Reporting Stephanie Stahl
By Stephanie Stahl
SEWELL, NJ (CBS) — Weight loss surgery is a life saver for millions and is often prescribed by doctors when diets don’t work. It’s routinely covered by insurance, so why did one New Jersey father get turned down? With his life in jeopardy, the family turned to 3 On Your Side desperate for help.
It’s a struggle just to stand for Bill Conway. He weighs 505 pounds and can’t walk on his own. But he still tries to play with his young sons.
“It’s killing me. You know, it’s just–my life has been challenging like you wouldn’t believe,” said Bill.
“He has so much trouble doing so many things,” said William, Bill’s son.
Bill, who’s six-foot-four-inches and lives in Sewell, New Jersey, says he’s always struggled with his weight, but never like this.
He broke his back in a horrific car crash eight years ago, and then there were a series of complications and knee injuries.
“From that accident to today there was continual weight gain. Initially after that first year, there was really no activity that I could really do,” said Bill.
He says the weight gain got even worse because of depression, prescription drugs and being laid off. Twenty pounds turned into 50 pounds and then hundreds more.
Stephanie asked, “Not to be insensitive, but I’m sure you’ve heard people say, ‘Why don’t you just not eat so much?’”
Bill replied, “Oh, I’ve heard that a lot. It’s a struggle every day. I’ve tried every diet you can think of, and there’s just been so many issues.
Bill’s doctors said weight loss surgery–a gastric sleeve–was the only solution. The family thought the policy covered the procedure and says all the necessary paperwork was provided, but Horizon Blue Cross Blue Shield of New Jersey repeatedly refused to pay for it, saying “medical necessity has not been established.”
“When I called the insurance company, they wouldn’t even talk to me about it. It’s my only hope. I believe that if I don’t have this surgery, I really don’t think I’ll live a very long life.”
Desperate, Bill’s wife Heather emailed 3 On Your Side.
“I was just thrilled that you actually got involved,” said Heather.
We called the insurance company, and three days later, Horizon decided to pay for the surgery. They said it had obtained additional information that was omitted in the original documentation.
“I am so grateful. Thank you so much from the bottom of my heart. You know, my new life begins because of the help you guys gave me,” said Bill.
Bill’s gastric sleeve surgery is expected to happen within the month. The average weight loss is 50 to 70 percent of excess weight over two years.
“I’m just so excited, and I owe it to you,” said Bill.
Experts say about 25 percent of patients considering bariatric surgery are denied insurance coverage three times before getting approval. About 60 percent report their health worsened during this waiting period.