Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

I was denied because I hadn't had a BMI of 40 or above in the past 3 years, and I didn't have the required co-morbidities for the past 3 years. I do have co-morbidities, just not the ones that they recognize. I have high cholesterol, GERD, borderline diabetes taking Metformin to prevent getting full blown diabetes, knee problems and moderate sleep apnea.

I found medical records showing my high cholesterol for longer than 3 years, and I have a strong family history of diabetes, so I'm hoping that will be enough. I also found where I weighed in with a 39.1 BMI back in 2011, so that may help.

Oh ok. Can you get your doctor you see about your knee to write a letter saying if you were to get some weight off your knee that it will help with the problems you have been having? With my insurance (Aetna) GERD and sleep apnea are recognized. I have both of them.

Share this post


Link to post
Share on other sites

I was denied because I hadn't had a BMI of 40 or above in the past 3 years, and I didn't have the required co-morbidities for the past 3 years. I do have co-morbidities, just not the ones that they recognize. I have high cholesterol, GERD, borderline diabetes taking Metformin to prevent getting full blown diabetes, knee problems and moderate sleep apnea.

I found medical records showing my high cholesterol for longer than 3 years, and I have a strong family history of diabetes, so I'm hoping that will be enough. I also found where I weighed in with a 39.1 BMI back in 2011, so that may help.

Oh ok. Can you get your doctor you see about your knee to write a letter saying if you were to get some weight off your knee that it will help with the problems you have been having? With my insurance (Aetna) GERD and sleep apnea are recognized. I have both of them.

Share this post


Link to post
Share on other sites

I was denied because I hadn't had a BMI of 40 or above in the past 3 years, and I didn't have the required co-morbidities for the past 3 years. I do have co-morbidities, just not the ones that they recognize. I have high cholesterol, GERD, borderline diabetes taking Metformin to prevent getting full blown diabetes, knee problems and moderate sleep apnea.

I found medical records showing my high cholesterol for longer than 3 years, and I have a strong family history of diabetes, so I'm hoping that will be enough. I also found where I weighed in with a 39.1 BMI back in 2011, so that may help.

Oh ok. Can you get your doctor you see about your knee to write a letter saying if you were to get some weight off your knee that it will help with the problems you have been having? With my insurance (Aetna) GERD and sleep apnea are recognized. I have both of them.

Share this post


Link to post
Share on other sites

I've included my knee problems with my other medical information. I actually had surgery on my right knee a year ago due to a torn cartiledge, but since then, both knees are stiff and painful. I have had to resort at times to getting a cart at Walmart to shop. I've bought a cane to help when I need it also. They wake me up at night sometimes hurting.

BCBS recognizes sleep apnea, but only when it is severe, not moderate like mine, and I was only diagnosed last April, not 3 years ago, although I've probably had it for 3 years.

Share this post


Link to post
Share on other sites

Oh ok! Well ill be praying that God touch who ever your dr will talk to for the peer to peer!! Keep me posted! It will work out!

Share this post


Link to post
Share on other sites

LFG do you know "God is a wonder to my soul"? I think of the song when I hear of stories like yours. Surgery is around the corner. And health benefits to follow. God is a wonder...

Share this post


Link to post
Share on other sites

LFG do you know "God is a wonder to my soul"? I think of the song when I hear of stories like yours. Surgery is around the corner. And health benefits to follow. God is a wonder...

Yes he is. I prayed and I said God its in your hands. I was doubting and I prayed and told God to help me with that and he did!! God is wonderful. Have you hear William Murphy "It's working"? WONDERFUL SONG!!!

Share this post


Link to post
Share on other sites

Your story truly shows the power of prayer. I waited and prayed for two years about this surgery. I wanted the sleeve but my insurance did not cover it at the time. Late January last year I became very ill and was in the hospital for several days. I was told that I have copd on top of high blood pressure, no thyroids, sleep apnea, and diabetes. I was told I had to get the weight off. After several months of steroid shots I continued to gain. In July I really started praying that god make a way for this surgery. I called and got the process started in August. I found that my insurance now covered the sleeve and my out of pocket went from 2500.00 to 375.00. So God had not only answered the prayer for surgery, but answered the financial part too. Due to being in the hospital early in the year I had the surgery and only spent around 200.00. I no longer have the high blood pressure, diabetes, or sleep apnea. I am now down over 60 pounds and had surgery Oct. 30. We serve a great god.

