Denied!

[JourneyOfAFatKid 6]

Soooo, I got denied for my insurance because basically, Im fat, but not fat enough and Im "too" healthy. I have a BMI of 38 and at the time of my weigh in weighed 248lbs and my height was at 5'7 1/2 (i slouched a little lol) and I am NOW (about a month later) weighing in at 253lbs but it hasnt been documented. My insurance is (empire BCBS) telling me that I either need to have a BMI of 41 or higher or I need to have a co-morbidity with my current BMI and I dont. Im very healthy, Im just fat. But apparently not fat enough.

So i guess my question is, would it be ethical to gain 12-15 more pounds just to get this insurance approval? Because when push comes to shove, without it, Im not getting this surgery. I just cant.

So any advice on how to gain a quick 12 to 15lbs? or advice on what to do at all?

Thanks

<3

Caitlyn

[myrori 55]

do you have pain anywhere, knees, back? Blood pressure elevated? High cholestorol. Surely the doc can find something and resubmit:)

[RSREED53 4]

Eat your favorite foods--develop joint pain and pre-diabetes.

[JourneyOfAFatKid 6]

This is verbatim what my denial letter says.

"The request for coverage of surgery for obesity is not approved. The member has a BMI of 38. They are also reported to have heart burn, some pain and swelling in the feet and ankles, and low back pain. for a person with a BMI from 35 to 40 there must be serious medical problems related to obesity (such as life threatening heart or lung problems, significant diabetes mellitus, heart disease, or hypertension). The notes provided do not meet the health plan medical policy: Surgery for Clinically Severe Obesity, to show that the surgery is medically necessary. Without records showing such disease the member is not considered a candidate with a BMI between 35 and 40."

So I tried to complain about as many things as I could. lol It wasnt good enough...

My blood pressure is 120/80....

I was thinking of developing ankle weights!!! LMAO

[+change 5]

I have a BMI of 36/37 & thought my only co-morbidity was high cholesterol. I was sent for a sleep study & was diagnosed with sleep apnea which is an accepted co-morbidity. I never dreamed I had this condition so maybe you could request a sleep study. I now qualify for VSG after completing 6 mos of Weight Watchers. Don't give up.

Jan

[foxgirl74 5]

As horrible as it sounds I did gain weight so I could qualify for surgery because I wasn't fat enough. How terrible is that?? My BMI had to be over 40, and it was around 39 ish, and I was also worried because I did not have a BMI over 40 for 5 years straight. Thankfully that was not needed as I was approved. I think because there is so little you have to gain I would either gain the few pounds you need (you lose them quick with the pre-surgery diet or right after surgery) or I have heard that people have used ankle weights, or slipped weights into their pockets. Sometimes just having something on file like depression or anxiety can help as a co-morbidity too, so something to consider. Good luck!!!

[mariesleever 7/27/11 0]

this sounds horrible, but I had a friend put 10 pound weights in her bra, to make her weigh more. This did make her qualify, but not sure how safe this is. Also, they weigh you right before the surgury.

[earthchick97 0]

I had the same exact situation. Obsese but otherwise healthy (I was right on the border for BMI as well). As someone else has suggested, go and get a sleep study. I had "mild sleep apnea" but since they recommended a CPAP machine I was in the clear and my appeal was approved. It's harmless and worth a try. Please try this route before gaining 10-15 pounds. You'll be happy you tried this first!

Soooo, I got denied for my insurance because basically, Im fat, but not fat enough and Im "too" healthy. I have a BMI of 38 and at the time of my weigh in weighed 248lbs and my height was at 5'7 1/2 (i slouched a little lol) and I am NOW (about a month later) weighing in at 253lbs but it hasnt been documented. My insurance is (empire BCBS) telling me that I either need to have a BMI of 41 or higher or I need to have a co-morbidity with my current BMI and I dont. Im very healthy, Im just fat. But apparently not fat enough.

So i guess my question is, would it be ethical to gain 12-15 more pounds just to get this insurance approval? Because when push comes to shove, without it, Im not getting this surgery. I just cant.

So any advice on how to gain a quick 12 to 15lbs? or advice on what to do at all?

Thanks

<3

Caitlyn

[longer-life 139]

I had the same exact situation. Obsese but otherwise healthy (I was right on the border for BMI as well). As someone else has suggested, go and get a sleep study.

I had the same exact situation as well and was diagnosed last week with severe sleep apnea. I had many of the symptoms but always thought it was my allergies! Now my insurance will pay.

Best wishes!

[mariesleever 7/27/11 0]

Put 10 pound weights in your bra, I had a friend do that so she would qualify. you only have to be that weight, for 1 day. Try it, it might work!

Good luck!

[CT Fats 82]

Im not a woman but wouldn't walking around with 10lbs of extra weight up there be kind of hard and cumbersome?

[JourneyOfAFatKid 6]

probably not if it was only for an hour! lol