I don't Qualify-- Need to gain 5 pounds

[laurenlee 1]

my story is the optitomy of stupidity. i did not weigh enough with a BMI of 33. BMI of 35 with any comorbidities and i thought i'd be covered. even slouching to deduct a full inch off my height and i was still under. i didn't imagine i wouldn't have bariatric benefits. so, stupid stupid stupid me gained 15 pounds - yes double digits - 15 pounds only to find out i do not have bariatric benefits......i never cried so hard. here i was already overweight and i gained 15 pounds for NO REASON. how stupid is THAT??? so here i sit, 25 pounds down from my highest (and ugliest) after being banded April 1st. I try not to imagine where i'd be if i hadn't gained (for no reason). did i mention it was for no reason??? ughhhhhh

first fill may 1st. i can't wait -- i'm hungry......

[sms1964 0]

Hard to beleive that they are refusing you for 5 lbs. Amazing how the insurance companies work. I needed to have a 40 BMI to qulaify for my insurance co. I am currently a 41 BMI, and was told with a wink to not loose too much while I was going through the process because I could drop under the limit. So I gained 3 lbs at my 2nd drs appt :rolleyes2: first time I stepped on a scale and was not too upset that I gained 3 lbs in a month. I'd do some of things others have suggested, heavy meal with sodium the night before, lots of Water, weights in your underware :tongue: - what ever it takes... Best of luck and keep us posted.

[WDW Luver 0]

my story is the optitomy of stupidity. i did not weigh enough with a BMI of 33. BMI of 35 with any comorbidities and i thought i'd be covered. even slouching to deduct a full inch off my height and i was still under. i didn't imagine i wouldn't have bariatric benefits. so, stupid stupid stupid me gained 15 pounds - yes double digits - 15 pounds only to find out i do not have bariatric benefits......i never cried so hard. here i was already overweight and i gained 15 pounds for NO REASON. how stupid is THAT??? so here i sit, 25 pounds down from my highest (and ugliest) after being banded April 1st. I try not to imagine where i'd be if i hadn't gained (for no reason). did i mention it was for no reason??? ughhhhhh

first fill may 1st. i can't wait -- i'm hungry......

:thumbup: knewme. You can't look back because you can't change anything there. Only look forward. And 25 pounds down is awesome! :smile: I always look at the hunger pains as my body burning some of that excess fat. Not long until that first fill and hopefully you will get some restriction, but remember that slow and steady is the best and it sometimes takes a few fills to really get to that comfort zone.

I am still not completely sure that my insurance is going to approve me, so all that I am doing may be for naught. I weighed this morning and I have completely lost the 5 pounds I had gained. Damn stomach bug. :drool: So I am not going to worry about gaining it again. I am just going to eat normally and go ahead and use some of the tips others have given to make sure I am the correct weight when I hit the scale on Monday.:thumbup:

There is just something so psycholgically messed up about trying to GAIN weight and being disappointed that I lost weight. I think my head is spinning!:thumbup:

[naynayto2 0]

:w00t: So frustrated. I am at 39 BMI but am the healthiest darn obese person around apparently. I don't have any of the serious comorbidities--diabetes, high bp, cholesterol, or heart probs. What I do have is a complete disability in my feet. My insurance has already paid for several years of podiatrist appts, months of physical therapy, several medical devices, and 3 surgeries. I am unable to walk for more than about 5 minutes at a time. Currently my future is bleak and my insurance could end up paying for more foot surgeries, and my inactivity is putting me at risk for clotting. Insurance has already also paid for an ER visit and multiple tests for a suspected lung clot related to this. 2 podiatrists and my PCP agree that weight loss is really the best thing to help my feet and I will probably see about a 75% improvement if I do (there are also genitic issues involved)

But NOOOOOO! That isn't enough. If I don't have one of the big five then I don't qualify, YET. But if I can gain 5-7 pounds then I will be at 40 BMI and then qualify automatically. I have to gain 5 pounds in order to lose 100! Insurance stupidity at its finest.

I was prepared to start with a dietician this week and already had made a menu to alter my diet to high Protein and low fat etc... Instead it will be pizza, ice cream, soda, and my favorite Mexican place. It just seems so wrong.

Did anyone else have to do this? Any actual "healthy" ideas for gaining a few pounds. I really do prefer at this point to not do it with junk.

My insurance has the same requirements but they also

required me to show documentation for the last 3 years from a doctor that my BMI was 35 or over with one comorbid disease or a BMI of 40 or over with or without a comorbid disease.

My friend is in the same boat as you except she has diabetes and several other things but she does not

meet the last 3 years criteria. We both have BCBS of Al.

[paisleypea 1]

My insurance has the same requirements but they also

required me to show documentation for the last 3 years from a doctor that my BMI was 35 or over with one comorbid disease or a BMI of 40 or over with or without a comorbid disease.

My friend is in the same boat as you except she has diabetes and several other things but she does not

meet the last 3 years criteria. We both have BCBS of Al.

So what exactly does "show documentation" mean? I cannot find my highest weights in my records ---- but I KNOW I have hit my highs and when. Can you just tell the dr. what those were in your past and he put them in the record? does that count? really getting worried that all the work and hoops I've gone thru so far will end up not working for approval. :smile2:

[paisleypea 1]

My insurance has the same requirements but they also

required me to show documentation for the last 3 years from a doctor that my BMI was 35 or over with one comorbid disease or a BMI of 40 or over with or without a comorbid disease.

