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Shocked and disappointed.

K

KellyMarie

Member
My surgeon's office called me today and told me that my insurance was not approving my surgery because my BMI isn't 40.. it's 39.9 (I'm 218 pounds). I'm pretty sad today. I don't WANT to gain weight in order to be approved, but I CAN'T lose it on my own. I've tried for years. I just feel like crawling in a hole today. Sorry for the downer, but I have no where else to vent.
 
DON'T GIVE UP! Do you have any co-morbidities--- like high blood pressure, diabetes, high cholesterol? My surgeons have a BMI of 40 as a cut-off, but a BMI of 35 with one or more co-morbidities will qualify.
Work with your doctors office and file an appeal.
 
I have sleep apnea and PCOS, but they said my insurance still won't cover it. I'll see if I can figure out how to file an appeal. Thank you!
 
KellyMarie-I think Karenina's advise is accurate and I would mention this in your appeal. If that doesn't work then try plan B, if you are within .1 of a pound to quality I would make another appointment with the surgeon and then eat a couple of fast food burgers for lunch or dinner for each of the 3 days prior to the appointment, seriously. Weigh yourself each day and adjust your calories higher if needed. Afterall, it's only 1/10 of a pound. Your medical insurance is going to hold you accountable to the letter of their requirements and you need to keep them accountable for theirs. Go for the 1/10 of a pound. Here's plan C, put a couple of rolls of quarters in your socks before weigh in *LOL* No damage done!!!

8/4/12-OK, I just realized that I was thinking in pounds when you are speaking in terms of BMI. If you can figure out how much weight it would take to raise your BMI 0.1 points I would go ahead and gain the weight PROVIDING it is only a minimal amount and will not impact any health conditions you have in a dangerous way. Of course, try the appeal first. I know a lot of people will disagree with the weight gain but in the grand scheme of things...

I had to wait over 6 years for my surgery and it was Hell. My issue was insurance coverage that wouldn't pay for bariatric surgery under any circumstance and until I changed insurance I couldn't have the surgery. Because of this I can empathize with others when they are denied surgery and tend to want them to take a path that is fast but safe.
 
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Hi Kelly Marie, Appeal it and do as every one suggested and normally I wouldn't suggest the fast food or cheeseburger thing but whatever works at this point but I would think that sleep apnea would be a qualifier with you being so close to 40 bmi and I am not sure what PCOS is but I am sure that should also factor into it. Meanwhile keep venting as much as you need :cool: Tom
 
drink plentyof water and eat protein. this will definitely help good luck

KellyMarie said:
My surgeon's office called me today and told me that my insurance was not approving my surgery because my BMI isn't 40.. it's 39.9 (I'm 218 pounds). I'm pretty sad today. I don't WANT to gain weight in order to be approved, but I CAN'T lose it on my own. I've tried for years. I just feel like crawling in a hole today. Sorry for the downer, but I have no where else to vent.
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drink plenty of waer and eat protein it will help balance your system. water weighs lbs. good luck patti
 
I am at 246 pounds I have diabetes, high blood pressure, had a TIA, high cholestral and sleep anapa hoping they approve mine too. I will fight them on mine, My health is suffering.Do what ever it takes to get through to them. Good Luck
 
I feel your pain! In 2007 during month 5 of 6 of a physician's supervised diet my employer changed insurance companies and the new company did not cover any bariatric procedures. I went back to weight watchers with limited success but eventually put all the weight back on. In 2011 my employer changed insurance again and the surgery was a covered benefit. I was never so happy to hear that the surgery had been approved! I just had my surgery about two weeks ago. All I can say is hang in there and don't give up. If it were me - I'd gain the weight to qualify - but ultimately you have to decide what's best for yourself. Best wishes on your journey!
 
I also have the PCOS. And my doctor and I were concerned that I wouldn't be approved because I gained 10lbs within my 6 month pre op. and we were prepared to make an appeal and go though all the steps we could. My doctor also told me that you can re submit as many times as you want, so maybe go one more month and send it. And maybe you'll get a different person to review the application and approve!! Keep trying!
 
You need only gain about 4 pounds to go from 39.9 to 40 I think. Insurance companies try to discourage you so you will drop off but they do not understand that you will cost them much less thinner!
 
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