I am so mad n disappointed--I could cry

[thinkthin73 0]

Hi,

I am new here, well not so new I have been reading this board for awhile. My first post. I want this, it sounds exactly right for me. The gastric-bypass is just too scary and invasive for me. This just seemed so perfect--to good to be true if you will.

I am a mother of four, my youngest is 11. I was always thin growing up, and it seems after each pregnancy like food more n more. I have been on all kinds of diets, and spent a small fortune on excercise equipment and diet pills.

I have a disability, when i was younger (13) I was a passenger on a 3-wheeler and got hit by a truck. I crushed my right ankle, and broke both bones. It has been a struggle to try to get weight off, because I have pins, and plates in that leg. It swells and becomes painful very easily. This seemed like the answer, and insurance covered it too. Man I hit the jackpot.

WRONG!!!! The lady that sets everything up called today and said basically I am not fat enough-I have never heard such in my life.

I am 5'5 237pounds she said I need to be about 245-250 the BMI must be 40 mine is 39.6 ARE YOU KIDDIN ME!!! so let me get this straight I have to gain weight to lose weight. The insurance wont cover if these things aren't met. I said well what if I pay myself she said I have to have something wrong with me like sleep apena in order for the doctor to consider it. So again I am confused so if you don't have some kind of disease -then you don't qualify.

Then she said I have to have 3 years worth of proof of my weight....I know I am going on and on and I am so sorry.

I am just having a hard time understanding the criteria for the surgery. I mean she also said a diet has to be followed for 6 months. I mean "like i haven't tried dieting" please don't misunderstand this by I want a quick fix, I mean I have been like this with the yoyo weight for 10 years....and to be told that I just miss the level is incredible to me.

I explained about the disability and she said that it didn't count.

I am crushed...I needed this...for me, my kids, and my husband. I know I would feel so much better, and I know that I would be able to work out if I weighed less.

I again apologize, I am sorry to be ranting and raving!!Good Luck everyone who has had it done DO it for you first then DO for us who can't. I thank you for listening and allowing to me to get that off my chest. I guess I will go back to diet pills --I can't just not do anything.

[AppleSmith1226 1]

I am crushed to hear your story sweetie. I know exactly what it feels like to find a light at the end of the tunnel. And then it just goes out ... that really sucks like hell. But alot of people here were self pay. I say look into that if you are able to. Or try and change insurances if possilbe thats what I had to do. Alot of people say a BMI of 40 or 35 with co-morbitities. I am a pharmacy tech and I argue with insurace companies all day everyday. So when it came time for new insurace I changed for the new year to the insurace that I knew would cover it and would not give me a hassle. They approved it in 2 days. But once again I am so sorry to hear this happened to you. But do WHAT U HAVE TO DO to be banded. That's all I can say. But did they even submit this to the insurance or is this just that particular doctors office saying to you. If so find another damn surgeon! Because who are they to dictate your life?!?! But lots of love to you honey bunches of oats! And let us know how you make out. Any of us are here if you need to talk. As my grandma would say dust yourself off anf put you big girl panties on and keep it moving! Life won't wait for yoy that's why you have to do this now! Lots of LOVE APPLES!

[EileenTesta 0]

Listen, don't get discouraged yet. my insurance denied my surgery too the first time, and my doctor did a peer-to-peer review and explained my health situation to them and if they have proof that you've been dieting for years and due to your health issues with your leg and cannot exercise, their should be enough documentation to that effect, they might be okay with that. usually once a doctor gets involved, and takes the time to make the phone call, the insurance usually complies with the request. it's an expensive surgery, so they are going to do their best not to pay for it. Just don't give up hope yet. have the doctor make the phone call and if that doesn't work, call the hospital administrator where you are supposed to have the surgery done and ask them to intervene for you on your behalf. Obviously having the extra weight isn't good for your legs and if your orthopedic doctor could perhaps send a letter too, that also might help on your behalf. keep pushing!!! the squeaky wheel gets the grease!!!

I'd love to hear the great news once you get approved! I'm praying for you!

Eileen Testa

[SpecialK 22]

Most insurances say something like: BMI 40 alone or BMI of 35 plus co-morbidities like sleep apnea, high blood pressure, diabetes, high cholesterol, arthritis or joint pain, plus prolonged evidence 3-5 years of medically documented weights. They can take an OB/GYN's records of weight since you said you had kids. Just some ideas. Keep hanging in there.

