so frustrated

[wildflowergirl 23]

I went to see the doctor November 4th 2014. The doctor thinks I'm a perfect canidate for the sleeve. But even though I am 5 foot 3 and weigh 230 pounds now, my insurance won't approve me because I have not been diagnosed with any co-morbidities. (I am pre-diabetic, my blood pressure is a little high but no medication, and my cholesterol is a little high again no medication) I have been doing Weight Watchers for 3 years and have been loosing and gaining to same 15-20 pounds. My BMI has been over 35 for those 3 years but has only been over 40 for a few months. So I either have to stay at this weight for 2 years or I just went for sleep apnea test and if thats positive then I have to stay above 35 BMI and have sleep apnea for 2 years to get approved. It's just so frustrating because I obviously can't loose this weight and keeep it off on my own. So it looks like I may qualify for surgery by October 2016 . OK I'm done complaining

[della street 213]

@@wildflowergirl Just a suggestion--have you thought about appealing? Explain all that and see what they say - the worst they can do is say no again -- but it might be enough, along w/a letter from your doctor, to have them approve -- best of luck!

[deedee19625 31]

Hang IN there it is a long fustraiting journey.

[wildflowergirl 23]

I did try appeal no go but I'm determined and I know it will work out it just may take a while.

[BeagleLover 1,020]

If you haven't already, take steps to avoid going from pre-diabetes to diabetes. That's the point in which the islet cells in your pancreas can't keep up and half of them die, not producing insulin. If you are able to, you might avoid this by exercising aerobically for an hour a day. It reduces you chance of getting it by 80%. If you don't feel that you know enough about your diet and possibly avoiding diabetes, I suggest you go to a diabetic nutritionist.

[CountryGirl5584 115]

The dr can do a peer to peer appeal and speak with the dr at the insurance company that denied your request

[wildflowergirl 23]

The weight loss doctor wanted my primary doctor to do just that but my primary doctor said he would not because weight loss surgery is not his area of knowledge. But he thinks this is a great idea for me to have the surgery.

I am just going along with life and keeping my own records of weight and doctor appointments and making the doctor make notes when I see him of his concerns for my health as related to my weight. (If he talks about my sugar, blood pressure or Cholesterol being high but not high enough for medication yet) I ask him to write that in his notes (and I watch him write it) and I ask him to note that its related to my weight. I discuss my weight at every appointment and the things I've tried and how I always gain weight back plus some. (I ask him to make notes of that too!)

October 4th 2016 will be two years and I will be ready for the insurance company this time. I have copies of what they require and I keep in touch with the nurse at the weight loss surgeons office to make sure all t's are crossed and I's are dotted!

I plan on starting my 6 month supervised weight loss plan in April 2016 and getting psych evaluation and nutrition done by September 2016 so on October 4th 2016 I will be at the surgeons office with everything ready to be submitted to insurance! Two years seems like forever but when I think of how many years I've been overweight and know that this will make a difference I know I can do it!!!

I made a count down calendar and each month I cross off I know I'm that much closer!!

It will happen!

[Zane's Mom 184]

I'm not sure what your out of pocket would be but my insurance did not cover vsg no matter what. Health care marketplace.

They did cover my psych eval and the edg. And because I had a hiatal hernia they paid to repair it.

My doctor has a cash price no matter what my deductible was to follow up after the hernia repair and do the sleeve.

My out of pocket was $8200. However in my area many doctors are advertising out of pocket as little as $2500.

You should check that out in your area. And... Because I was technically self pay, I was sleeved within 1 month of my consultation of the surgeon I ultimately chose.

I say better now than later!!!!

[wildflowergirl 23]

Just to keep you posted on whats happening with me

Still over 40 BMI (40.92 -231 pounds) and into 4th month of 24 months of having 40+ BMI to be able to apply again to insurance. I also had sleep test and have sleep apnea so even if I did manage to loose some weight on my own I would still qualify (according to insurance) 24 months from January 2015 (when i was diagnosed with apnea) if my BMI is over 35 (198 pounds or above) with comorbidity (sleep apnea) (that would be 33 pound loss and the most I've ever been able to loose is 20 pounds. The bariatric doctor said he would be happy if I could just keep my weight where it is until we can get the surgery approved. He said usually people that are 100+ pounds over weight (me) would be lucky to loose 25 pounds on my their own and keep it off.

I make sure that every time I go to my PCP I talk to him about my weight and how it relates to my health and I make sure he documents what we talk about. When I am able to apply again I am going to be sure to have everything in order!

Still have borderline high blood pressure (no meds) pre diabetic (no meds) and borderline high cholesterol (no meds) the bariatric doctor said I am just a fairly healthy obese person (which keeps me from surgery- thanks insurance) but eventually it will all catch up to me and he would like me to have surgery and loose the weight before I have several health issues to deal with.

So I'm just keeping a smile and waiting until I can apply to insurance again.

October 2016 if I don't loose any weight (40+ BMI)

or

January 2017 if I loose more than 5 pounds (35+ BMI with sleep apnea)

[kyrickchick64 468]

I would be having a problem with my primary. If he is saying yes it's a good idea but then won't stand up to the insurance company then id be finding a new dr. It's better to endanger your health until you are on drugs for co morbidities which is almost certain than to get it done before your body starts to shut down. Id find a new doctor to fight for me.

[The Candidate 3,215]

@@wildflowergirl I just wanted to say that you have a wonderful attitude. I have no doubt that you will beat the system or continue to work within its restrictive parameters as you have been. You are 100 percent correct - you WILL get your surgery some day. I'd wish you best of luck, but you've obviously already got this in the bag. Carry on.

[chunkyloverlovesyou 197]

Skip the BS and go to Mexico, they will take you in a heartbeat

[wildflowergirl 23]

Just a quick update. Aetna changed their policy as of November 2014 (No longer says you need a two year documented history) So I started my 6 month supervised WL with Doctor in April 2015 and will be done October 5th. The surgeons office will be submitting that first week of October (Woooohoooo I've spent these 6 months collecting copies of all my medical records and labs. I have a notebook full to include when everything is sent to Aetna. I have a copy of their policy and have been following it to the letter. (I even had to inform the surgeons office of some changes in the policy they didn't know about) So keep your fingers crossed that I get approved and with luck will have my surgery before the end of 2015!! Oh and I'm still smiling

[Inner Surfer Girl 12,015]

That is great news. I was reading through your previous posts and it sounds like you were on a supervised diet previous to April. Wouldn't that count?

[wheezysmom 146]

Good for you! I am glad to hear that Aetna changed their policy and you no longer have to wait two years.

And good for you for having such a positive attitude and hanging in there. I don't think I would have been as patient as you were.