Including a Letter For Insurance Review - Thoughts?

[SleevePerry 248]

I spoke with Bariatric RN at Aetna regarding my VSG Approval concerns. I just feel like I'm going to get denied, and I can't allow that to happen. I have a BMI of 41, but had a 38 BMI the previous two years. The RN said I wouldn't be denied outright for this, but that it would go to to the Big Boss for review.

I am getting a letter from my PCP, stating that I have been attempting weight loss and management for 10 years.

I'm also including this letter. Thoughts?

To whom it may concern:

My name is XXXXX. I am 43 years old and have been obese since early childhood. At age 13, I weighed 200 pounds. At age 17, I weighed 225 pounds. At age 23, I weighed 245 pounds. At age 33, I weighed 215 pounds. At age 42, I weighed 232 pounds. In the last 10 years, I have fluctuated between 200 and 255 pounds. Regardless of how much or how hard I exercise, no matter how strict my diet, I cannot seem to get down to a healthy weight and to maintain that weight. I am writing this letter to ask for your help.

I have been consistently dieting and exercising all of my life. I spent 3 years on the Atkins plan, faithfully eating less than 20g of carbohydrates per day, which allowed me to maintain an average weight of approximately 200-215 pounds. I spent 6 months on Nutrisystem, which resulted in a 5 pound weight loss. This past year, I paid $130/week for 12 weeks of 1,200 calorie per day meals from Diet2Go and, from that, lost one pound. I was exercising a good amount during all of these weight loss attempts, and I still continue to move each and every day. I don’t give up. But it seems that, no matter what effort I make, the number on the scale continues to rise and, the older I get, the more difficult it is to stop that number from its seemingly steady incline.

I have been on a high-Protein, low calorie diet for the last four months, and I have been recording my diet and exercise and meeting with a nutritionist, who seems to agree that I am doing a good job of staying on plan. 10 weeks ago, I ended a pack a day, 30-year smoking habit and, while I haven’t managed to lose a substantial amount of weight during this quitting process, I have not gained a single pound. Of this, I am proud.

At 43 years old, I weigh 251 pounds. My BMI is over 41. My body is straining to support this extra weight, and I am greatly feeling the effects of this strain. I am experiencing pain in my knees, in my back, in my feet. Despite remaining physically active, something as minor as climbing two flights of stairs leaves me winded, sweating profusely and with an alarmingly-rapid heartbeat. Without medical intervention, I fear that these existing maladies will only deteriorate with the coming years, and that more ailments will soon join them. Should my condition continue to deteriorate, I fear that I will require a succession of reactive surgeries. I have an immediate family history of Diabetes, of Heart Disease, of Heart Attack, of High Cholesterol, of Hypertension and of Cancer. I know that my weight and my propensity to hold the majority of this weight in my midsection increases my risk of Heart Disease, Cervical Cancer and Diabetes and, as a morbidly obese person, this is of great concern to me.

I recognize that weight loss surgery is not an answer, but a tool. I feel that I’m well-prepared, dedicated and disciplined enough to effectively use that tool and to become a Weight Loss Success Story. I hope very much that you’ll give me this chance to do so.

Best regards,

[Miss Mac 6,262]

I like it. This would be an interesting thread for newbies who could use a boost in the application process. So, on that note, here is a copy of mine with identifiers taken out. I was approve in two days from submission of my packet.

October 24, 2013

This letter is a heartfelt request for BCBS to approve bariatric surgery to help me lose a significant amount of excess weight that has caused me many chronic health issues and has seriously affected my quality of life.

My adult life started at 108 pounds at graduation, at a time when I was both anorexic and anemic. The reason for that was deliberate. I did not want to be morbidly obese like the rest of my family, many of whom weighed over 300 pounds. My oldest brother died of a heart attack at the age of 47 – at a weight of 420 pounds.

My mother died at the age of 67 because of an abdominal aortic aneurism. She was 5’2” and weighed 320 pounds. My father survived two heart attacks and eventually died from a stroke. Two of my sisters have been large from childhood and currently weigh over 300 pounds as do many of my cousins.

