Harvard Pilgrim Requirements for BMI 35. Will my back injury be enough for a comorbidity?

[Overheard 1]

30 y.o., 5'8", 230-240 (fluctuating weight)

Weight and Weight-Loss Attempt History: Been overweight since I was 19. Went up to the 220s-230s for years. Pre-diabetic and fed up .. was able to get down to 180, but that was with an unsustainable schedule for myself: 1.5 hours workout in the morning followed by a 2 hour workout in the evening. Plus a calorie restriction. I was constantly exhausted, unsatisfied, and unhappy. Since, the weight has come back and I'm back to the 220s-240 range. I've tried yoga. I've had therapy. I've had trainers. I have had online trainers and nutritionists. I have had logs and trackers. I have been trained in mindful eating. I went to a stay away weight loss / therapy / nutrition / physical therapy program for over a week. Through it, it became clear I love working out and eating well, but it is very hard to feel full. It takes a lot more food to feel full, and I feel full for less long. I heard many others talk about how they eat because they don't know what hunger or fullness feels like. I totally know!

Insurance: I called a Center for Excellence here in Boston (Mount Auburn), and at first they said Harvard Pilgrim requires a BMI ≥ 35 and a co-morbidity. At first, Mount Auburn said that HP wouldn't accept it. However, after calling HP, they told me that they accept apps on a case-by-case basis, and that Mt. Auburn should submit all relevant info with the application.

Compressed discs (L5/S1) as a result of an initial and repeated injuries as the result of domestic violence. I have had numerous visits to the E.R. and my primary care physician. All she could find was a compressed disc. However, my back - especially since my weight gain - has made life difficult. I throw it out frequently, miss numerous days of work, and am unable to enjoy healthier activities. Above all else, it prevents me from working. I'm a teacher, and have to sit, lie down, or stay home. Sitting up from bed or even bending over to look at my students' work feels like a strain on the back, and can sometimes send shooting pain through my back/leg. Every doctor has said there isn't anything to do. So at this point, combined with my weight, my health and quality of life is worsening.

I feel stuck. I can follow a program, but every program I try is not sustainable because at the end of the day I am just hungry. And the gastric sleeve seems like the teammate I need to help with the hunger, while I take care of everything else.

QUESTIONS: Has anyone had similar experiences, or experiences with HP? What do you think my chances are? What - if any - documentation or details should I provide to Mt. Auburn so they can submit it to HP? Anyone know for sure what HP's requirements are?

Thank you all for any help, and I hope you all find assistance and help in here too!

[merry1126 42]

Search Harvard Pilgrim bariatric surgery and the policy should be one of first links (its a pdf file). One comorbidity is

Severe, weight-bearing back or joint disease evaluated by an orthopedic or neurosurgeon

so you maybe eligible for surgery. Hope this helps, best of luck

[Overheard 1]

Thank you, Merry!