Oh Well - So Much For That

[eyeononederland 27]

My doctor's office just called.

I told them from day ONE that my BMI is not normally > 40. It registered 40.1 at my first visit. It's normally about 38.

My insurance requires 2 years' history of a BMI > 40 (without comorbids). I pointed that out on DAY ONE and was told by the SURGEON HIMSELF that it was fine and not to worry.

Well...now I'm told there's nothing I can do that will help. Too late for the sleep apnea test, and even if I did have it, I don't have the other qualifying comorbids.

I guess I'm on my own.

I'm not giving up, I'm just frustrated.

I'm going to continue exercising and watching what I eat. I've lost 3lbs this week already.

I'm determined - with or without WLS - to not continue down this path.

I wish all of you the very best of luck.

[NWgirl 574]

Good luck on your journey

[Sara75 8]

I was in your shoes several years back. It's a stupid rule because at the time I could prove I was gaining and gaining each year. Here I am several years later over 100 lbs over weight and just had my surgery. If only they had done it years ago! Good luck to you! I hope you find another tool that works for you,

[PattyGirl66 1,243]

OHH I am so sorry to hear about this! what horrible news! I really hate some of these insurance rules.

I wish you only the best, keep in touch with us and let us know how you are doing hon

[eyeononederland 27]

Thank you!

[waitingpatiently 250]

I'm so sorry...I know that is very dissappointing!! hang in there. Any chance in doing self pay?

[eyeononederland 27]

I'm so sorry...I know that is very dissappointing!! hang in there. Any chance in doing self pay?

Absolutely not. Broke as a joke as it is.

[waitingpatiently 250]

Absolutely not. Broke as a joke as it is.

That really sucks!! Take your day to wallow...you deserve it. But tomorrow....You still need to get busy. This is just a speed bump. Your health is still just as important as it was when you decided to do the surgery. There are a lot of people in this word that love you and need you to be healthy and fit. This blow means a different approach will be needed but the goal is still the same......a healthier you here for a long time to come.

If you every need a sounding board please email me thenoelsx7@msn.com I know you can still do this!! Head high!! walking shoes on!!! junk food in the trash.Take the challenge...it will be worth it.

Attitude is everything!!!

[eyeononederland 27]

That really sucks!! Take your day to wallow...you deserve it. But tomorrow....You still need to get busy. This is just a speed bump. Your health is still just as important as it was when you decided to do the surgery. There are a lot of people in this word that love you and need you to be healthy and fit. This blow means a different approach will be needed but the goal is still the same......a healthier you here for a long time to come.

If you every need a sounding board please email me thenoelsx7@msn.com I know you can still do this!! Head high!! walking shoes on!!! junk food in the trash.Take the challenge...it will be worth it.

Attitude is everything!!!

Thank you. I might just take you up on that sometime!

I think the hardest part about this is that when I decided on surgery it was because I had told myself I couldn't do this on my own. Now I have to.

I think this has been a reality check for my husband, too, though. He admitted last night that he has not been terribly supportive or motivating. He was banded 2 years ago and is just 20lbs from his goal weight now. He has some restriction, so he can never eat much at one time...which means he may only eat a few bites of dinner, and then later he'll have some ice cream or some other "slider." Me? I eat all my dinner...then eat ice cream with him...and that's got to stop. It has stopped, actually. (I've gotten better at saying "no thanks" when he sits down with M&Ms, etc)

We talked last night and he said, "You're not doing this alone. We're doing it together." He's renewed his vow to make healthier choices as well. He wants to lose that last 20lbs but has been putting it off. We have three kids - one with special needs - and it can be exhausting! But we both know we will have more energy if we exercise and eat right. I'm really glad he understands how important this is and is willing to help motivate me and keep me on track.

Yesterday, before leaving work, I confessed to him that I've been fantasizing about all the horrible foods I could bury my sorrows in on the way home. For the last several months, he'd have said something like, "Get me something, too!" Instead, this time he said, "Don't do it. It's not worth it."

That's what I need. I need someone to not only support my healthy choices, but also steer me towards them, too. We're meeting for lunch today and he suggested we hit this salad place we love...even though we have a gift certificate for LePeep, because he knows there are too many temptations at LePeep.

Once again...I'm rambling.

