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BMI - Insurance Question



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Okay...after waiting a month and a half for my consult appointment I go in for a 2 hour appointment where they take my picture, the dr. spends tons of time explaining the procedure to me (most of which I already knew because of this board and watching the surgery on youtube...but I listened patiently because every dr. is different and I need to know what he does) they sent me up for an ekg .....................after all that.....................I am 7/10ths under the 40 bmi. I am 3lbs away from what I needed to be. I have always said I am 5'4" and the nurse measured me at 5'5"! So now I am in the waiting portion to see if my insurance will pay for it...and hoping I have not gotten my hopes up for nothing. 3 lbs difference!!! The dr. said since I have borderline high blood pressure and acid reflux he will add that in his report but I don't have any comorbities other than that. I have already done the nutrition appt. and the psych appt....Will they really reject me for 3 lbs...that I could have drank Water to gain before my appt? I have Anthem Blue Cross Sisc ...needing postive insight...feeling a little frustrated :(

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I was under my BMI much more than you are and I have Anthem too. I was approved with 2-3 weeks. Health issues make a difference. The measured me an inch taller than I thought I was too. Good Luck! By the way I'm scheduled for surgery on Jan. 7th. :lol:

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It's hard to say, but I'm betting it goes through. I own a medical billing service billing health insurance for a living, and let me tell you one thing...doctors are experts at documenting what is needed to get approval. Their salaries depend on it. If your insurance doesn't approve you right now, stuff your face with cake and chips, gain 5-10 pounds and go back in a month and have them try again!!! That's what I'd do!!

Okay...after waiting a month and a half for my consult appointment I go in for a 2 hour appointment where they take my picture, the dr. spends tons of time explaining the procedure to me (most of which I already knew because of this board and watching the surgery on youtube...but I listened patiently because every dr. is different and I need to know what he does) they sent me up for an ekg .....................after all that.....................I am 7/10ths under the 40 bmi. I am 3lbs away from what I needed to be. I have always said I am 5'4" and the nurse measured me at 5'5"! So now I am in the waiting portion to see if my insurance will pay for it...and hoping I have not gotten my hopes up for nothing. 3 lbs difference!!! The dr. said since I have borderline high blood pressure and acid reflux he will add that in his report but I don't have any comorbities other than that. I have already done the nutrition appt. and the psych appt....Will they really reject me for 3 lbs...that I could have drank Water to gain before my appt? I have Anthem Blue Cross Sisc ...needing postive insight...feeling a little frustrated :(

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Thanks for your replies...I'm not getting my hopes up but am definitely hoping for an approval. Best wishes on the surgery Kathy...may I ask...did you have other issues that helped with your approval?

Mattie...I'm hoping you are right. I even said to the dr...if my appointment had been later and I'd had coffee and Breakfast this would be a non issue. I had the stomach flu two days before my appointment so that definitely didn't help. I just wonder if I go back and weigh in 5lbs more in a month would they approve it or would they say no based on they know I gained it just to make the limit...grr. I guess I will just have to wait and see. Thanks for your replies and best of luck to you both!

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Hopefully your Dr. documented that you'd been sick and your weight is down as a result. Let us know the outcome!

Thanks for your replies...I'm not getting my hopes up but am definitely hoping for an approval. Best wishes on the surgery Kathy...may I ask...did you have other issues that helped with your approval?

Mattie...I'm hoping you are right. I even said to the dr...if my appointment had been later and I'd had coffee and Breakfast this would be a non issue. I had the stomach flu two days before my appointment so that definitely didn't help. I just wonder if I go back and weigh in 5lbs more in a month would they approve it or would they say no based on they know I gained it just to make the limit...grr. I guess I will just have to wait and see. Thanks for your replies and best of luck to you both!

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If you are denied, make sure you file an appeal. I was denied because my Dr didn't list my co-morbidity and my BMI was 36. I sent an appeal letter with a letter from my gp about the co-morbidity and it was approved. Funny thing,, it was denied in 1 day and they took 32 days to review and approve. Do you think they thought I would just go away??? BTW, my surgery is scheduled for January 12th.

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oh I'd like to say I'm surprised about the 32 days, but I'm not! Just wait, if/when national healthcare happens, this sort of thing will only get worse. It's already started just the average joe doesn't realize :(

If you are denied, make sure you file an appeal. I was denied because my Dr didn't list my co-morbidity and my BMI was 36. I sent an appeal letter with a letter from my gp about the co-morbidity and it was approved. Funny thing,, it was denied in 1 day and they took 32 days to review and approve. Do you think they thought I would just go away??? BTW, my surgery is scheduled for January 12th.

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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