Got turned down last year, trying again. Any ideas?

[erinm51 3]

Last year I went through the process and at the end got turned down by my insurance who said that although I met all the critiria they felt I could loose the weight on my own? I'm trying again now and was wondering if anyone had a similar experience or any ideas. I have united Healthcare choiceplus in Florida.

Thanks

[lifelongSolution 17]

Last year I went through the process and at the end got turned down by my insurance who said that although I met all the critiria they felt I could loose the weight on my own? I'm trying again now and was wondering if anyone had a similar experience or any ideas. I have united Healthcare choiceplus in Florida.

Thanks

I was turned down twice even though I have sleep apnea and back and foot problems. I fought it, and papers after papers they wanted from different doctors. I was so angry because my struggle with weight was ongoing for over 14 years. I did program after program and went up and down like a yo-yo. The clinic I worked with was very helpful and put together a convincing proposal of how medically necessary it was and after 7 months finally got the approval. My main problem was my BMI being too low but they wanted to be blind to the declining health conditions. Don't give up, there must be something you havent thought of, make a list of all the health conditions you have due to your weight, and all the different things in the past that you have done on your own and try again. Good Luck

[Miss Mac 6,261]

Here is a list of obesity co-morbidities the http:/www.nih.gov the government website for The National Institue of Health. Claim as many as you can. For most of us, that is more than a few.

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease

• Family history of stroke

• Family history of diabetes

• Family history of heart attacks

• Hyperinsulinemia

• Diabetes

• High blood pressure

• Coronary-artery disease

• Hypertension

• Migraines or headaches directly related to obesity or cranial hypertension

• Congestive heart failure

• Neoplasia

• Dyslipidemia

• Anemia

• Gallbladder disease

• Osteoarthritis

• Degenerative arthritis

• Degenerative disc

• Degenerative joint disease

• Recommended joint replacement from specialist

• Accelerated degenerative joint disease

• Asthma

• Repeated pneumonia

• Repeated pleurisy

• Repeated bronchitis

• Lung restriction

• Gastroesophageal reflex (GERD)

• Excess facial & body hair (Hirsutism)

• Rashes

• Chronic skin infections

• Excess sweating

• Frequent yeast infections

• Urinary stress incontinence

• Menstrual irregularity

• Hormonal abnormalities

• Polycystic ovaries

• Infertility

• Carcinoma (breast, colon, uterine cancer)

• sleep apnea

• Pseudotumor cerebri

• Depression

• Psychological/sexual dysfunction

• Social discrimination

• Premature death in the immediate family

[Edavidson 84]

erinm51: I think it is hard to get the surgery if you don't have a high BMI. My friend at work was

turned down because of that. I had records from the pain clinic, my Doctor, the hospital from all

of the surgeries. I had high blood pressure and was on tons of pain pills. I was spending a

fortune just to be able to walk. Do you have medical issues caused by your obesity? I live in

Florida as well and they are very strict about approving weight loss surgeries, especially BCBS.

It is like pulling teeth. I went to the first seminar in September and had my surgery on December

10, 2014. I don't know if you are as determined as I am but when I made the decision to have the surgery I didn't stop. I called BCBS every day, I would not stop. Your surgeon could really boost

your chances by writing a letter to the Ins. company describing the complications you are having

due to your weight. Don't give up, keep pushing. If this is what you want don't let anyone get in

your way. Take it to the mattresses. Fight, fight, fight. Good luck

[samuelsmom 670]

Forgive me if I rant, but this stuff drives me crazy. Obesity is a disease. Nobody disputes that. However, when seeking treatment, you have to jump through hoops and it makes me nuts!

Keep at it and good luck to you!

[erinm51 3]

Thank You for all the replies! My BMI is 41 so I meet my insurance crieria on that but I will definitly bring up some of my conditions for that list (thanks) and you right I do have a few on there. I did not fight or even call my insurance last year I did not really know you could do that or it would make a difference, but I will do that this time if the turn me down again.

Thanks again

[Edavidson 84]

Wow, I can't believe they turned you down. My friend went through the same thing. They want you to

give up. This is your health and you want to live a long, healthy life. Drive them crazy and you

will get your surgery. Send them so much paperwork they will be happy to get rid of you. Have a good

day and keep us posted.

[samuelsmom 670]

@@erinm51 Denying you when you meet the criteria set by the insurance company is, in my opinion, discrimination. Please don't tolerate it. And, if you do get denied, make sure you appeal!

[erinm51 3]

Last year when I went through the process my insurance did NOT have a 6 month supervised diet requirement, I just saw online that they changed this. Wow, I'm so frustrated this is going to delay the process even further and seems so pointless as I have been on every diet imaginable over the years including a doctor supervised diet five or so years ago (I lost a buch of weight really fast and put it right back on plus 30lbs).

Has anyone had to do this 6 month diet? and what if your BMI drops below 40?

Thanks again for any and all advice

[karla777 1]

What bmi is the one that counts? The one as of now or the one from ur past history. I have federal bcbs

[karla777 1]

?

[ellynmae 1]

I am 3 wks into a 6 month required diet. No way will I lose enough to go below 40BMI plus I have severe sleep apnea. That said, I do think your BMI, at the time the insurance company, is what they use to make the decision.

What I don't know is how they use the dieting success or failure in their decision. So far, I'm doing well keeping to the 1500 calorie and the exercise requirement. Not doing well drinking the 64 oz per day. Down 6lbs so far. I use MyFitnessPal app to track my eating and exercise. I can print the results, from it, to show the nutritionist.

Ellyn

[karla777 1]

I hope so. I have a bmi of 4o some tight now now but the past 2 years was a 40 and 2012 a 34.78

[Edavidson 84]

There are two reasons they want you to lose weight. 1) to prove to them that you are capable of

losing weight on your and 2)they want to shrink your liver to prevent them from possibly damaging

it. You can still gain your weight back with any weight loss surgery. It still takes will power to

lose weight and they need to know that you are committed to this new lifestyle. Of course at first

you will not gain weight because of the surgery but if you fall back into your bad habits the

surgery was for nothing. I am, after 4 1/2 months able to eat food. I still fear I might gain

weight even though I can't eat much at a time I still stay hungry and I want to eat. I have to

remind myself not to do bad.