So Bummed. Husband Denied.

[Fluffnomore 1,235]

UGH. I was really hoping to go through this lovely experience with my husband, even though he was about 6 weeks behind me in the process with the surgeon's office.

I thought he was a shoo-in and I was going to be denied, but the opposite has happened. And because his BMI is only around 37, instead of the one co-morbidity he has, they are asking for two.

We will appeal it, but apparently the appeal goes to the same person who made the initial call, so it is very hard to fight. Unless he can get a physical from his PCP and have another co-morbidity added, he is out of luck.

What a bummer.

[Butterthebean 8,146]

Dang it.

Well I must say....if insurance hadn't paid for my sleeve, I would have gone to Mexico. It's worth it.

[woo woo 872]

[Fluffnomore 1,235]

Yeah, self-pay is not an option right now. Could be in the future, just not now. And there was something nice about having the same surgeon. I used a center of excellence that one of my good friends used, and just having the familiarity has helped so much.

Well, onward and upward.

[5.0junkie 770]

Sorry to hear the bad news.... Being denied of any WLS can be tough. No one likes rejection. It's always nice to have a partner to go through these sorts of things together. Hopefully your appeal will work and he will be sleeved and can join in on the post op side. My wife and I tried to get her WLS and insurance said they would not pay for two in one year and they would have to review to even do them in consecutive years. She was bummed and but we are working doing everything we can to get her closer to being on the post side. Keep up the good fight and good luck to you

[Fluffnomore 1,235]

Ugh, 5.0. That makes no sense! I mean, I understand the costs are higher if both spouses do it (I wonder if that's not part of the rejection? Probably not, as he works for a large company.) But to deny someone on that basis? If both gall bladders were exploding, they wouldn't deny surgery to the second.

Sigh.

Yes, the companionship would have been better, for sure.

[5.0junkie 770]

It doesn't make any sense but they say since its an elective surgery they have the choice to pay or not to pay. I can't afford it on my own and I definitely can't go to Mexico. Her BMI was borderline when we both tried out and out doc suggested I go first. It sucks because she is jealous of my loss now and I feel like I'm doing something wrong every time she asks me how much I've lost. We are working through it though.

[Fluffnomore 1,235]

Yes, I can't deny that I worry about that. He has a tendency to be jealous of weight loss or fitness gains. So that is going to be sticky if we don't get him approved.

Then again, I did have the qualifying BMI at least in the visit that they sent in for approval (I was right on the edge most of the time, like 39.6, 39.8 territory) and he has the delightful, uncanny male ability to drop weight if he stops snacking.

But like most of us here, he puts it right back on when he's not very careful.

[5.0junkie 770]

Just show him the new found you can rock his world!!!! That should take care of the jealousy issue

[PdxMan 4,292]

My insurance did not offer bariatric services. None, zip, notta. I couldn't even go see the dietician post-op because I had WLS surgery ...

But, I couldn't afford the $10,400 they were charging for outpatient in Las Vegas (I didn't want to go to Mexico) so I took a second on the house to pay for it. The family buckled down for the next 20 months and we were able to pay it off. Just the other night my wife told me it has been the best $10K we ever spent.

Don't let getting denied stop you. Find a way to finance it. You can do it.

[moonlitestarbrite 902]

yup, that is the same as my insurance... if your bmi is less than 40, you need 2 co-morbidities. .

[Fluffnomore 1,235]

Hey PdX, thanks for the encouragement. When I say we can't right now, I do mean that there are no immediate options. It would be scrimping for months or years to put together self pay. That's not to say we can't do it; it just won't be anytime soon unless something really changes.