I Got A "no" From My Insurance Company

[Wheetsin 714]

Apnea should definitely count as a comorbodity. Also you might want to talk to your PCP and see if you have anything else going on. Lots of people have comorbidites and don't know it. I had early onset osteoarthritis, and had no clue... I just got a gritty sensation when I turned my head on humid days. I would throw in your BP and diabetes, too, because those will be costly to insurance in the long run.

At your height, 218.5 lbs will put you at a BMI of 40. What has your weight gain looked like in the past few years? E.g. do you have a trend of gaining about 10 lbs a year or anything? You could also "project" (as long as you have history to back it) a likely timeframe when your BMI will reach 40, and include that info. It won't win you an appeal, but every little nudge in your favor helps.

You can also see if your PCP could write you a letter explaining adjusted BMI. BMI really is a crock of poop. By any BMI stnadards, weightlifters with under 10% body fat are still "obese" because they're heavy. "Modern" BMI charts account for your age, gender, and build as well. One of my co-workers is very tall and lanky, "beanpole" if you will, and weighs around 200 and is categorized as "obese" and wears a 34" waist. Sigh...

Yes, thank you! I have a BMI of 38, 210/5'2". I am borderline on high blood pressure and diabetes but not on medication for either at this time. I did a sleep study and was diagnosed with sleep apnea. The insurance requires 40 BMI for automatic approval or 35 BMI plus one co-morbidity. Since I was diagnosed with Apnea, I am wondering if really is move one by them to see if they deny if I will give up.

[Wheetsin 714]

BTW, I was denied on my first submission for a VSG revision (even though they had just approved my lapband removal). I appealed and was approved, but my insurance changed before we could schedule the surgery. So I had to start over from square 1. All in all from my band removal to my sleeve revision it took about 7 months. I was going to wait about 3 more weeks and if I didn't have an approval by then, was going to self pay. So in my case, patience (a little, anyway) and persistence saved me about $11k. Definitely hang in there...

[SouthernSleever 228]

Keep on swimming keep on swimming. Persist like the above poster said, you will eventually wear them down.

[dreamnslim2012 15]

Wheetsin, thank you for all the great suggestions! It had crossed my mind this morning that I could possibly get my Internist to maybe help me push on this since she was very supportive of me taking this path for help when I mentioned to her. And, of course she has the records of all my bloodwork, etc. We have been struggling for the past two years trying to find a cholesterol medication that would work for me which might could help too. The weight gain, in spite of multitudes of attemtpts to get it down, has been steadily going to up by 6-10 lbs every year. It's simply in my genes. My brother got sleeved last July and he just looks great and is so much happier, energetic, and healthy.

[joyful noise 101]

I have high bp ;and my "good cholesterol" is not good; sleep apnea and pre-diabetic; forgot - stage 3 kidney disease - I'm sure hoping this is enough. My BMI is 36 and I have 100 pounds to lose.

[NCHope 0]

I am also your same weight and height. This is the 8th working day that ins. has had my information. I can't hardly stand the wait. I have BCBS and my surgeon's office says they have seen people with lower weight be approved. So I still have hope. I also have sleep apeana (sp?).

I have been calling my ins. co. I'm embarrassed to admit.