice they should have.
— rachel W.
April 8, 2003
Hi. Please keep in mind that in some cases it's the EMPLOYER that wishes
for certain procedures to be excluded from a plan. However, I do agree
that WLS should be available for anyone meeting the minimum requirements.
Some companies do add ridiculous requirements as mentioned below, such as
being MO for 5 years or longer. Anyway, I did want to point out that it
isn't always the insurance company that is holding back on insurers, as
many times it's your employer!
— roryleigh
April 8, 2003
I believe all insurances should have to pay for wls if you qualify. The
qualifications should be strict though. A BMI of 40...and a demonstrated
inability to lose the weight and keep it off through conventional means. I
don't think it would be a very good idea for wls to become a fad diet,
which is what would happen if it were not strictly guarded.
There should also be a mandatory, insurance covered psych eval and follow
up psych---how many times do we see people unable or unwilling to adapt to
the post op way of life? And then blame the surgery or their surgeon. I
also believe that any and all medically documented plastic surgery should
be covered after wls. Have a Sparkling Day! ~CAE~
— Mustang
April 8, 2003
I think that all insurance companies should cover this but there have to be
strict guidlines. I see that some people disagree with the being MO for 5
years to quilify but I think that there is a reason for that just like
there are reasons for all the other requirements. I don't think you can
truely say you have tried everything out there to lose weight if you
haven't had a weight problem for some amount of time beforehand. I think
that employers should consider the needs of there employees when choosing a
plan. If they have a number of employees who are overweight or obese then
this should be an option in their plans, even if it costs the employee and
the employeer a little more in premiums.
— S C.
April 8, 2003
— Amber L.
April 8, 2003
Since everyone has pretty much covered all the bases on this question, I'll
keep my two cents to myself. BUT, I did want to say to <b>Amber -
GREAT RESPONSE,</b> you were pretty much dead on as far as tappin'
into this brain of mine and voicing my thoughts!
— [Deactivated Member]
April 8, 2003
IF this surgery were for purely cosmetic reasons then I could understand it
not being covered. But for some people its medically necessary, which I
believe should then be covered.
I also think that for this surgery that the restrictions should be
enforced, like the diet history and the physician followed diet, exercise
program, psych exam, and possibly therapy to make sure that the patient is
truly ready and not pulling the wool over your eyes just to have it.
I have 2 insurances and one requires the 3 mths supervised diet and the
other requires a 6 mth supervised diet. Thankfully my PCP knows me quite
well and knows how much I have tried to lose weight and I have even gone
thru his weight loss program and didn't have much success. So at least I
have the proof that I have tried several methods to lose the weight.
— Beverly S.
April 8, 2003
I feel it should be covered by all insurance companies and medical aid
services. The reason I say this is because obesity is a disease that needs
treatment, surgery helps most people live a longer healthier life.......
— Deanna Wise
April 8, 2003
Amber you're well spoken and have a head on your shoulders. The one thing
I have a problem with is this. Insurance companies aren't offering
insurance to cover it for us and just asking us to pay more. They are
REFUSING to allow overweight people access to these plans. I'd HAPPILY pay
for insurance, even though its more costly, BUT the only plan I've even
found in my state (BC of Id) refuses me access. They consider me a
"high risk". My state mandates that they allow everyone access
but the problem is the plans they offer by mandate are terrible and
certainly won't ever cover WLS. So being obese I'm lumped in with cancer
victims and those with heart attacks as "high risk". I realize
they are in business but I feel by denying us QUALITY coverage and access
to plans that would benefit us they are really just discriminating against
us. And as for employers. Any and all employers (unless maybe they have
agreements through a union or some such) aren't going to ever opt for
anything but the bargain basement plan. I live rurally and those who do
happen to offer insurance to their employees offer very limited coverage.
Again its through BC (as always here) and so far I've not seen a plan
around that covers WLS.
— Shelly S.
April 9, 2003
I live in Canada where health care is covered by our provincial
governments. This coverage includes doctors and specialist fees, diagnostic
testing, blood work, hospitalization and meds rec'd in hospital,
anithesiologist for surgery. The provincial government health plans are
paid for by taxes deducted off of our paychecks. For a person making
$35,000/year that tax grab would be about 25%. We do consider ourselves
taxed to death.
Our health care system is a mess, money is collected and we don't receive
the services we should. Although we have all the latest technology and very
nice hospitals, we have a major shortage of doctors and hospital staff.
Many have left Canada to work in the U.S. My husband, like many other
Canadians, pays for private insurance also through his employer at a cost
shared 50/50 with his boss. The 50%amount for us weekly is $34. This
coverage is for prescriptions, 80% of dental, eyeglasses and a death
benefit. The American system looks good to me except for all of the
documentation and red tape required. Many of you have difficulty
understanding your coverage, not your fault, they make it difficult to
understand. Many of your consults and diagnostics are not covered but might
be if you appeal. Some of your surgeons take care of all of your paperwork
and with others you have to do all of the paperwork and phone calls
yourself. This is very confusing to me because Canadians don't have to do
any paper work at all. Your surgery dates come quickly, YEA!!!by that I
mean with your insurance you get a surgery date within a 4-8 month period.
Here we don't have to pay a dime for wls or do paper work but the wait time
is a good 2+ years. Our surgeons are excellent, skilled, kind and not in it
for the big bucks but there are only about a dozen here in Canada that do
wls. Surgery and hospitalization is not big business here, there are no
'middle men'(insurance co.) so the surgeons that stay in Canada are in fact
in the medical profession to bring good health to ppl who are sick or
diseased not to be millionaires. There are obvious drawbacks and benefits
to each system and both could stand major improvments in access and
services. Less paperwork for Americans and more wls doctors for Canadians.
— mary ann T.
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