Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

I was denied because I hadn't had a BMI of 40 or above in the past 3 years, and I didn't have the required co-morbidities for the past 3 years. I do have co-morbidities, just not the ones that they recognize. I have high cholesterol, GERD, borderline diabetes taking Metformin to prevent getting full blown diabetes, knee problems and moderate sleep apnea.

I found medical records showing my high cholesterol for longer than 3 years, and I have a strong family history of diabetes, so I'm hoping that will be enough. I also found where I weighed in with a 39.1 BMI back in 2011, so that may help.

Oh ok. Can you get your doctor you see about your knee to write a letter saying if you were to get some weight off your knee that it will help with the problems you have been having? With my insurance (Aetna) GERD and sleep apnea are recognized. I have both of them.

Share this post


Link to post
Share on other sites

I was denied because I hadn't had a BMI of 40 or above in the past 3 years, and I didn't have the required co-morbidities for the past 3 years. I do have co-morbidities, just not the ones that they recognize. I have high cholesterol, GERD, borderline diabetes taking Metformin to prevent getting full blown diabetes, knee problems and moderate sleep apnea.

I found medical records showing my high cholesterol for longer than 3 years, and I have a strong family history of diabetes, so I'm hoping that will be enough. I also found where I weighed in with a 39.1 BMI back in 2011, so that may help.

Oh ok. Can you get your doctor you see about your knee to write a letter saying if you were to get some weight off your knee that it will help with the problems you have been having? With my insurance (Aetna) GERD and sleep apnea are recognized. I have both of them.

Share this post


Link to post
Share on other sites

I was denied because I hadn't had a BMI of 40 or above in the past 3 years, and I didn't have the required co-morbidities for the past 3 years. I do have co-morbidities, just not the ones that they recognize. I have high cholesterol, GERD, borderline diabetes taking Metformin to prevent getting full blown diabetes, knee problems and moderate sleep apnea.

I found medical records showing my high cholesterol for longer than 3 years, and I have a strong family history of diabetes, so I'm hoping that will be enough. I also found where I weighed in with a 39.1 BMI back in 2011, so that may help.

Oh ok. Can you get your doctor you see about your knee to write a letter saying if you were to get some weight off your knee that it will help with the problems you have been having? With my insurance (Aetna) GERD and sleep apnea are recognized. I have both of them.

Share this post


Link to post
Share on other sites

I've included my knee problems with my other medical information. I actually had surgery on my right knee a year ago due to a torn cartiledge, but since then, both knees are stiff and painful. I have had to resort at times to getting a cart at Walmart to shop. I've bought a cane to help when I need it also. They wake me up at night sometimes hurting.

BCBS recognizes sleep apnea, but only when it is severe, not moderate like mine, and I was only diagnosed last April, not 3 years ago, although I've probably had it for 3 years.

Share this post


Link to post
Share on other sites

Oh ok! Well ill be praying that God touch who ever your dr will talk to for the peer to peer!! Keep me posted! It will work out!

Share this post


Link to post
Share on other sites

LFG do you know "God is a wonder to my soul"? I think of the song when I hear of stories like yours. Surgery is around the corner. And health benefits to follow. God is a wonder...

Share this post


Link to post
Share on other sites

LFG do you know "God is a wonder to my soul"? I think of the song when I hear of stories like yours. Surgery is around the corner. And health benefits to follow. God is a wonder...

Yes he is. I prayed and I said God its in your hands. I was doubting and I prayed and told God to help me with that and he did!! God is wonderful. Have you hear William Murphy "It's working"? WONDERFUL SONG!!!

Share this post


Link to post
Share on other sites

Your story truly shows the power of prayer. I waited and prayed for two years about this surgery. I wanted the sleeve but my insurance did not cover it at the time. Late January last year I became very ill and was in the hospital for several days. I was told that I have copd on top of high blood pressure, no thyroids, sleep apnea, and diabetes. I was told I had to get the weight off. After several months of steroid shots I continued to gain. In July I really started praying that god make a way for this surgery. I called and got the process started in August. I found that my insurance now covered the sleeve and my out of pocket went from 2500.00 to 375.00. So God had not only answered the prayer for surgery, but answered the financial part too. Due to being in the hospital early in the year I had the surgery and only spent around 200.00. I no longer have the high blood pressure, diabetes, or sleep apnea. I am now down over 60 pounds and had surgery Oct. 30. We serve a great god.

Edited by Sherry73

Share this post


Link to post
Share on other sites

Your story truly shows the power of prayer. I waited and prayed for two years about this surgery. I wanted the sleeve but my insurance did not cover it at the time. Late January last year I became very ill and was in the hospital for several days. I was told that I have copd on top of high blood pressure, no thyroids, sleep apnea, and diabetes. I was told I had to get the weight off. After several months of steroid shots I continued to gain. In July I really started praying that god make a way for this surgery. I called and got the process started in August. I found that my insurance now covered the sleeve and my out of pocket went from 2500.00 to 375.00. So God had not only answered the prayer for surgery, but answered the financial part too. Due to being in the hospital early in the year I had the surgery and only spent around 200.00. I no longer have the high blood pressure, diabetes, or sleep apnea. I am now down over 60 pounds and had surgery Oct. 30. We serve a great god.

Now that really was God. We serve a wonderful God. Yes we do!

Share this post


Link to post
Share on other sites

Honestly, I think it's like applying for disability. They know that you qualify in the very beginning but I think they've made it standard practice to deny the initial application just hoping that many people will give up, which so many do and don't take advantage of the appeals process.

Share this post


Link to post
Share on other sites

Bamaboo64

Your right. Lots of people do give up and don't fight. But they should fight for it. But what I don't understand is why insurances make it so hard. Think about it, people having the surgery will save them money in the long run because It will cut out alot of health issues by losing weight

Share this post


Link to post
Share on other sites

Do you have a surgery date yet? If not, you need to let us know when you do so we can pray for you that day!

Share this post


Link to post
Share on other sites

Do you have a surgery date yet? If not, you need to let us know when you do so we can pray for you that day!

No I dont have a date yet. I called the coordinator at my dr office today to let her know my denial was reversed. So I had to email her a copy of the letter Aetna sent me. She called me back and said the lady that does the insurance had to verify my benefits for 2014 and that they will call me to set a date!

Share this post


Link to post
Share on other sites

Yippie!!!!! Keep us updated.

Share this post


Link to post
Share on other sites

Yippie!!!!! Keep us updated.

I surely will!!!!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • 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. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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.

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×