Life Changing and Medically Necessary

I need bariatric surgery and my employer doesn't cover it on the insurance policy. I have always been on the larger side but have been able to keep it somewhat in check by staying active. About four years ago I began experiencing all over pain, which was later diagnosed as fibromyalgia, which stopped me in by tracks. The weight started coming on as I could no longer be as active due to severe pain. I was told by several medical doctors that I should have bariatric surgery to assist in the weight loss therefore lessening the pain. Okay, challenge accepted. Well it wasn't that easy. I called my insurance company and they informed me that my employer opted to not choose bariatric surgery as part of their policy because they don't believe it is ever "medically necessary." I called my employer to see if there was anything they could do and the answer was no. I was stunned by the answer but I was not willing to give up hope. I called the hospital directly and spoke to the financial department to see if there was anything they could do. She suggested I take unpaid time of from work to become financially eligible for the hospital to cover the cost. I thought about whether this was morally right but decided that the need for the surgery was so great that I should continue this avenue. I took the time off from work, lost the weight I was supposed to lose, made great life changes and was so excited for the journey I was on. I spoke to the lady in financial services several times throughout this period to make sure everything was in place with all my T's crossed and my I's dotted. The three months were done, I was now financially eligible and life was going to be great. Not so fast!! The lady from the financial office called just days after I returned to work and with a nervous giggle in her voice. She said, "Um, I think I forgot to tell you that you will need to become financially eligible again before the surgery." "WHAT?" "Oops, ya, I thought I forgot to tell you that. Sorry." There was no way I could take another three months off from work and still keep my job.  I spoke to bariatric department themselves and explained the situation, They in turn spoke to others in the hospital and in the end they said it was my fault because I didn't read the fine print. I would have accepted this answer had the financial officer not told me that I could just wait to get the papers because I would have to go in and sign anyway. I guess it is my fault for trusting her to do her job correctly. 
In the meantime, the pain is almost intolerable at times, my activity level would be zero if I wasn't so determined to fight through the pain in order to have some semblance of a normal life. I have been diagnosed with over 100 fibroid tumors in my uterus and several on my ovaries that add a different type of pain to my daily routine. I was denied surgery to have my uterus out due to my weight. I have severe arthritis in my right knee that should call for a knee replacement but have been denied treatment due to my weight. I have looked into getting bariatric surgery in Mexico but quickly thought better of that. I have looked at other states and have not ruled out going somewhere that is less expensive. I am concern about pre-treatment and post-treatment if it becomes necessary to travel a long distance for the surgery.
I am at my wits end, caught in a catch 22, I can't move much because the pain is so great, but the pain will be better when I can lose weight and exercise. 

If there is any help you can give I would really appreciate it. My journey has been rough so far but I have not and will not give up. 


  • Jay Hester 
    • $100 
    • 2 mos


Kathy Bunker 
Ellsworth, ME
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