Tell me what I should do.....

[marnie723 0]

Here's the story. I started out 11 mths ago doing a supervised weightloss to qualify for the 12mth supervised diet for ins. When I started my BMI was 38.6 & I was tested for co-morbidities. Found out I had none after the 2nd mth of weightloss appts. I was sure I had sleep apnea (hubby swears I do) but apparently I just snore alot. i brought this to the attention of the doctors office & said I don't think I qualify now. They gave me a copy of my ins requirements.BMI>40 or <40 with 2 comorb. They told me to keep coming they were sure I would have no problem getting approved. Now please keep in mind here, I HAVE NO experience dealing with insurance co. for health so I took them at their word. Every mth they bille dmy insurance 300$ for my weigh-in & I'd pay my co-pay portion. Now EVERY mth I would question doing this, would I qualify etc. I was always told it should be fine. Finally I get a different Nurse one day & she agreed with me. After some questions were asked & the Dr.'s office called their insurance specialist I was told I would need to gain the weight to get up to a BMI of 40. (in 2mths) or the last YEAR would be pointless.

I am really upset now. At myself for trusting that they new what they were doing. They said I "fell between the cracks & they didn't catch it" as they would now with their new system. They offered some money back or told me I could finish this with 2more appts to see what ins.will say. I don't know what to do from here. Do I get some of my money back if they will, or do I risk losing that money only to be denied. Part of me feels like they just kept it going to make some money. Again be kind with your answers, I am not use to the insurance game for health related matters but I may have learned a hard lesson. By the way I was only 9pds away from a 40 BMI when this started but they won't change my weight on the first visit.

I've spent almost a year wasting my time. I know

[kaninag 35]

I'm sorry but if you're going to a bariatric surgeon then they know the rules of the insurance companies by heart....when you were found to be - for sleep apnea they should have stopped right there....

most insurance companies also say that if you have no comorbidities then your bmi has to be >40 x3years not just a few months....good luck to you but I would def be worried about that doctors office...

maybe you can still get approved though...do you have shortness of breath, high cholesterol, arthritis, lower extremity swelling? These are all things that could possibly help your case.

[destiny79 0]

I would just gain the weight to get the BMI of 40, but that's just me

[kaninag 35]

Insurance prob still wont pay for it. BCBS told me that your BMI has to be >40 for 3 consec years! Look at their medical policies

[jenncore 0]

Hi, I have neighborhood health plan so i don't know how helpful my comment will be. When I started the process in August I got all of my paperwork together. I started with a BMI of 43 with no co-morbs but didn't have a consistant weight history for more than 2 years. My insurance co. approved me based on medical necessity and the fact that I didn't have a weight history didn't play a role. Talk to your Dr. again to find the best way to move forward. I really feel for you and hope it will all work out for you in the long run!

Jenn

[marnie723 0]

thanks for your responses. I have 5yrs of med. records to show weight but I also had 2 pregnancies in there so not sure what that does for the insurance. My insurance is BCBS and I am currently at my heaviest BMi around 39.5

This far in I will at least submit to my insurance but I just feel like I wasted a year doing the supervised diet. I have mild comorbidites but not on the list from the insurance. I have high -blood pressure but not medicated for it. 139/85 I exercise often 4-5times wk for 40-60min. I just can't keep food consumption under control. If the lap band is not approved I feel like I'm just wasting time till my health deteriorates & I can get approved. Again my biggest complaint is that the doctors office just strung me along. Do I have any further action to take? Is it right to feel the doctors office screwed me over. I know I should have been more skeptic about this but I felt they should know what they are doing even though my gut feeling was that something wasn't right.

[kaninag 35]

Have all your doctors write a letter for you saying why they think you need the surgery...that will help