I'm not giving up. I am determined to do this. I got down to 214 last year...then went on vacation...and never mentally came back from it. Then I spent most of the year on phentermine. Eventually that stopped working...then I went off it and gained back what I'd lost.

No more mental vacations. A day here or there, sure. But no more weeks, months at a time.

I'm not denying myself things, but making better choices. I'm still going to happy hour tonight with a friend, but I've already planned what I will eat and designated those calories for dinner so I know how much I can eat during the day... all about preparation.

Okay...enough blabbering from me. If anyone wants to reach me - saritarose@yahoo.com Take care! Good luck!

[angbutler0712 30]

Your story is so very similar to my own. It's so disheartening!!! It took me two years to get approved for WLS. The first go around I was denied, I appealed and was denied again.

Reason for denial, I wasn't heavy enough for long enough!

I wrote this long appeal letter to the insurance company (AETNA) begging them to reconsider.. and pointing out specific health problems that are made worse by the weight, but the wouldn't consider my problems as co-morbidities. (I had even had two heart surgeries for atrial tachycardia and they wouldn't count that.. it had to be heart disease.)

After my second denial I was absolutely CRUSHED!

My doctors office said, the only thing you can do is wait it out until after the first of the year (I would be 2 years over the specific BMI at that point) and go through our program again. It was about a 6 month wait.. and when the first of the year came, I called up my doctors office and started the ENTIRE process again. Thankfully I didn't have to repeat the sleep study, but every other presurgery test had to be redone. We went through EVERY possible test to find any comorbitity that I could possibly have.

Now, I started out at a 39.5 BMI this second time. so I needed two co-morbidities to go along with the weight. I was hoping my heart problems would be a factor.. it wasn't. I was diagnosed with GERD (1 comorbidity) and osteoarthritis (2nd comorbidity) They also submitted that I have high blood pressure not treated with meds.. all they had were a couple high readings from when I came into their office. (Ins counted that as a third comorbidity) Once I could prove that I had been over a 35 BMI for 2 years, I was approved immediately.

Now, GERD and Arthritis are not listed on my insurance providers list of comorbidities.. so definitely talk to your surgeons office. There should be someone there who specializes in working with the insurance companies and can talk to them to find out what they will consider as comorbidities.

Before my approval, I was discussing with the doctors what a second comorbitity could be for me.

I have a herniated disc, but my insurance wouldn't take that either.

My doctor suggested I get an xray done of my back, just to check if I had arthritis.. low and behold, came back positive. It was very minimal, but still there and able to count as a comorbidity. He told me that most people who are obese have some form of arthritis in their back.

If your surgeons office is not going the extra mile to assist you with insurance, then they DO NOT deserve your business! Did they do any tests on you looking for comorbidities? Barium swallow (GERD), Heart Echo (heart disease), Diabetes test, xrays to look for arthritis, Upper GI to make sure your stomach is healthy enough for the surgery...

Oh yeah, they submitted depression as a weight related problem to insurance also.. Since I had been taking anti-depressents for years. Not sure if the ins co counted it.. but it can definitely be used as a comorbitity the doctor said..

The day I was approved, the woman I had worked with for 2 years to get approved called, she said "Angela, you are approved!! When I took this off the fax and read that you were approved, it gave me goosebumps and I knew I had to call you before I left for the day!" It was 5pm and closing time. That entire office worked so hard for me. I am forever in their debt..

So with all that said, DO NOT GIVE UP!

Okay.. this is getting lengthy.. Just know that you are not alone. Its so hard to fight with insurance, but so worth it to save your own life.

Of course there is so much more I could tell you with this process, but I'll spare you.

If you ever have any questions or want some advise, email me. abutler0712@gmail.com

~Angela

[Jackie's girl 32]

Hang in there. Timing is everything. If it is meant to be for you, it will happen! Not now does not mean never! In the meantime, work hard, maybe you won't need this at all and if you do, the option will still be around later. I know it is discouraging, but don't lose hope.

[RobinGirl 34]

I just went throughout the same thing. Don't give up. After I was denied I had a sleep test and another A1C test. Low and behold I DO have sleep apnea and insulin resistance. Plus my GERD has worsened. My surgeon filed an addendum with the new results instead of an appeal and I was just approved today. Do what you can and don't give up!