[teeniebeenie79 0]

They also told me that I am not fat enough to get approved. I am 253lbs, BMI was 38.6!! But the nurse pretty much said gain 10 more and you will be fine. SO here I am trying to gain 10 lbs. You'd think it would be easy...lol

So hopefully after I get 10 more frikin pounds on they can get things going for me.

Good luck to you. Maybe you can just gain a few more pounds and take the suggestions here? The squeaky wheel really does get the grease!!

[kaninag 35]

Most doctors if youre self pay do not require you to have probs or have to jump thru hoops...IF you want to be self pay find another doctor that will take care of it for you....If you want to see if insurance will cover start your 6 mo diet.....it has to be MD supervised so if there is a local weight loss clinic go there.....Do you have any health issues?? High cholesterol, high bp, sleep apnea (to list a few) if you have 2 problems then insurance should cover you bc your BMI is >35. Do some research...you cant give up this easily if this is what you want....YOU CAN DO IT!!!!!!!

BTW...what insurance do you have....go to their website and search for "surgical management of morbid obesity" and that should pull up there policies about the lap band and that way you know exactly what you need!!!!! My insurance for example required the following:

1. BMI >35 with 2 comorbidities or BMI>40 (some insurances say for at least 3 year but mine did not have that stipulation I have Empire blue)

2. 6 consecutives months in a medically supervised diet

3. psych evaluation

4. nutrition evaluation

5. surgical evaluation

Good luck to you KEEP TRYIN!!!

[Chris61 0]

I have a letter that might help you out. This is something we used to get approved. I was tight on the edge of 39.8 and was approved. If you e-mail your address I will forward it to you and this might help you out also. Have you talk with your OBGYN and other doctors to have them do letters as well and show problems in regards to your weight?

Chris

[4jin 0]

I would look for any doctor's office that won't give you this negativity before you even consult with the surgeon.

The medical coordinator should meet with you in person and go over your policy if they do allow bariatric procedures.

At that time in person she should explain and go over your insurance company requirements. ( I looked it up on my own) You can call them and ask for certificate booklet or tell them to show you where you can view these requirements online and print them out. go over them yourself they are very precise and you will understand what they need.

I gained some weight in order to qualify.(did a bit too well actually) LOL

Don't give up that is only the beginning and it can be a stressful process. If the surgeon's office is giving you more stress instead of being on your side and taking away some stress or attempting to relieve it I say time to find another office!

[sharona 2]

just put on some more weight, that should be easy enough

sharon

[Angie4b1g 1]

Where do you live?

[bettyann29 0]

Hugs to you.. Believe me I know its disappointing.. When I originally looked into it a few years ago I wasnt heavy enough.. I ended gaining a little that put me over the weight that I needed to be approved.. My insurance company originally said that I had to have 12 months of supervised diet, psych eval, stress test, sleep study.. From the time I originally looked into they changed it to 6 months of supervised diet.. I did my sleep study and found out I have sleep apnea that I never knew about.. I knew I woke up alot at night but didnt attribute it to that..

I got my approval today.. Keep your chin up.. If this dr wont do it then find one who will.. there are quite a few out there..

[gviscio 0]

They're trying to scare you away.

[GreenChrysalis 1]

Hey thinkthin, first off, I am so sorry that you have had to deal with this. There are lots of people on here who have appealed and won with their insurance companies; search yours and see what you find. You might also check out ObesityLaw.com -- they help people with appeals to their insurance company. Make sure you have all of the requirements of your insurance company and meet them to the best of your ability so you're armed to the teeth. I think when your BMI is only 0.4 less than the minimum then it's worth fighting for. There are a lot of people here who have been through this and I know that you can find the information that you need. I wish I could help, but my insurance co. excludes all WLS, period, so I was self-pay, all the way.

The lady you spoke with was wrong, by the way. There are many surgeons who will perform lapband surgery on patients with BMIs under 40 if they are self-pay, if that is the route that you end up needing to take.

Don't give up yet!

[gviscio 0]

Viscio Law and The Obesity Law Center - Documents and Research

That is the link to the NIH Criteria. It is over 40 with no co-morbs and 35 and over with one co-morb and NOT a significant co-morb like they say sometimes,when they'll ask for some deadly disease. Arthritis or depression can count as well.

Gary

[webashley 0]

Thanks G, just downloaded the NIH study.

Ash go Viscio Law and The Obesity Law Center - Welcome

(happy those giants won or what??)