What can I do? I am so frustrated.

[Tina Martin 0]

Hi everybody. My name is Christina. I am from North Texas. I am 23, happily married for four years and a full-time student about to graduate. I have a seemingly good life, except for the big elephant in the room...which is me. I currently weigh 356 pounds. I have a BMI of I believe 58.1. I decided about 5 months ago to go to a Lap-Band seminar, and met up with "True Results". I have been doing all of my lap-band insurance approval requirements through them. I have Aetna: Open Access. I went through the four-months documented nutrition meetings, chest x-ray, blood work, psychiatric evaluation, sleep apnea test and submitted all the documented "weight history over the past two years" that I could. Here is my problem.

I was denied.

I was denied because I could not prove that I have been morbidly obese for two years. I did not have insurance until about 6 months ago. I did not have insurance between 2008-2010. I found two more records today from 05', and one from 07' from an emergency room. I do not know what to do. I was wondering if anyone had any suggestions? Can I submit pictures with time stamps? I have plenty of those. I would really appreciate all of the advice/help. You are all such wonderful, strong people. I have been reading your boards for months and never had the courage to join and say anything myself.

Has anyone else gone through this? What should I do?

Thank you,

Christina.

[cheryl2586 3,053]

Usually insurance companies want proof via a doctor that you have been obese for over two years with no way to control your weight. It has to be documented in your chart for two years. If you only have sporadic times you saw a doctor and the ER doesnt count then they may want you to wait two years unless you have severe comorbidities like diabetes or high blood pressure

[Tina Martin 0]

I do not have diabetes. My doctor told me I am "pre-diabetic", but I do have high blood pressure.

[Rachel412 116]

I would imagine the ER records would help... do you have any doctors records from before 2008? I mean I'd assume they realize if you were obese 3 or 4 years ago, you didn't get magically skinny in between then and now... but I'm just guessing.

[TKW 501]

Don't give up, where there is a will there is a way. Quite a few people on this forum were denied and appealed and got the surgery. Hopefully some of them can shed some light on it for you. Good Luck!

[njm 0]

My insurance company accepted date stamped photos

[stateofzen 46]

Many insurance companies do accept dated photos. Just keep appealing and get your doctors to help. It is assinine to believe that someone was obese in 2004, 2007, and 2010 but not in between 2007 and 2010. It's not like you're on the border of obesity. You should have a strong case of appeal with pictures and the emergency room data.

[Tina Martin 0]

I did find some records from 2007, and two from 2005. I did also find some pictures. One with a time stamp and one without. I am hoping that this goes through!

[thsisme 14]

call the customer service hotline and ask them if they take time/dated photos and if they will take the documents that you do have. prediabetes and hypertension are comorbities, if you have joint problems, this can be considered a comorbidity. Good luck!

[xavier 153]

Just don't give up!!! The insurance company is betting their money that they can wear you down and you'll go away! Keep going!

[PJ384 3]

Hi everybody. My name is Christina. I am from North Texas. I am 23, happily married for four years and a full-time student about to graduate. I have a seemingly good life, except for the big elephant in the room...which is me. I currently weigh 356 pounds. I have a BMI of I believe 58.1. I decided about 5 months ago to go to a Lap-Band seminar, and met up with "True Results". I have been doing all of my lap-band insurance approval requirements through them. I have Aetna: Open Access. I went through the four-months documented nutrition meetings, chest x-ray, blood work, psychiatric evaluation, sleep apnea test and submitted all the documented "weight history over the past two years" that I could. Here is my problem.

I was denied.

I was denied because I could not prove that I have been morbidly obese for two years. I did not have insurance until about 6 months ago. I did not have insurance between 2008-2010. I found two more records today from 05', and one from 07' from an emergency room. I do not know what to do. I was wondering if anyone had any suggestions? Can I submit pictures with time stamps? I have plenty of those. I would really appreciate all of the advice/help. You are all such wonderful, strong people. I have been reading your boards for months and never had the courage to join and say anything myself.

Has anyone else gone through this? What should I do?

Thank you,

Christina.

[PJ384 3]

did you go to your primary care doctor and ask for copies of your medical visits over the past 2 or 3 years? I had to do this and it was extra hard because my primary care doctor had in fact died so time before and I had to go back to every doctor I had ever seen in the last 5 years and ask for any records they might have on me that showed my weight and the date it was recorded so take a moment and think back on every doctor you ever have seen for any reason in the past few years then call them and ask for copies of all your visits to them that have a date and your weight recorded on them but do not give up it is the insurance companys job to keep expenses down and so they will use every reason no matter how weak to deny you so make sure you know exactly what they require your surgeon should be able to tell you exactly what you have to have documented to get approved then make sure you have it in spades if they want 2 years give them 3 or 4 if they ask for one doctors letter get 2 or 3 and I believe you will be successful.