Since my late 20’s I began having problems controlling my weight and I consequently yo-yo dieted for three decades. Boy-oh-boy, I feel like I tried everything that came along, from South Beach, Sugar Busters, food Combining, Weight Watchers, Richard Simmons, even the Dolly Parton Diet, among many others. Remarkably, I did have 50 pounds of success with the Atkins Diet twice, and gained it all back much quicker than I lost it.

For about 15 years I have been taking medication for chronic high blood pressure while working physically demanding jobs.

On 9/11/2010, I suffered a Cardio Vascular Accident. Due to outstanding care at XXXXXXX Hospital, damage was minimized. The most significant lasting effect was loss of balance and altered proprioception. This has rendered me to be a moderate fall risk and forced me into an early retirement from federal service. I am unable to leave my home unassisted and can no longer drive because even though I can see, people and curbs and cars are not where I think they are.

In 2007 my right knee had to be replaced. At that time, my weight was around 180 pounds. I gained even more weight during recovery and eventually had to have a partial replacement of my left knee on 11/7/2012. Osteoarthritis is another issue that has hijacked my health. My vertebrae have degenerative disc disease with seventeen herniation, and my body is failing to support my current weight which fluctuates from 220-235. On 2/14/2013 I had a three level ACDF. I also am being treated by the XXXXXXXXXX Pain Clinic for thoracic radiculopathy, sciatica in my left leg, and femoral nerve impingement in my right leg (which is exaserbated by my overhanging 53” belly).

In order to get around, I must use a cane, my walker, or someone to assist me because I cannot stand for more than a couple of minutes without high levels of pain in my back, sides, hips and legs. Also, this belly has affected my posture so much that standing up straight, although it can be done, is painful in its self. Turning over in bed is painful because my weight is difficult to maneuver with this pendulous belly. The skin under the overlap gets red and irritated, so I am using medicated powder per doctor’s orders.

At the time of the CVA I was diagnosed with pre-diabetes, another condition than not surprisingly runs in the family. I am still taking meds for this condition to prevent transfer to full-on diabetes. My cholesterol is chronically high, so I am taking Lipitor for that.

Due to chronic digestive troubles and reflux, my primary care physician, XXXXXX XXXXXXX, ordered an EGD on 2/22/2012. The findings then were: Irregular GE junction, Hiatal hernia, Acute gastritis, and Reflux esophagitis. The attending physician, XXXXX XXXXX, prescribed Omeprazole to relieve the reflux. Since the stroke, Dr. XXXXXXX has had me on a 1200 calorie USDA Pyramid diet (allowing for a Mediterranean chef in the house). Dr. XXXXX asked me to follow a 1000 calorie diet with adjustments for preventing reflux (i.e. no soda, citrus juices, caffeine, fried foods, etc.

In spite of my best efforts at diet and exercise, my weight continues to rise. I am in pain every day, and my home has become my prison. I am taking Bupropion to battle depression and anxiety as I tend to have much worry about becoming a wheelchair-bound invalid. My weight issues have not been resolved even under my doctors’ care and concern, and I fear that I am becoming my mother and facing a premature death like hers.

Surgical intervention will certainly produce positive outcomes for me. I am not big-boned, but a naturally petite person who is carrying another person around her waist. I will follow my doctors’ orders and be the best patient ever. Your consideration is appreciated and I look forward to being a much healthier me in the future. Thank you so much - you are saving my life.

Comorbidities that indicate I would benefit from weight loss surgery:

1. BMI of 40.06 when my PCP referred me to Loyola’s Bariatric Clinic

2. Metabolic syndrome

3. Pre-diabetes

4. Osteoarthritis

5. Degenerative disc disease

6. Neuropathies

7. Joint replacements

8. Mixed hyperlipidemia

9. Hypertension

10. 53” waist

11. Family history of heart disease

12. CVA on 9/11/2010

13. Family history of stroke

14. Family history of diabetes

15. Family history of heart attacks

16. Family history of coronary artery disease

17. Gastro esophageal reflux

18. Hiatal hernia

19. Depression and anxiety

20. Family history of obesity related premature death