Hello! This is my first post! I have been reading here and on some other forums, and I have felt so inspired by all the people who have made this huge decision and worked so hard to make it work. I had never even thought about WLS until very recently, but after reading and reading and reading, I have started seeing this little ray of hope that maybe there is something I can do about my weight and help to ensure that I will be healthy and alive as long as I can for my daughter.

I called my insurer (Federal Employee BC/BS Basic) and got all the information about what is required. I fit within their criteria - BMI of 35+ and co-morbidities for at least 2 years (although I have obviously been up and down as I am always trying to lose the weight and then regaining everything I lose), etc. HOWEVER, my PCP has never weighed me or taken down my weight! How in the world can I prove that I meet the 2-year requirement???? Am I out of the game before I've even started?

I doubt there are many people out there with this exact problem, but I am hoping someone might have some words of hope for me, some suggestions, something. I have an appointment with my PCP in a couple of weeks, and I am going to broach the subject with him, but I don't really know what he could do.

Thank you so much! I really am excited to join your community.

Welcome. I don't have any real advice about your insurance or PCP. I hope you can get that all worked out. But you've found a great forum here. If anyone has a better solution for you, you'll probably hear about it. Make sure to do some insurance-types of searches. You may find the answers you're looking for. Good luck to you!

Thank you for replying and for the warm welcome! I will keep looking around - I have not spent much time in this particular forum, so you are right - my answer may already be out there!

Have you looked at your medical records from your PCP's office?

What criteria are you trying to prove with the records? Are you just needing to show a history of obesity, or are you trying to prove supervised weightloss attempts, or what? (the wording determines what exactly is needed)

Have you seen any specialists that would have weighed you? If you just need something to show you've been overweight for a period, it doesn't have to be nearly as formal. OB visits, etc? What about a gym membership - they will have weighed you during an orientation. Etc.

Good luck & let us know if you need any help.

Thanks! I am supposed to show that I have been at it above a 35 BMI with comorbidities for at least two years. My PCP has no weight records not does my GYN. It's my own fault - I have never wanted to be weighed, and they haven't required it.

Actually, no one has a weight record for me except me.

I was reading on here that some people have used pictures. So maybe I will see if my doc will write a letter corroborating my own weight history and then submit photos to go with that. I can't believe that my own embarrassment at getting weighed at the doctor's office may now derail the possible solution to my problem! Oh, the irony........

I also had went to a 1001 diet centers etc. but they required a physcian overseen diet attempt for the insurance. I had to go to a Dr. diet center for 6 months. It wasn,t so bad while i did that I had my tests with cardio, gastric, etc. and then had my surgery. Good luck If there's a will there,s a way!

Your insurance may allow you to present photographs over the last three years as a substitute for weight and a supplement to physician's records. It is worth a try.

Thanks for the responses! I will definitely give the photos plus doc note a try.

I wonder whether I should just call the insurer and ask about it now. I mean, it seems kind of nuts to decide on a surgeon and get myself all psyched up just to be denied because of the weight record. Ugh - hard to know what to do!

Hmm... ER visits? Anything? My first submission for the sleeve was denied and one of the reasons was because I didn't prove that I had been compliant with the prescribed diet of the lapband. Well, the lapband doesn't have a prescribed diet, so how do you prove you've been compliant with it?

I pulled up every study I could find that showed %EWL at 12, 24 and 36 month marks, and then added a line of my own numbers, showing that even after my slip I exceeded the mean numbers (including numbers from FDA trials that were used as the basis for the band being approved) by no less than 30%. In order to do that I had to get REALLY creative. I had some weights, but not consistently for the 6 years I was banded. And I had a lot of numbers that could easily look like failure unless I could adequately explain (e.g. "weight gain" that was actually a pregnancy).

I also took the dates I could find (PCP, OB, ER, joining a gym, for my job I had to go through an extensive medical review and they had my weight recorded from our phone conversation, weights from surgeries, etc.) Then I built a "timeline," plotted out the verifiable weights, and then added event points to show fluctuations (e.g. pregnancy, delivery, slip diagnosed, etc.) I figured if my weightloss of almost 200 lbs wasn't enough to show compliance, what would be? So I grabbed a copy of my PCP's paperwork showing where I had them indicate I had an NSAID allergy (which I don't, but we wanted to make sure no one mistakenly prescribed any b/c they were a no-no). It's not technically diet, but it is compliance.

