Insurance - How tough is approval?

[gabrielle2014 38]

I'm starting to worry and worry about this and thought I'd ask the question here for those that have gone through it. How tough was approval from your insurance company? I know all are different but I'm just curious in general how tough it was.

BCBSRI requires a 40 BMI or 35 with one of the comorbidities. I'm very close to 40 BMI and actually trying to gain a few pounds to put me over it a bit but I'm unsure whether my Atrial Fibrilation would be seen as 'hypertension.' BCBSRI also said that they want to see that I've been morbidly obese for more than 2 years - which I haven't. Though I've suffered from Afib for at least 5. I do have severe arthritis in my ankle and am on beta blockers, etc. for my afib.They want to see my weight loss failures - so I have my dates from Jenny Craig and WW and from seeing a nutritionist but not anything like Medifast or Optifast.< /p>

I'm just worrying out loud - and looking for any info folks have to share.

Thanks.

[LoriDee 11]

I just found out last night that if you answered the qauestionerre in the beginning, that yes you were abused as a child, surgery is an automatic NO! They will make you go thru months & months of psychiatric care....so NOW I am not sur if I will get my surgery soon or not, I do NOT remember how I answered that question. BUT I have already had 10 yrs. of therapy. Don't know if that counts or not..

[gabrielle2014 38]

Oh no LoriDee - that is tough. I'm so sorry.

[smiley922 447]

I just found out last night that if you answered the qauestionerre in the beginning, that yes you were abused as a child, surgery is an automatic NO! They will make you go thru months & months of psychiatric care....so NOW I am not sur if I will get my surgery soon or not, I do NOT remember how I answered that question. BUT I have already had 10 yrs. of therapy. Don't know if that counts or not..

Where did you hear that and which questionnaire, the one for yhe psychiayric exam? I indicated a history of abuse and it did not affect his approval or go ahead for the surgery

Edited August 27, 2014 by smiley922

[ready2B 263]

Do you have any other comorbidities that your doctor can document such as sleep apnea, diabetes, or anything else that is directly related to your weight? My PCP used "degenerative disk disease" as one of mine since I have back pain. A lot depends on how your doctor codes things. As far as the previous diet history, I don't think you need a lot there, just a statement from your doctor that you have tried other things and were unsuccessful at losing and keeping the weight off. I had only done WW (officially) and that was enough because of the way he worded things in his letter. I suppose some of this would depend on your insurance too.

As far as past abuse goes, I seriously doubt that would be an automatic disqualification. Around 1 in 5 girls in the US are sexually abused before the age of 18. If you consider other forms of physical and emotional abuse, that's a huge number.

[gabrielle2014 38]

I do have a really bad ankle that is filled with arthritis and has me with a handicap placard. My orthopedic surgeon wants to fuse it but I really don't want to because it is such a complicated and difficult surgery. I also suffer from Atrial Fibrillation and am on a ton of meds for it so they may consider that an issue. I see my cardiologist and my ortho guy the same time and I'm hoping to get them to at least write a recommendation - though they have both told me it is not directly related to my weight.