JourneyOfAFatKid

Soooo, I got denied for my insurance because basically, Im fat, but not fat enough and Im "too" healthy. I have a BMI of 38 and at the time of my weigh in weighed 248lbs and my height was at 5'7 1/2 (i slouched a little lol) and I am NOW (about a month later) weighing in at 253lbs but it hasnt been documented. My insurance is (empire BCBS) telling me that I either need to have a BMI of 41 or higher or I need to have a co-morbidity with my current BMI and I dont. Im very healthy, Im just fat. But apparently not fat enough. So i guess my question is, would it be ethical to gain 12-15 more pounds just to get this insurance approval? Because when push comes to shove, without it, Im not getting this surgery. I just cant. So any advice on how to gain a quick 12 to 15lbs? or advice on what to do at all? Thanks <3 Caitlyn

probably not if it was only for an hour! lol

SUBSCRIBED!!

Soooo, I got denied for my insurance because basically, Im fat, but not fat enough and Im "too" healthy. I have a BMI of 38 and at the time of my weigh in weighed 248lbs and my height was at 5'7 1/2 (i slouched a little lol) and I am NOW (about a month later) weighing in at 253lbs but it hasnt been documented. My insurance is (empire BCBS) telling me that I either need to have a BMI of 41 or higher or I need to have a co-morbidity with my current BMI and I dont. Im very healthy, Im just fat. But apparently not fat enough. So i guess my question is, would it be ethical to gain 12-15 more pounds just to get this insurance approval? Because when push comes to shove, without it, Im not getting this surgery. I just cant. So any advice on how to gain a quick 12 to 15lbs? or advice on what to do at all? Thanks <3 Caitlyn

The only problem is that my last appointment where i weighed in at 248 was 6 weeks ago. In order to become a BMI of 41 I have to weight 270. It would be hard for even me, to gain 22 pounds in 6 weeks... I dont want them to get suspicious...lol

lol you guys are funny. I might just do it!

Soooo, should I just call my insurance and beg?? lol I dont know how to write an appeal letter for this type of rejection... Im not sure how to convince them that it IS medically necessary... Any ideas or templates? lol

Hey everyone. I was recently denied by my insurance and so now I am trying to research all of my options. If you don't mind sharing, what did going to Mexico and having the surgery there in the very end cost you, all together (passport, flight, stay, everything!). The cost of my surgery here without insurance is something around 14 or 15k. What would I look to spend going to Mexico, in money and time? (ie: getting a passport, how long did it take to get one?) All stories and advice are welcome... Thanks so much! <3 Caitlyn

Ha! The burger thing is funny, I try and do that too with at least one bite of everything I eat just to see if I will still be able to stomach it after my surgery...LOL so far, not much luck in finding something that tastes nearly as good liquified...lol

Wow! Thanks everyone for your responses! It really helps, so the bulk amount, the 4500.00 or 8750.00 or whatever, covers everything medical and stay and recovery?

I have done all of the former workouts and the psych eval and all of the previous diets and I have lost weight. however, I gained it back. I wouldnt be trying to get the surgery if it werent a last resort. Im not looking for an easy way out.

My surgeons nurse took before pics of me at my consultation, but i was in a t-shirt and capris... no nude stuff for this girl!

Id rather not go to Mexico if I could avoid it... I trust that the doctors are amazing from what everyone here says, but if I can get it done 5 minutes from my house I would rather do that. I live approximately 10 miles from the hospital I would be going to.

LMAO! You better believe I would too!! I just dont know where i would hide them so that it wouldnt be noticed! I dont want to get caught and look like a fool!!! hahahaha!!!

This is verbatim what my denial letter says. "The request for coverage of surgery for obesity is not approved. The member has a BMI of 38. They are also reported to have heart burn, some pain and swelling in the feet and ankles, and low back pain. for a person with a BMI from 35 to 40 there must be serious medical problems related to obesity (such as life threatening heart or lung problems, significant diabetes mellitus, heart disease, or hypertension). The notes provided do not meet the health plan medical policy: Surgery for Clinically Severe Obesity, to show that the surgery is medically necessary. Without records showing such disease the member is not considered a candidate with a BMI between 35 and 40." So I tried to complain about as many things as I could. lol It wasnt good enough, so i dont know if bad cholesterol will be enough for them... My blood pressure is 120/80.... I was thinking of investing in ankle weights!!! LMAO

This is verbatim what my denial letter says. "The request for coverage of surgery for obesity is not approved. The member has a BMI of 38. They are also reported to have heart burn, some pain and swelling in the feet and ankles, and low back pain. for a person with a BMI from 35 to 40 there must be serious medical problems related to obesity (such as life threatening heart or lung problems, significant diabetes mellitus, heart disease, or hypertension). The notes provided do not meet the health plan medical policy: Surgery for Clinically Severe Obesity, to show that the surgery is medically necessary. Without records showing such disease the member is not considered a candidate with a BMI between 35 and 40." So I tried to complain about as many things as I could. lol It wasnt good enough... My blood pressure is 120/80.... I was thinking of developing ankle weights!!! LMAO

wow! congrats on your loss!! You look amazing! and I am in LOVE with those heels in your before pic! That bikini is super cute too!!!

I too am interested in all of the responses here. I also have a two year old daughter and want so desperately to be healthy for her. But I think for me, its not so much the complications of the sleeve, as it is the surgery itself. Im afraid of being put under and not waking up. I am a total control freak and hate taking even asprin, let alone being put to sleep. Sheesh!

Ok so, the nurse at my surgeons office called me today to schedule my CONSULT! YAY! I got the surgeon I wanted too! (Dr. Sydney Hu) DOUBLE YAY! ANYWHOO, so i went and turned in my absence request for my employer and he told me that he wasnt sure that they would be happy to give me all this time off. So I said "well its for surgery, Im going to HAVE to have some time off" to which he replied "well, we dont HAVE to employ you" uuuuummm....??? say what? what am I supposed to do with that??? Just in case... does anyone know anyone hiring an administrative assistant in the Topeka Kansas area!? lol SHEESH! Is there anyway to make everyone happy in this scenario??

Can I be part of the cool kids and hang out with you guys even though I'm a stinkin Topekan? Lol