Maybe you can do something similar (timeline) using your pictures, and write an explanation that you declined office visit weights due to your discomfort, desire to avoid embarrassment, etc. Dated pictures if you have them. Do you post pics on social media sites? E.g. facebook has the timeline feature you could use as a guide, if so. I'd also request a letter from your PCP stating that weights were not recorded, but you have an X year history of obesity... that way there's at least official confirmation that your weight wasn't recorded vs. just your word.

The best lesson I learned - you have to be creative and a little loose with interpretations, and as much as I hate to say it, you have to find ways to "think outside the box". Clothing receipts that would show sizes purchased and corresponding dates? Home videos? Etc. Anything, regardless of medium, that could chronicle your weight.

Definitely call them, but expect elusive answers. I remember calling them and asking, specifically, "How can I prove compliance to a diet that doesn't exist? What will you accept as proof of that? Tell me and I will get it, but I need to know what will meet your criteria." I was basically told it was up to me, get what I could, submit it, and then they'd let me know if it was enough (in the form of another denial, or a reversed initial denial).

If you don't get a good answer when you call, hang up and call again. I think about 90% of it is who you happen to get on the phone.

Oh, aside from the actual records, it might be worth asking your PCP (or other healthcare provider) if your weight (as a general condition, not a number/pounds) was mentioned in their dictation. Often doctors will note things like "patient is visibly morbidly obese" in dictation, even if you aren't weighed. I once got a copy of all my PCP's dictations and was surprised how much information was recorded. Things I'd said that I didn't even remember saying. Notes on how much weight I had lost/gained since the last visit. Etc. It wouldn't surprise me at all if your PCP has noted something in dictation (which you'll be able to match up to a date) about your weight, even if he/she hasn't weighed you.

Thank you so much for your wonderfully thoughtful and useful advice. I have not let myself be photographed much, but I definitely know the dates of all photos I do have (although it would just be my word, I save and categorize pictures very carefully). I would even be able to figure out the size of clothes I was wearing in a given picture.

I have personally tracked my weight for long periods over the course of the years, so I could offer that too for what it's worth - maybe worth more with my doc's statement that those weights correspond to what he saw in person over the years as far as me not appearing significantly thinner at any given time.

Hmm, I will keep thinking and pondering! Is it the surgeon's office that has to submit all this crazy stuff?????

The surgeon's office does the submission, but what they'll want to submit will be your PCP records. Usually if it's an unusual condition like this you will have to do the legwork. Surgeons' offices are really good at faxing. I ended up doing most everything else, in my case. But I also knew a lot more about insurance than their coordinators did. (I wrote my appeal, did all the research, pulled all the statistics, timelined it all out, etc. -- then handed it over for them to fax).

Yeah, I figured I would have to do the work. Isn't that always the way? Hahaha. Just wondering whether the surgeon's office will think I'm insane or will understand and be willing to submit. I guess there's no way to know until I try!

Hello! This is my first post! I have been reading here and on some other forums, and I have felt so inspired by all the people who have made this huge decision and worked so hard to make it work. I had never even thought about WLS until very recently, but after reading and reading and reading, I have started seeing this little ray of hope that maybe there is something I can do about my weight and help to ensure that I will be healthy and alive as long as I can for my daughter.

I called my insurer (Federal Employee BC/BS Basic) and got all the information about what is required. I fit within their criteria - BMI of 35+ and co-morbidities for at least 2 years (although I have obviously been up and down as I am always trying to lose the weight and then regaining everything I lose), etc. HOWEVER, my PCP has never weighed me or taken down my weight! How in the world can I prove that I meet the 2-year requirement???? Am I out of the game before I've even started?

I doubt there are many people out there with this exact problem, but I am hoping someone might have some words of hope for me, some suggestions, something. I have an appointment with my PCP in a couple of weeks, and I am going to broach the subject with him, but I don't really know what he could do.

Thank you so much! I really am excited to join your community.

If you were ever in Weight Watchers, they keep those records for a while, also your GYN should have some records and also any gyms that you might have been a member of, they might have those also. Just a couple of ideas, not sure if they will work.

Also, your PCP may not have weighed you, but there may be those dreaded marks like "obese" or "morbidly obese" in chart notes. Those aren't specific weights but do have specific weight connotations that you insurance provider may consider.