Sphinx

I'm glad things have worked out for you, Lena

Really hate that just because my BMI is just over 38 that I have to have a specific comorbidity for my insurance to pay. I have plenty of health problems but not directly linked to my weight. My insurance recognizes even a couple less than some insurances. Like 5 pounds or so and I will be a hair under 40 and will be ok per the insurance coordinator at the clinic. However my insurance apparently does not require the 5% loss while I go through the 6 month pre-surgical program. So basically I have decided to stop trying to lose for now and eat the way I had been. I figure if I can eat lots of salty crap before I weigh in I could squeak by, but for 6 months? I have no doubt that if I continue as I am without dieting I can reach 40 but it seems so stupid I have to gain to lose! I know if I tried I could lose a little weight on my own but doubt I could get below 35 and keep it off! I feel strongly that the band is the tool I need in my weight loss journey but I feel I am stuck between a rock and a hard place. I am scheduled for an eval at a sleep clinic but not until the end of November! If I do get dx with OSA I can try and lose the few pounds before surgery. But who knows. I'm seriously considering doing the Mexico thing but not sure anyone here would do the fills. Plus if anything goes wrong I'm a wee bit screwed. I just wish I could keep weight off once I lose. But ever since the early 90's I keep gaining. I managed to lose a great deal of weight around 2001 or so but over the next several years gained most of it back. This is getting me down. I need clothes so badly and can't find what I want in a size that fits. :/ Am I nuts? Has anyone ever felt this way? Has anyone gained a few pounds just to qualify? I really need some support.

I called my PCP today to see about getting eval for a sleep study (waiting for a call back, might end up being tomorrow). My labs all came back normal re: other comorbidities and I am not hypertensive.

I signed up for the seminar today (it's not til 9/27) after a couple days of stress when I couldn't even get registered because I don't have the textbook co-morbidities. When I talked to their insurance coordinator I accidentally transposed a couple numbers in my weight (I do that with numbers all the time!) so was able to get through the door. Who knows what will happen once I get there, as it stand now my BMI is just a shade over 38. I'm getting tests for co-morbidities so who knows what that will bring......but being unsure about it all can be very frustrating! Good luck to you! Seems like you've had a long time of it too, hopefully things will work out this time!

LOL! Yeah, I am pretty polite......not the most assertive person! When I try to be more direct it is often because I'm so mad, but when I lose my temper I sometimes start to cry which never works haha! Anyhoo....... The insurance coordinator called me back today. I swear I didn't do it on purpose, but when she asked my height and weight she said "Well, you're BMI is 40 so you should be ok". I'm like, ummmmm, I thought it wasn't? She said it was 39.8 but that would count as being 40. I know it's just a hair over 38 and I realized I must have told her something wrong, but decided to let it slide. So after we talked I figured out what I must have told her to get a result of 38.8 and called to make an appointment, and told her that. I know that's bad, but I just wanted to get in the door. So I am registered for a class September 27th. It will probably be a waste of time but ya never know.

I don't think insurance will cover if your BMI is less than 35, even with comorbidities. Don't know about private pay though! BTW, try posting this as a separate new topic, you'd likely get more responses, since this is tacked on the end of my post it might not get seen

Oy. Called the surgeon's office. The woman who answers the phone strikes me as a gatekeeper who doesn't necessarily know the score. She didn't even know if they had an insurance coordinator. She did "go and check" and transfer me to someone, but that person didn't answer. I left a message but didn't hear back. Will have to try again tomorrow.

Thank you for some much needed clarity. I guess I was just so confident that going shot down before having a chance really killed me. I believe the person at my insurance company was speaking of the surgeon as they need to send over a pre certification not a referral (I don't require a referral for any specialists with my insurance. So I will try to call the surgeon again and see I their insurance coordinator will help. As it stands I can't even register for a seminar! I also had my labs drawn today and once the results are in plan to see if my primary doc will refer me for a sleep study and x rays of my knees and hips. Haven't ha my hips done in a couple years and never had my knees done (never had knee pain until the past few months.....not surprisingly when my weight started creeping up again haha). So maybe something will turn up there. Well I have a phone call or two to make then off to the gym! Gotta keep working at it!

But if the doc won't see me how can that happen? Argh!

Oh and I just called my insurance and they said they may or may not pay but they have to get something from the doc for per certification but

Well turns out it's all for nothing. I called the surgeons office and I can't even get an appointment because I need to have degenerative arthritis (RA doesn't count), Hypertension, Diabetes or sleep apnea and be on daily medication for the above. She said my insurance wouldn't make exceptions for my other diagnoses. I asked about private pay and she said that the same guidelienes apply. I knew that these were the accepted comorbidities, but was hoping to start the process and try to work with my insurance based on my RA and whatnot (reflux, etc). I know that weighing less would help my RA pain but I guess it doesn't matter. Even if my labs come up with diabetes I have to be on daily meds, not diet controlled. I am really bummed. Not that I'd purposely try to gain weight but if I keep gaining as fast as I have been I may just reach 40. But I hope not.

I am excited but also cautious. It's unknown whether or not my insurance will accept my many dx as comorbidities. I'm having loads of lab work in case anything else shows up. I'm calling the surgeons office tomorrow. From what I can tell it looks like the next seminar or whatever it's called is at the end of next month. I hate waiting! I'll have to do the physician monitored diet, from what I can tell with my insurance if I do a comprehensive program as part of surgery preparation I only have to do 3 months not 6. The only other thing is that even though my BMI is 38 now, it's dipped below 35 a bit and I'm not sure what insurance will think of that. To me it just shows what a yoyo I've been. But we will see how it all goes and I am thinking positively! Of course saying all this right after I polished off a too large meal. Well, I have to work on that one. I get so hungry at work! (At work now). How are you doing?

I saw my doc yesterday and she gave me the referral

I saw my primary doc today and she gave me a referral! I was worried because I'm a new patient to her (5 months) and wasn't sure what her opinion of the surgery was. My former doctor suggested it a couple years ago, putting the idea in my head and thinking about it since then Too bad it's Friday and I can't call the surgeon til Monday, lol......I know I have a long journey ahead of me and want to jump in with both feet! Not sure about insurance coverage. Although I have numerous health problems, none are considered comorbidities (my BMI is only 38 so need a comorbidity). I do have reflux, which she says may be considered a "soft" comorbidity, my RA as well. She is running many labs to see if I may have any other things that could be taken into account. I am thinking positively about getting approved. I also have to do the physician supervised nutrition/weight loss of course. I am thinking positively. I know it's not going to happen tomorrow, and I'm ok with that. I am looking forward to this journey! I know it will be hard but I am ready!