Denied <BMI 40 - has anyone gained weight for approval??

[RLittman 4]

I am borderline BMI with no serious co-morbidities even though I am borderline diabetic, have high cholosterol and have a very arthritic back. My doctor wants me to do a sleep study but according to Unicare if I do not have 'severe" sleep apnea they will not approve. I am only 15 pounds away from the golden BMI 40 without co-morbidities needed for automatic approval by Unicare. Has anyone been denied and then gained the weight to meet the BMI 40 needed for approval? Do they see this as suspicious? With my luck it would take me forever to gain it.

[em1125 0]

So sorry you were denied. My surgery was schedule in two weeks. However, I was denied on June 26th and I'm in the appeal process. I have a BMI of 39. My insurance company stated that I did not have life threatening co-morbitities. High cholestorol and Irregular heart beats are not enough. I have other issues, but not life threatening. Anyway, the answer to your question about gaining weight to have the surgery-- Not a good idea. Don't self sabotage. Just fight fight fight. Is your BMI over 35?

Let me know. Good luck.

Emily

[Randi 0]

RLittman,

Check out this thread:

http://www.lapbandtalk.com/showthread.php?t=19809

[ralheit 0]

I know several women who had bypass that did exactly that. They were denied because they weren't big enough and didn't have the comorbidities. So they gained weight to qualify. I don't know that it was a good idea, but they did it and were happy about it.

[GinaJ 2]

I have know of a few people who have been turned down, and then gained wt and were approved. They had all previously been at the higher wt before, and was about a 10lb gain.

[RLittman 4]

BMI was 38.5 about 2 months ago when I first saw Dr. Spivak, but having just finished a cruise, I have gained 5 pounds and would have about 10 to go. I hate feeling this additional weight already and gaining more would put me at the highest weight I have ever been. Not sure what to do.

[em1125 0]

I've heard of people wearing very heavy clothing with large pockets and putting heavy things like rocks in their pockets. You would be surprised to see how much more weight would show up on the scale. Eat a big meal and about 16oz of Water before you weigh in.

When I weighed in, my surgeon asked me for my height. He took my word for it. I made myself 1 inch shorter. That makes your BMI higher as well.

Just a thought. Good luck.

Em

[RLittman 4]

Unbelievable!!!

[Constance 0]

I actually gained for approval. I still don't know if I'm approved. AND I just found out that you need a 40+ BMI for at least 12 months and for me it's just been in the last 2. It was only 15 lbs...ha, "only" but I feel like crap and have new stretch marks from the fast gain. Sadly, I don't know if it will even make a difference! Please consider what even MORE weight will to do your body and self-esteem. Was the extra 15 lbs worth 15K$ ? Yes, probably. If I don't get covered will I feel like an idiot? Yes!

[Iulizbug 0]

I put on 5 lb ankle weights on each leg and that jumped my BMI up 2 points. Still wasn't fat enough accord to my insurance co. but it did help me gain 10 lbs w/out sitting at home eating myself to death. You can get the ankle weights at Walmart for like $10. I wore big baggy sweat pants and took them off discretly in the bathroom and my PCP had no clue. Good luck.

~Liz~

banded 03/10/06

Dr.Ortiz

241/190/150

5'7''

[wantlapband 0]

its sad what we have to do huh?

I was thinking about that yesterday when I went for my first visit. I was too afraid though of getting caught, then I went there and I got weighed with all my clothes on, so I could have done it easily. Damn huh?

My BMI is 35.2, but I have co-morbities, but still if I could have just brought my weight up 25 more lbs...then I would have the magic number 40.

[em1125 0]

Iulizbug and wantlapband

That is one hell of a creative idea. Love it. Atleast you didn't truly gain the weight. I don't believe that is a healthy way to go. After all, there is a good chance that you won't get approved right away. Then what. You now have all this extra weight that you need to take off.

Wantalapband - Add a ten pound ankle weight on each ankle. lol

As far as insurance companies go, Hey, I say, whatever works. I don't believe in cheating the system, however, I have read so many of these posts where men and women have been denied WLS with a BMI of 44 and even higher. All I can say is shame on every insurance company that gets away with this. I ask, who is truly cheating the system?

I have a BMI of 39 and I'm in my first appeal. I have just got notified from Walter Lindstrom, Obesity Law, who is willing to take my case. He believes I have a solid case and I should not have a problem getting the decision reversed.

If the decision does not get reversed with my assertive but strong letter of first appeal, I am going to hire Walter for as long as I need to.

I am very upset at how inusrance companies are get away with this. I will do whatever I need to get around this BS. I say fight until you win the war. They may have won the first and second battle, but I believe in the longrun, we can all win the war.

I also think it's very important for everyone concerned that we continue to fight the insurance companies and not give up so quickly to self pay. I'm in the position to self-pay but, it's truly not about the me paying out of pocket. This is about a serious issue that is affecting over sixty percent of Americans. The 60% consists of overweight or obese individuals. Not to mention that about 600,000 Americans die each year from diseases directly attributed to morbid obesity. I could go on, quoting statistics. Instead, I would like to see the Insurance Companies open their eyes to this serious epedemic. This is why I have chosen to fight to the bitter end. And if I have to pay out of pocket at that point, I will.

I just think about the many many people out there who cannot self-pay. And for that, I feel very strongly about this. Fight Fight Fight!!!!

Hope I didn't put you to sleep. Good luck.

Emily

[wantlapband 0]

Did anyone's doctors told them they shouldn't have a problem with their insurance company to get approved?

Or is this the standard line they say?

[em1125 0]

My surgeon's office and PCP thought I would not have to appeal this. They felt that I should get approved without a problem. Who is your insurance carrier?

[Iulizbug 0]

Wantlapband,

My surgeon told me since I had UHC I would have no problem whatsoever getting approved. I went into the whole ordeal thinking for sure I would be fine. Got down to the very end and somehow my cholesterol went down 15 pts even though I was in last supper mode and eating everthing in site :cry so I didn't have enough co-morbities with my BMI of 37-38 to get approved. My bariatric coordinator told me I could wait another yr and gather more documented weight loss attempts and try again but I was not willing to wait. I think that a lot of doctors feed us a lot of B.S. and that if there is a shot that we would not be approved regarless of what insurance co. we have we should be informed from the get go. I was misled and super-frustrated having to self-pay at the very end. I am SO very glad I didn't wait to do my surgery though. I already feel so much better.

~Liz~

banded 03/10/06

Dr.Ortiz

241/189/150

5'7''

banded 03/10/06