Dramatic weight loss complications
It's one of the most incredible weight loss success stories you will ever hear, it's also one of the most shocking. Mark Leipski reveals the health problem his insurance won't pay for even though the excess skin, is because he became healthy. You see, Mark used to weigh more than 400 pounds.
"I used all the excuses,” says Mark, “glandular problem, thyroid not working right, parents heavy set."
A normal day for Mark consisted of two, two-liter bottles of Mountain Dew.
“My idea was sit on the couch, eat a bag of potato chips and watch movies," Mark says.
Two big events in Mark's life motivated him to make a change. The first was his father’s dying wish that he would lose the weight, and then, a car accident. Mark says he was so big; he broke the seatbelt and was bounced around like a ping-pong ball.
"I was shocked, I never thought I was that heavy," says Mark.
Leipski who had already survived two heart attacks, also got a stiff warning from his doctor.
"He literally said, your 400 pounds and you’re bound to have another heart attack sooner or later," Mark says.
The doctor ordered him to have gastric by-pass surgery, but mark was resistant.
"I didn't want gastric,” he says, “I didn't want them cutting into me.”
Almost two years later, this father of two managed to lose 215 pounds, the old fashioned way. Today, he's dwarfed by his former giant jeans, fattening treats have been replaced with healthier low fat foods, and now, as a lifelong Weight-Watchers member, he tracks everything he eats. But mark's drastic weight-loss caused a serious complication.
“What I actually need done,” says Mark, lifting up the flaps of skin around his stomach, “there’s these lower panels and side panels, that’s all hanging skin."
This is the remnants of Mark's former self, but this isn't just a cosmetic issue.
“You have hanging skin and it leads to infection,” Mark says.
He uses products to soothe the excess skin. They work for a short time, but infections return. His doctor says plastic surgery is really the only answer.
“The skin reduction would cure the problem,” says Mark.
But Leipski's insurance will not pay for the surgery. We contacted Cigna, his health insurance provider, who says in a statement...
"We congratulate Mr. Liepski on his remarkable weight loss. Many insurance plans do not pay for this type of surgery, but we encourage our customers to take advantage of the appeal process."
Mark is in the middle of that appeals process. It's a lengthy he says, he’s not giving up on.
"I’m never going to go back to that 400 pounds,” says Mark, “there’s no way.”
Insurance plans that cover weight loss surgery, or skin removal after significant weight loss, often cost more. Cigna says that's why most employers pick plans without this coverage.
If you are in a battle with your health insurance provider over a procedure or coverage, we have some tips to help you fight for your rights.
1. Get help
Your doctor, hospital business office, and employee benefits office can be a lot more powerful than you are. There’s also a non-profit group called the Patient Advocate Foundation, which employs 72 case managers to help people work out insurance issues.
2. Be persistent
Appeal again and again and again. You may go through three or four levels of appeals before you get a favorable resolution," says Nancy Davenport-Ennis, co-founder of the Patient Advocate Foundation.
3. Use the right words
Certain words will trigger a denial, according to patient advocacy groups. For example, sometimes insurance companies refuse to pay for surgeries related to cleft lip or palate, saying it's not medically necessary. When parents appeal saying the child needs the surgery for "cosmetic" reasons or to "enhance esteem," the appeal often fails, according to “cleftAdvocate,” a group that works with families. Appeals that mention problems with "biting," "chewing," or "swallowing" are more likely to work.
4. Ask your doctor to try again
Often a tweak in paperwork will change everything. For example, Bailey Robinson took one drug for two purposes: It improved the effectiveness of his chemotherapy, and it helped his anemia. The insurance company refused to pay for it as part of his chemo. When the doctor re-filed the request mentioning anemia, it worked.
EMILY DISHNOW, REPORTER
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