Edited by Sherry73

Share this post


Link to post
Share on other sites

Your story truly shows the power of prayer. I waited and prayed for two years about this surgery. I wanted the sleeve but my insurance did not cover it at the time. Late January last year I became very ill and was in the hospital for several days. I was told that I have copd on top of high blood pressure, no thyroids, sleep apnea, and diabetes. I was told I had to get the weight off. After several months of steroid shots I continued to gain. In July I really started praying that god make a way for this surgery. I called and got the process started in August. I found that my insurance now covered the sleeve and my out of pocket went from 2500.00 to 375.00. So God had not only answered the prayer for surgery, but answered the financial part too. Due to being in the hospital early in the year I had the surgery and only spent around 200.00. I no longer have the high blood pressure, diabetes, or sleep apnea. I am now down over 60 pounds and had surgery Oct. 30. We serve a great god.

Now that really was God. We serve a wonderful God. Yes we do!

Share this post


Link to post
Share on other sites

Honestly, I think it's like applying for disability. They know that you qualify in the very beginning but I think they've made it standard practice to deny the initial application just hoping that many people will give up, which so many do and don't take advantage of the appeals process.

Share this post


Link to post
Share on other sites

Bamaboo64

Your right. Lots of people do give up and don't fight. But they should fight for it. But what I don't understand is why insurances make it so hard. Think about it, people having the surgery will save them money in the long run because It will cut out alot of health issues by losing weight

Share this post


Link to post
Share on other sites

Do you have a surgery date yet? If not, you need to let us know when you do so we can pray for you that day!

Share this post


Link to post
Share on other sites

Do you have a surgery date yet? If not, you need to let us know when you do so we can pray for you that day!

No I dont have a date yet. I called the coordinator at my dr office today to let her know my denial was reversed. So I had to email her a copy of the letter Aetna sent me. She called me back and said the lady that does the insurance had to verify my benefits for 2014 and that they will call me to set a date!

Share this post


Link to post
Share on other sites

Yippie!!!!! Keep us updated.

Share this post


Link to post
Share on other sites

Yippie!!!!! Keep us updated.

I surely will!!!!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LadyVeteran1

      Sleeve surgery is on April 14th.  I am counting the days!!  Can't wait!
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      Down 33 lbs and slightly stalled, but I'm gonna reevaluate and push through. I started back to work last week after 2 years of being disabled due to mental health as well as my weight. It's a great job and I'm just so happy to have this opportunity at a second chance at life. Hope everyone is having their best journey ❤️ Together, we got this!
      · 2 replies
      1. DaisyChainOz

        Great work Anna! Keep it up 😁

      2. buildabetteranna

        Thank you ❤️

    • Bashbee91

      Hey guys new to the process looking forward to this new life. 
      · 0 replies
      1. This update has no replies.
    • Bugg

      Hi everyone! I’m brand new here. I just went through all my pre-op requirements per my insurance company and now everything has been submitted and I’m just waiting for final approval and my surgery date. I’ve been doing research, watching YouTube videos, TikTok’s, ect.. trying to prepare my mind and what to expect so I’ll be ready for the surgery. I was so sure and so set and so ready and excited. However, now that I’ve done everything & it’s almost here, I am sooooooo scared! I know why I want it bc I’ve tried everything and I just don’t feel like I can lose weight by myself. I’m tired of being overweight my entire life. I’m miserable, but I keep psyching myself out afraid of GERD bc I know how that can be and I don’t want to have to get a bypass after already gaining the courage to even get VSG. I’m scared of complications like I’mgoing to regret doing it and be depressed that I didn’t just be more disciplined and try again to lose the weight on my own even sitting here typing this knowing in my mind i just can’t and don’t possess the discipline. I’m also afraid I won’t be able to handle the restrictions of the sleeve. What do I eat? I don’t know how to eat healthy really and don’t enjoy healthy food. I don’t know how to do this! I feel so defeated!Someone tell me they felt anything similar to this or am I not ready? I thought I was. I am so tired of being sick and tired and so tired of myself and so tired of being stuck and stuck in this body and somebody different on the outside from what I feel inside. I just want to ball up and cry.
      · 1 reply
      1. stevieoriole

        Am feeling this right now. My surgery date is 4/1. Sign the consent tomorrow. I feel like I overloaded myself with too much info, too many opinions. Got to the point where I was wondering if I should do this. Then I thought of my reasons for taking this step and that settled my nerves. Still get moments of doubt but am striving forward. Am just going to follow my book from the surgeon. Joined this because I was told by my dietician that I should do this for support

    • buildabetteranna

      over 20 lbs down since4 the pre surgery diet and surgery on the 14th
      · 1 reply
      1. Selina333

        Yay!! Congrats. I know how good that feels. 🤩

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×