Mrsace13

I am going to call my insurance, however I was wanting to know if anyone here knew first. My friend told me that most insurance's now do not require you to have a BMI of 40 or higher, has anyone heard that? I used to be on here daily and have not been on in so long since my insurance denied me since at that time my BMI was 39.4 and I did not have any medical issues that they felt were reason enough to cover it. Since then my weight is up and down and up and down, I am going crazy with all this. My friend is about to get bypass and she just told me this. Thanks, and again I know I need to call my insurance. I haven't gone through to see if any of my old friends are on here, if you are HI!! Teresa Haha, just saw my weight info on here and dates of my Dr visits, that was a couple of years ago too.

Wow, I called my insurance and they told me as of 2011 that do not cover any type of sergury for weight, nice to know that now!! OK, just a sign to not have it done I guess.

I have B/C B/S OH and they have denied me because my BMI 39.4 and I do not have two (even though my policy does not say I need two) medical conditions. They did the Peer to Peer and denied again. I wasn't sure how that works since the only thing they could talk about would be the paper work they already had when they denied me the first time. Too much stress so I waited until after the holiday to start going 100% with this appeal again but I don't know what I can do. My dr office is sending me a package so I hope that helps me understand. My dr office said to keep calling my insurance, but what am I supposed to be saying or asking if I call daily??? My BMI is now 40 with the stress and of course the holidays just ending. I also round up saying I'm 5'4" when I'm really 5' 3.5" and the half does make a difference with BMI, lol. I told my dr office that today and she said we could do a new weigh in and send it but since I have not had a BMI of 40 or more for the last two years that we shouldn't go there, I don't understand that, it doesn't say in my policy that I have to have a BMI of 40 for two years but I know my dr office knows what they are doing. I'm just feeling no hope at this time, I'm so depressed and stressed out. I was so excided thinking I would be banded by Jan and now I'm wondering if I'm ever going to win this. I know I wont give up but I just don't know what I should be doing, writing, saying when I call, I feel lost. I guess I don't have any of the medical conditions even though I have never been to a sleep study but my dr said not to do that right now so I don't know what to do. Any help would be great!! One of you had emailed me your appeal letter and it was great but I guess I don't have medical conditions to add even though I am a 40 BMI now. Thanks, I really need this. I have other issues and I cant even hardly walk due to my weight but that is not life threatening they said. I am in pain daily due to my weight, I need some off to even start working out.

Walter, thank you. They did a peer to peer and then sent me the package to do my letter. Nan, I HAVE HER LETTERS, THEY ARE PERFECT!! She emailed them to me and I am doing the same thing, using hers as a shell letter and filling in my own info and yes, crying as I am doing so. I just pray my end result is the same as yours.

Thank you to all that are here for me. I really feel like giving up, maybe this wasn't meant for me. With the holiday stress and my grandmother going in the hosptial two days before Christmas I decided to wait until after the holidays to fight full force, I have been working on my appeal letter and wanted to get it out by tomorrow. My grandmother passed away at 4 pm yesterday, even with knowing she is in a better place and out of pain, it is still so hard and watching my mother cry is hurting me so much. So again, hard to work on my letter again. I feel like I'm fighting something I can't win. When they put my info in my BMI was 39.2 or .4 or something so they denied me. I guess I dont have have life threatening issues and of course that is a good thing. I really thought they would find something if needed. So now that I know my BMI is over 40 since I quit smoking, stress and the holidays, it hasn't been over 40 before so they don't want to try to use that. I feel stuck. So I am going to do my best with my appeal letter and if I get denied again, what more can I do? Does anyone know, if I decide to not appeal after that, how long do I need to wait to start fresh and do another claim knowing I'm over 40 BMI now? I dont know if I'll have to do all those visits and $$$$$ again that I have done. This is so stressful!! I wish I could afford to be a self pay and just get done!! Thanks again everyone, I just feel defeated!!

I called my insurance this morning since they said last week it was pending and should be completed soon. I was told it was denied but now pending again and they were waiting to hear back from my doctors office. When I called there they said they were already on it and in touch with my insurance. Later my dr office called and said it looks like they are going to deny me since my BMI is a 38 and they dont think I have enough medical issues. I dont know what more they want from me!! My PC dr wrote on the letter that I have pain with walking and so on. Dr office said she will give me the information to appeal it. I will appeal it until they approve me, I will not give up on this. I have so much pain from my weight. I hope to hear something tomorrow. I am going to call first thing and see who will talk to me. I can't get denied, I just cant!!:cursing:

Holidays can always be hard and you were new and not fully into your new habits. The holidays are now over, it is a new year and a new life for you. Dont think about the past, let it go and move on. The more you think about what you DID, the harder it will be to go forward. New day, good luck

Suzanne, Thank you so much for sending me your appeal letters. I feel they are going to be very helpful with my appeal. I just received my appeal package and everything they told me to put in the letter, you already had. So it was great to use your two letters as a shell letter. I need to see my PCP to record updated information and then I should be ready to send it off. Wish me luck. If they do not already have a place here or a site, they should make one where people like you can send in approved appeal letters that others like me can use as a shell letter. Thanks again and I will let you know what happens.:tt2:

My drs office is sending me an appeal package and I am starting my letter. Anything that might have helped you in your letter, please advise me. I have gained weight as you can see by my ticker. I'm sure it is the stress of this, the hoildays and I quit smoking. I am not trying to gain weight and I don't want the insurance to think I am.

