Phase 1: Getting insurance approval

[john-mke 6]

I’d like to share my experience with getting insurance approval, in case it helps anyone out.

For the past 5 years I’ve been struggling with Type 2 Diabetes starting out at a 10.8% A1C in late 2009 with a BMI of 35.8. This was a life changing event for me, so I kicked into gear and did really well getting my weight down to 263, BMI down to 33.3 and A1C of 6.1%. I always knew what foods to eat as my Sister is a dietician, but man, I love cheeseburgers. I cut them out, moved on to low fat foods and lots of walking which worked really well.

After 6 months of focus on my health I lost my job, picked up another one quickly but that seemed to be enough for me to tell myself I could get back on the cheeseburgers. By the end of 2010, I was back up to 278 and a BMI of 35.2.

My BMI continued to hover between 36 & 36 up until 2014 when I asked my Doctor about the benefits of RNY for Diabetes management. He was surprised I asked and referred me to the Gastric team. I had an initial Surgeon consultation in Feb, 2015 in which he explained the process and benefits of RNY for Diabetes management. I was very excited, but now I had to go through a 6-month journey on supervised weight loss, which so many of us get a little bummed about but I went through the program. I found it extremely beneficial as you concentrate on changing your habits. I gave up a couple of vices; sodas and fast food, but I needed to maintain a 35 BMI.

Whoa, 6 months up and now it time to submit the paperwork. I’ve dotted all of the I’s and crossed all the T’s and I’m ready. I was so excited and then my letter came in the mail – Denied. WHAT? I’ve done everything, but wait, there are more rules that you don’t know about. My BMI had to stay above 35 for 3 straight years and I needed evidence of addition weights loss attempts. Turns out my BMI dipped down below 35 on a few occasions at my recorded height. Life saver, I shrunk a half an inch since they recorded my height some twenty years ago.

Now this is where having a great relationship with your primary physician really helps. He wrote a letter detailing everything, my height was incorrect, I attempted to lose weight under his supervision and he documented all of my co-morbidities. AWESOME!

Yesterday, I received the phone call I’ve been waiting 2 months for. I have been approved and Phase 2 – Surgery will be scheduled shortly.

Trust your medical team and good things will happen.

Tonight it’s chicken on the grill, No Cheeseburger!

Edited August 23, 2015 by john-mke

[Daisee68 2,493]

​Congrats! Thanks for sharing that! It will be an encouragement to those who are bummed at getting a denial and show that an appeal sometimes works!