My friend is in the same boat as you except she has diabetes and several other things but she does not

meet the last 3 years criteria. We both have BCBS of Al.

So what exactly does "show documentation" mean? I cannot find my highest weights in my records ---- but I KNOW I have hit my highs and when. Can you just tell the dr. what those were in your past and he put them in the record? does that count? really getting worried that all the work and hoops I've gone thru so far will end up not working for approval. :smile2:

[WDW Luver 0]

So what exactly does "show documentation" mean? I cannot find my highest weights in my records ---- but I KNOW I have hit my highs and when. Can you just tell the dr. what those were in your past and he put them in the record? does that count? really getting worried that all the work and hoops I've gone thru so far will end up not working for approval. :smile2:

For my insurance I had to get actual copies of my medical records with the weights recorded. I think it is pretty much the same for most all insurance. Any dr visit that took place in those years where they took your weight is fine.

I got several from my PCP office, but found out they had no weight recorded for last year--I was in a Cam Walker the entire time so they never weighed me. But my Gyn office had it because they made me take it off and get weighed!

Check with your PCP office/gyn office (if you are female!), any ER visit you might have had, urgent care etc. As long as you stepped on the scale and someone wrote it on your record you can get a copy and present it.

[LAN2k 0]

What if you had weighed in at a BMI of 35 (with co morbids) in 2000, were under medical treatment (not surgery) for weight loss, lost weight and got down to 150 lbs...and then put the weight back on from 2005-2008? I am now back up to a 35 BMI only older and more disabled from the regain. So would this mean, according to most ins. co's...that I will need to stay obese for a couple of more years in order to qualify for surgery?????!

[xavier 153]

Lan, Wow! For your sake, I really hope not! Cali

[WDW Luver 0]

What if you had weighed in at a BMI of 35 (with co morbids) in 2000, were under medical treatment (not surgery) for weight loss, lost weight and got down to 150 lbs...and then put the weight back on from 2005-2008? I am now back up to a 35 BMI only older and more disabled from the regain. So would this mean, according to most ins. co's...that I will need to stay obese for a couple of more years in order to qualify for surgery?????!

It all depends on your insurance. But most insurance companies that do look at history only look back 5 years on your weight--and many of them don't look back at all. Just choose the highest weight for each year to give to them if needed. Do you have any of the top comorbids: heart, cholesterol, high bp, diabetes issues? If you don't then many insurances won't qualify you. So you would need to be at 40 BMI to qualify.

Check out the Insurance Section of this board and see if you can find what others are saying that have your same insurance. You can also just call your insurance co. directly. That is actually the best thing to do first-- some companies (the company you work for ) choose not to have the bariatric ryder in their insurance contract, in which case you are really out of luck.

[jbcatc 0]

I am going through the same thing! I have to gain 3 lbs! I literally asked the nurse if she could just put down my weight plus the 3. I will be drinking lots of Water before my next visit where I weigh in again. 20 oz= 1 lb!!

[WDW Luver 0]

*UPDATE! *

I had my reweigh today and I MADE IT! Had to run and pee as soon as I got off the scale but I did it! Never been so happy to be fatter than usual!!

Still no idea if the insurance will approve me, but for now I go through my insurance mandated 3 mo program and then find out if they give approval.

[LAN2k 0]

*UPDATE! *

I had my reweigh today and I MADE IT! Had to run and pee as soon as I got off the scale but I did it! Never been so happy to be fatter than usual!!

Still no idea if the insurance will approve me, but for now I go through my insurance mandated 3 mo program and then find out if they give approval.

Well congratulations it is an important step in the right direction.

[LAN2k 0]

I'm in NY, my insurance is medicare, I did call medicare to find out that I am able to switch if necessary to a medicare advantage/HMO plan IE...oxford medicare, among others. Today I spoke with someone at NYU's dept of bariatric surgery and was told that I should stick to medicare but be prepared to have a fight to get the sleeve...I was told that I'd need to go on a 3 month medically supervised weight loss plan/diet etc. as one of the requisites under medicare. Another facility told me the exact opposite, that with medicare it is not necessary at all to do that since medicare says it is already implied that an obese person seeking weight loss surgery has tried dieting, etc...Two other NYC facilities told me that Oxford Medicare covers the sleeve IF I qualify. Comorbids also vary according to procedure and insurance specifications. Mine include, "mild sleep apnea" osteoarthritis, and high cholesterol but since I very much prefer having the Sleeve procedure, and it is still considered "experimental" by most, the odds are stacked against me. I have been on the Internet and on the phone so much that my neck is stiff. One facility tells me one thing and another says something contrary!.. In any event, I am relieved to have read this thread since I was feeling sneaky and awful at the notion of gaining lbs in order to BMI qualify. It's sad that the guidelines are so inflexible. I actually feel absolved of any sort of guilt now and will be shopping for those weights used for fishing tomorrow!

[naynayto2 0]

So what exactly does "show documentation" mean? I cannot find my highest weights in my records ---- but I KNOW I have hit my highs and when. Can you just tell the dr. what those were in your past and he put them in the record? does that count? really getting worried that all the work and hoops I've gone thru so far will end up not working for approval.

I had documentation from my PCP but I heard you can use weight watchers documentations or other weight loss programs that kept up with your weight but I also heard some ppl showing pictures from previous years.

Good Luck!