Not obese enough???

[TRN87 0]

So today I had my psychiatric evaluation. Everything went well besides the fact that I had to answer about 1000 psychological questions on the compter and paper tests, literally. After 3 hours finally I met with the psychologist and he immediately questioned my weight. He said he loves numbers and it jumped out at him..(he was a weirdo)..well he compared my weight which is 262 with my height to the bmi chart and said "well im not sure that you are obese enough, your definitely obese but your insurance is probably not going to approve you". What the crap...not obese enough! That cracks me up and pisses me off at the same time! Obese is freakin obese!!

First of all when I began my 6 mos weight loss I weighed 294 and have lost the TEN PERCENT Cigna "would like you to lose before the surgery" but it puts me under the 40 bmi mark and unfortunately (how sad is that... it has become an unfortunate circumstance to not have any life threatening sicknesses) I have no co morbidies. Second of all the insurance associate at the Lab Band doctor said I could get down to 256 and still be okay, and at the moment I am 262 so if they dont approve me because of this reason this is all her fault and I think she should pay for my surgery (haha not really). And third, How the heck can they request you to lose 10 percent of your current weight in the beggining of your 6mos diet and then if it puts you under a 40 bmi not approve you, oh right because all insurance companies are shady a holes!

I have no doubt that I can lose weight. I have done it over and over again throughout my life and after recently puting almost 3/4 of the 120 pounds i lost in 2005 it is obvious to me that I need more than a diet. I am not someone who just sits around and eats potato chips every day, I am a very active person and after 21 years it is clear that my body will not allow me to stay at a healthy weight without starving myself. I need something that is going to change my lifestyle forever. And yes I understand that the Lap Band will not be an easy thing, and it will require a lot of hard work, but I know it is what I need to take control of my life and my health and that is why I am taking these steps.

So after my rant....I spoke with the insurance lady at my Lap Band doctors office and she said we would submit anyways and see what happens. Hopefully none of you run into this situation. Hopefully I will be one of those lucky people who has no problems, but im thinking thats not going to happen.

Life sucks sometimes but you just have to put on a helmet and keep on fighting.

Cignas not going to win this one.

:crying:

[KingsFan 0]

United Health Care denied my claim for not being obese enough for long enough. I have three co-morbidities (diabetes, HBP, metabolic syndrome) and they still would not pay. My insurance requires that you have a BMI of 40 for at least 5 years. I have gotten my final denial of my appeal so I am now deciding whether to sue. The denial was based on the specific language of my company's plan and if I sue, I really am suing my company (which won't go over well). I can't imagine a plan provision that says it would treat breast cancer but only after the lump in the breast reached an inch and sat there for a few years. I am in the process of collecting documents and then going to see a lawyer. I went ahead and self-paid and was banded on Sept. 12. I am glad I did it and lucky that I could afford to self pay. But I really feel for those who can't and get denied because appaently the insurance companies are afraid that too many people will want the band. It was a life or death decision for me according to my doctor and it's a major lifestyle change. It's not a diet. It's a medical procedure that addresses serious illnesses and conditions. Sorry to rant but I am looking at thousands in medical costs and a little irritable from not eating. Good Luck!

[MacMadame 81]

A shrink is not an expert on what the insurance companies will or will not approve. I'd just ignore him. :biggrin:

[It's_Christine 0]

Plus most insurances clearly state that the weight that "qualifies" you for surgery is your initial weight. So you are correct they cannot mandate that you lose 10% of your body weight and then deny you for being a few pounds shy of being "officially" obese. Good luck and I am sure things will go your way

[jclue 0]

I agree with it's Christine, during my entire 6 months I fell below the 40 BMI and they never once mentioned it, they always referred to the weight at my initial appointment. I had HealthPartners-they approved it, I also had Medica and they were in line to approve if HP denied it, so I think your shrink should stick to what he knows and not spout off at the mouth-that annoys me. Best of luck to you!

Start/Current/Goal

250/152/145

[TRN87 0]

Thanks for all of the encouragement. I have my nutritionist appt next friday and then I will submit everything! I am SO excited/nervous/scared!! Wish me luck!!

[dwrd73 0]

Did you call your insurance to see what they require to be approved? I was also told I wouldn't be approved and my first appointment was cancelled. I called my insurance and found out i would qualify and had to fight to get my appointment back. Finnally the insurance lady in at the doctor's office called my insurance and discover I was right and that I would qualify.

Call your insurance and find out their qualifications.

[TRN87 0]

I havent called them. We are going to go ahead and submit and see what happens and then we will fight if we have to! Thats good info to know though! Thanks!