A Parent’s “Thank You”

Insurance coverage

Maybe it just strikes a stronger chord with us when we get an adolescent approved for bariatric surgery after an insurer dares to tell her parents “no – you aren’t going to have the chance to improve your daughter’s health.”

Because that is what the “no” means and that response doesn’t sit well with either of us as parents or as advocates.

Kelley and I are, first and foremost, parents.  It’s our main job in life.  We have two amazing children so we are quite pleased with ourselves and proud of the people they are becoming.  Like most parents we would do ANYTHING to help them be safe, happy and HEALTHY!

We just got a 15  year old girl approved for a bariatric procedure being performed under a research study protocol by a world-renowned surgeon.  That’s pretty special but, honestly, we’ve done that many times in the past.  I thought it important to share parts of the email I received from the mom because her words speak to all parents who struggle with helping their child deal with morbid obesity and the difficult journey towards surgery.

What this mom expressed is what any parent would feel:  desperation, hopelessness, and anger at the situation created by their insurer.  Not only that, but their hesitancy in even seeking help from us is understandable given the desperation and urgency they felt.  Fortunately they did not have to pay out-of-pocket and worry about the possible complications which might run hundreds of thousands of dollars.  They realized getting help was not a sign of weakness.

If this mom’s words to me after we secured her daughter’s approval helps to empower even just one other parent to fight an insurer who is saying “No” to their child, this most certainly will have been a blog post well worth making!

“…We will do whatever we have to do to ensure their well being and in this case that meant surgery for our daughter. When the insurance company said she did not need the procedure, our first reaction was outrage. How could they say she did not need the procedure, when three of her doctors and we, as her parents, all believed that she needed the procedure. Our second response, was to remove the obstacle to our daughter’s well being. Even though we pay for insurance to protect the health of our family, if their decision was not to pay for the procedure we would find a way to pay for it ourselves. They were not going to stop us.

When the suggestion was made that we contact you before paying out of pocket, we were very hesitant because we thought it would be a waste of time and money, and as we were going to pay out of pocket, regardless of the outcome, this was money that we needed. Making the call was the best decision we could have made. Our conversation provided me with information that we did not know and gave us an opportunity to step back for a minute and let someone try to help. Realizing that delaying the decision to pay out of pocket was not a sign that we loved our daughter any less or did not prioritize her well being.

The letter of appeal that Walter wrote was exceptional. Although I had a vested interest in the outcome, I could not imagine anyone reading the letter and denying the appeal. The time the insurance company took to review the appeal was torturous. Our plans for the timing of the procedure were ruined, and not being in control of this “thing” that was affecting our child was almost maddening. You handled my anxiety and numerous e-mails by letting me know that I was still in control and could move ahead while reminding me of some of the adversities of that decision.

We can not thank you enough. Our best to you and your family and we will send you update in a few months. Thank you.”

601-C East Palomar Street #480 Chula Vista, California 91911 Tel - 877-992-7732 Fax - 844-384-9199

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