When they submitted it to the insurance my BMI was 39.4 so they are now giving me a hard time since I guess I don't have life threatening issues that we are aware of. I guess I just have to fight it with the fact that my BMI is over 40 now, my Wii Fit said so!! LOL, well, not funny but the stress is making me gain too!!:frown:

Is there a place I can find a list of the conditions they are looking for? I really think I need to go to a sleep study even though my dr office said I didn't need to do that. If I have sleep apnea, the insurance needs to know that. I just don't know if I have any conditions, I did the blood work they requested, would all of that been covered in that? I'm not to bright when it comes to these types of issues.

Great, that gives me hope. I'm going through an appeal now. What was the reason they denied you?

I messured my height and I'm 5' 3.5", not 5' 4" and that doesn't sound like a lot but when it comes to a boarderline BMI it means everything, lol. I can't do the appeal stress with the holiday stress so I'm trying not to think about any of this until after the holiday but then I will be 1,000% back to fighting them until I win. Thank you for your words and thoughts

I live in Royal Palm Beach (West Palm) and having my surgery with Dr. Wisman in Margate.

Just my update After the peer to peer the other day I was waiting for my dr office to call me, they never did so I couldn't handle the stress anymore and I called my insurance to find out that they said we needed to appeal. So I have been waiting to hear from my dr office, still haven't so I went ahead and called them. The girl that starts the appeal was out and they will be sending something and contacting me tomorrow. I keep offering to come in and weigh in again. They said my BMI was 39.2, after this stress it will be doubled soon if they don't get this done, lol. So, again, I'm waiting. I'm trying not to even come on here much. I need to keep my mind busy. The stress of all this is really making me sick, I can't even sleep, I'm not a person that crys much but this is really pushing me there:cry_smile:. I need this so bad and I'm sure I will be approved in the end since I'm not giving up anyway until I am, this waiting game and being told that they do not need me to do anything right now is killing me. I feel like I need to call or write or something!! Thanks for being there for me just to rant, I'm just sad today.

I finally got the denial letter and it said that I had gerd so I guess I don't need to prove that. The letter does not match the policy so I'm about to start fighting this. Thanks Jodi

I have been declined and now need to start an appeal. I know I have GERD and that is one of the medical conditions that are on my policy but I don't know how to prove it. I know records should be at my old dr office that is now closed that I had perscriptions but years ago when Prilosec OTC came out I noticed it was less expensive than my co-pay from my insurance so I have used it for years now and love it. So, how do I prove that?? I never really spoke about it with my dr. since the Prilosec OTC was working and I didn't feel I needed to. So, how do I prove that?? I guess I need to make an appointment with my PC dr. and get some things on the record here.

YOU SOUND LIKE ME!!!! We are not alone!! I call everyday too. That is what they did today, a peer to peer and sorry, for me anyway, they still said to appeal. I didn't know what my dr could tell their (insurance) dr that wasn't already in the paperwork. So, I guess I will let the dr appeal it too, but it is NOW time for me to speak as well. I'm getting ready to appeal and WIN!!!!

Do you have an update yet??

Thanks SO much!! That really gives me hope. I have the guidelines and thought I had enough problems but I guess I need to prove them better to them. My BMI was so close and I know I'm a 40 now so maybe I need to go let them weigh me and send it in. The dr has talked to the insurance dr today and I am waiting to hear back today if they approved me or do I need to appeal. I really think they are going to make me appeal this. Thanks for the hope. I hope it doesn't take 5 times, lol, they will need to add stress issues then!! LOL.

I know my dr has spoke to the insurance dr today and I am now waiting on the results. I really don't know what they can talk about. This dr has met me for 10 mins but I guess he knows what he is doing. It would have been better to speak to my PC dr that knows me. So, I'm just waiting now to find out if I still need to appeal it. This is so stressful. I'm off work today, I wish I was working to keep my mind busy, lol.

From losing and gaining already before the band they are already saggy so I'm sure they are not going to get any better. I have plans to have them lifted after I get to my goal, that will be my gift to myself after I work so hard to lose my weight.

poodles.me, I know what you are going through. I have been waiting on my approval and doing the same thing. Even my co-workers have noticed I am not eating good now. I think it is in my head that I feel like I don't need to diet now since I will be changing my life soon. This is such wrong thinking and like you, we both know it. I tried too to start practicing the pre-op but my head just wont allow me to. Now I was denied and will need to appeal and worried about my eating habits I have started. I have to get on track. But you will be done soon and on your way to your new life. Good luck to you!!

They said my BMI was a 39.4, if they need it 40, after the holiday, weigh me now, lol. I said that to the girl that works with the insurance at my dr office and she said sometimes they still want medical issues with a 40, but I would fight that too, if that is what they want, then they would need to have that in their policy. I know what you are saying, when I see someone approved or denied, I do feel like a family here and get happy or sad for them too. I get on here at least once a day just to check on people or to see the updated pics. Thank you and I will update when I know something.:angry_smile: