Source:
"After suffering a back injury three years ago, Neal Pittard's weight
ballooned from less than 300 pounds to 500 or more... Pittard and his doctors have
concluded that gastric-bypass surgery is his only realistic hope for
survival. But his insurance company doesn't see it that way. Nothing
unusual there: Few health insurers cover gastric-bypass and other
bariatric surgeries, most of which cost $20,000 to $30,000.
But Pittard's wife is a Florida Hospital nurse, and the couple are
insured by a subsidiary of the hospital's corporate parent, Adventist
Health System, which runs a nationally recognized bariatric-surgery
center on the campus of Florida Hospital Celebration Health.
With a Body Mass Index of 54, Pittard is well over the
morbid-obesity BMI threshold of 40. And, like most morbidly obese
people, he has other serious and life-threatening conditions, including
congestive heart failure, diabetes, sleep apnea, hypertension, asthma
and depression.
But despite letters of support from his primary-care doctor and
the recommendation of his cardiologist, Pittard's request for
weight-loss surgery was turned down twice last year. The procedure is
not a covered benefit and, according to one of the denial letters from
the insurer, Florida Hospital Healthcare System, it "does not have the
authority to override plan exclusions."
But the Adventist Health board can override such exclusions, said
Samantha O'Lenick, spokeswoman for both Florida Hospital and Florida
Hospital Healthcare. She said the Adventist Health board would review
Pittard's appeal on Feb. 20.
As for whether weight-loss surgery ever would be covered under the plan, she said that discussions are under way.
Though few insurance companies include weight-loss surgery in
their standard plans, employers still can offer it through rider
provisions, Sugerman said. Major companies such as Microsoft, Intel and
Toyota offer it, he said, because they see its value. Medicare last
year expanded its coverage for the procedure, calling it an important
option as long as it is performed by expert surgeons in properly
certified programs."
I wonder if, by going "public" with his story, does that effect the insurance coverage in any way? Will they be "guilted" into paying for the procedure because it's now public news? What typically happens if you put this out there - that you've been denied coverage? Has this happened to any readers? Discuss.
Source:
"After suffering a back injury three years ago, Neal Pittard's weight ballooned from less than 300 pounds to 500 or more... Pittard and his doctors have concluded that gastric-bypass surgery is his only realistic hope for survival. But his insurance company doesn't see it that way. Nothing unusual there: Few health insurers cover gastric-bypass and other bariatric surgeries, most of which cost $20,000 to $30,000.
But Pittard's wife is a Florida Hospital nurse, and the couple are insured by a subsidiary of the hospital's corporate parent, Adventist Health System, which runs a nationally recognized bariatric-surgery center on the campus of Florida Hospital Celebration Health.
With a Body Mass Index of 54, Pittard is well over the morbid-obesity BMI threshold of 40. And, like most morbidly obese people, he has other serious and life-threatening conditions, including congestive heart failure, diabetes, sleep apnea, hypertension, asthma and depression.
But despite letters of support from his primary-care doctor and the recommendation of his cardiologist, Pittard's request for weight-loss surgery was turned down twice last year. The procedure is not a covered benefit and, according to one of the denial letters from the insurer, Florida Hospital Healthcare System, it "does not have the authority to override plan exclusions."
But the Adventist Health board can override such exclusions, said Samantha O'Lenick, spokeswoman for both Florida Hospital and Florida Hospital Healthcare. She said the Adventist Health board would review Pittard's appeal on Feb. 20.
As for whether weight-loss surgery ever would be covered under the plan, she said that discussions are under way.
Though few insurance companies include weight-loss surgery in their standard plans, employers still can offer it through rider provisions, Sugerman said. Major companies such as Microsoft, Intel and Toyota offer it, he said, because they see its value. Medicare last year expanded its coverage for the procedure, calling it an important option as long as it is performed by expert surgeons in properly certified programs."
I wonder if, by going "public" with his story, does that effect the insurance coverage in any way? Will they be "guilted" into paying for the procedure because it's now public news? What typically happens if you put this out there - that you've been denied coverage? Has this happened to any readers? Discuss.