Denied!

[JourneyOfAFatKid 6]

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

[MeMeMEEE 206]

Have your Dr do a physical - check blood work, etc maybe you will have bad cholesterol?

[angel1 0]

I would say to wear heavy clothes for your weigh in and keep your keys and coins in your pockets. I'm don't like the idea of gaining because them insurance people you can never trust them. I will hate for you to gain the weight and they come back with something that will still denied covering it for you. Just a thought, but whatever you decide I'll will support you girl I understand the frustration.

[JourneyOfAFatKid 6]

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

[sleeve 4 me 910]

People have actually worn weights...just saying lol.

[JourneyOfAFatKid 6]

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!!!

[Margaret 4]

would you consider going to Dr. Aceves in Mexico? I have two friends who did that and had wonderful luck and no hassle of dealing with insurance regulations and ridiculous hoops to jump through!

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

[JourneyOfAFatKid 6]

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.

[tmela28 2]

Im going to be the one to tell you what you dont want to hear lol, but I am a month post op and i havent experienced allll the wonderful outcomes people talk about. And im doing fine and i know im only a month out but im just saying its not as easy as it seems . These people who lost this weight who look fab work there BUTTTTSSS off to look like that and get that way . It is certainly not the easy way out. Maybe just try a high Protein and low carb diet . Pretend its your pre op and just see your results . Maybe you will shock yourself and lose the weight, Believe me i know your thinking shut up you already have it your lucky . But Just think how you are actually a little more lucky then all of us who had it that your not as big as some of us ya know. Try to record everything you eat , you can even try liquid Breakfast and lunch and high Protein for dinner . And thennnn if it doesnt work bring alll of your records to your dr and explain to him how much you tried and there has to be something they can do . Did u have a psych evalutation. I had to have a psych evaluation , I had to make a diet plan history and my doc had to get 3 years prior history and my surgeons office had to send allll of the stuff to my insurance, I had oxford but was also biggger then you. Im not trying to be a jerk lol bc i had one friend who was like did u even try dieting blah blah blah or getting a personal trainer and i am thinking umm yea duhhhhh you stupid skinny idiot. Skinny people just dont understand, Me being not a skinny person am just saying to you donttttt try to gain weight ( you can try the weights lol) but try to psyche yourself out and pretend it pre op and do the high protein low carb !!!! I hope this made sense and i didnt come off harsh.

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.

[JourneyOfAFatKid 6]

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.

[tmela28 2]

Hey let me know if you get the message I sent you bc that post was just taken the wrong way and in no way shape or form would I want to hurt your feelings. !!!!!! Its like texting you never know the tone someone is talking in or in this case the other persons personality

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.

[sugarmamma7 2]

So sorry sweetie hope everything works out for you!

[wishes 125]

Oh no, keep us posted on what you decide to do! I will be keeping you in my thoughts, lady.

[Escape_Pod 358]

I thought I might be in the same boat as you, not heavy enough to qualify. Then I found out my insurance plan doesn't cover WLS for anyone. I could be 500+ pounds and they wouldn't pay for it. I'm very lucky in that I could scrape together the money to do this as a self-pay patient. It's expensive, but it's a major investment in my own health and happiness. And, there are companies that will finance medical procedures. (I didn't go that route, so I don't know whether their interest rates are reasonable, just sayin'....)

Like you, I really wanted to do this close to home, and have complete follow-up with the same doctor. I had surgery about a mile from my house, and though I could have gone elsewhere and saved quite a bit of money, it was worth it to me. Be aware,though, that there are less expensive, experienced surgeons here in the US as well if you're willing to travel but don't want to go outside the country. Honestly, it saved me about $2K having the surgery at my local county hospital rather than the more expensive downtown hospital, so even in your community costs may vary.

I'm a professional worry-wart, so I found a surgeon that had BLIS insurance coverage so I didn't have to worry about unexpected medical expenses from complications. Haven't needed it, and don't expect to, but it was really important to me as a self-pay patient. (BLIS also does financing, but they only offer insurance on particular doctors who've contracted with them and gone through the approval process)

Don't give up, you have options.

(And though no reputable medical professional will advise you to gain weight in order to qualify, I'm sure you wouldn't be the first to do so. Just be aware of how much more you'll have to work to get it off afterwards. And, if you gain it too quickly, I wonder if they'd get suspicious....)

Good luck!

(by the way, I remember your earlier trouble with your employer. Any luck finding a new job yet?)

[Guest Rosalind]

I don't have any co-morbities either but I am heavier than you. My insurance company accepts impact on joints as a comorbity. Have your knees check if you have been on your feet a lot.