frustrated and upset

[caracream 5]

I have to get this off my chest..I've been preparing for the day that my insurance bcbs would approve me for my gastric sleeve. I went through all the testing started exercising regularly and even began eating on smaller plates and drinking 30 mins prior or after my meals...to find out today my insurance does not believe I am co morbitly obese. I'm so frustrated. Any suggestions of what I can do to get this approved?

[Nessa39 28]

My BCBS flat out denied coverage for me to have any type of bariatric surgery so, I am headed to Mexico and will pay with my flight and all about $5000 out of pocket.... Amazingly, this is just $2000 more than my deductible and it's all inclusive and best of all, no hoops to jump through. Just something to consider.

[Miss Mac 6,261]

Would you qualify for anything else on this list? Also, I submitted with my packet, a personal heartfelt letter about how my weight and its complications negatively affected my quality of life and how the surgery would mitigate those issues. Here is the list of other conditions insurance companies consider in making their decision. I got it from

dsfacts.com. DS stands for duodenal switch. Hope this helps. Maybe you will find some you see as familiar.

In that letter, I explained when I started gaining weight and listed the diets and exercise programs that have failed me.

I told them about family members who have died of conditions on the co-morbities list.

I included a list of the medications I am taking for conditions related to my obesity.

I shared info about surgeries and joint replacements and other treatments necessary because of my weight.

I told them about inconveniences and the adjustments I have had to make to function throughout my day, and how how the weight itself prevents me from an effective and agressive exercise program.

Then I closed the letter by explaining how the surgery would drastically improve my quality of life, and thanking them in advance for approving the surgery which would surely extend my life and reduce the need critical medical care in the future.

When composing any good presentation, follow these 3 rules:

1. Tell them what you are going to tell them.

2. Tell them.

3. Tell them what you told them.

Good luck.

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

§ Family history of heart disease

§ Family history of stroke

§ Family history of diabetes

§ Family history of heart attacks

§ Hyperinsulinemia

§ Diabetes

§ High blood pressure

§ Coronary-artery disease

§ Hypertension

§ Migraines or headaches directly related to obesity or cranial hypertension

§ Congestive heart failure

§ Neoplasia

§ Dyslipidemia

§ Anemia

§ Gallbladder disease

§ Osteoarthritis

§ Degenerative arthritis

§ Degenerative disc

§ Degenerative joint disease

§ Recommended joint replacement from specialist

§ Accelerated degenerative joint disease

§ Asthma

§ Repeated pneumonia

§ Repeated pleurisy

§ Repeated bronchitis

§ Lung restriction

§ Gastroesophageal reflex (GERD)

§ Excess facial & body hair (Hirsutism)

§ Rashes

§ Chronic skin infections

§ Excess sweating

§ Frequent yeast infections

§ Urinary stress incontinence

§ Menstrual irregularity

§ Hormonal abnormalities

§ Polycystic ovaries

§ Infertility

§ Carcinoma (breast, colon, uterine cancer)

§ sleep apnea

§ Pseudotumor cerebri

§ Depression

§ Psychological/sexual dysfunction

§ Social discrimination

§ Premature death

For more information on the NIH qualifications for weight loss surgery:
Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference, March 25-27, 1991.

[ProudGrammy 8,322]

suggestions of what I can do to get this approved?

caracream

hold the phone

don't give up so quickly

i've seen many people appeal their decision successfully

or at least have insurance pick up some of the cost

the above co-morbitie suggestions that Miss Mac gave "above" are great!!

get your doc to sign off on as many as you might have

(sadly in this case for approval, the more issues/problems you have, the better chances you will be approved by insurance)

good luck

kathy

Edited March 15, 2014 by proudgrammy

[caracream 5]

Thank you so much for the information... I'm going to plead my case...I unfortunately do not have $5000.00 to spend on this surgery...live pay check to pay check. Mexico would be a vacation for me. Thank you however for the mexico suggestion.

[CBT 450]

Would you qualify for anything else on this list? Also, I submitted with my packet, a personal heartfelt letter about how my weight and its complications negatively affected my quality of life and how the surgery would mitigate those issues. Here is the list of other conditions insurance companies consider in making their decision. I got it from dsfacts.com. DS stands for duodenal switch. Hope this helps. Maybe you will find some you see as familiar. In that letter, I explained when I started gaining weight and listed the diets and exercise programs that have failed me. I told them about family members who have died of conditions on the co-morbities list. I included a list of the medications I am taking for conditions related to my obesity. I shared info about surgeries and joint replacements and other treatments necessary because of my weight. I told them about inconveniences and the adjustments I have had to make to function throughout my day, and how how the weight itself prevents me from an effective and agressive exercise program. Then I closed the letter by explaining how the surgery would drastically improve my quality of life, and thanking them in advance for approving the surgery which would surely extend my life and reduce the need critical medical care in the future. When composing any good presentation, follow these 3 rules: 1. Tell them what you are going to tell them. 2. Tell them. 3. Tell them what you told them. Good luck. Obesity Comorbidities To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery. § Family history of heart disease § Family history of stroke § Family history of diabetes § Family history of heart attacks § Hyperinsulinemia § Diabetes § High blood pressure § Coronary-artery disease § Hypertension § Migraines or headaches directly related to obesity or cranial hypertension § Congestive heart failure § Neoplasia § Dyslipidemia § Anemia § Gallbladder disease § Osteoarthritis § Degenerative arthritis § Degenerative disc § Degenerative joint disease § Recommended joint replacement from specialist § Accelerated degenerative joint disease § Asthma § Repeated pneumonia § Repeated pleurisy § Repeated bronchitis § Lung restriction § Gastroesophageal reflex (GERD) § Excess facial & body hair (Hirsutism) § Rashes § Chronic skin infections § Excess sweating § Frequent yeast infections § Urinary stress incontinence § Menstrual irregularity § Hormonal abnormalities § Polycystic ovaries § Infertility § Carcinoma (breast, colon, uterine cancer) § sleep apnea § Pseudotumor cerebri § Depression § Psychological/sexual dysfunction § Social discrimination § Premature death For more information on the NIH qualifications for weight loss surgery: Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference, March 25-27, 1991.

Wow! Seems to me you could get yourself a patient advocacy/appeals business!

Go you!!!

[Miss Mac 6,261]

Thanks for the vote. A stroke in 2010 forced my retirement, but if I had my life to live over, I think I would have gone for Healthcare Administration instead of Hospitality/Business Management. Oh well. I am enjoying retirement because there is no boss, no alarm clock, and I have all day for therapy, my genealogy project, and puttering around the house.

[BellaHugz 331]

I had this problem too my first letter of approval was denied. You havent mentioned your BMI and many of us have had to fight for the 2nd letter to be approved. Hang in there and fight the good fight. Your health is worth it.

[caracream 5]

My bmi is 34 however I weight 254 I'm 5'9 ...I'm literally 100 pounds over weight...I have taken the suggestion and wrote up an appeals letter to my insurance. Thank you all for the great suggestions!

[caracream 5]

I HAVE BEEN APPROVED! AT 100% ....SLEEVE HERE I COME!

[Nessa39 28]

I HAVE BEEN APPROVED! AT 100% ....SLEEVE HERE I COME!

Congrats on your approval!!!

[Madam Reverie 2,958]

Nicely done!

We'll all be seeing you on the losers bench shortly

[ProudGrammy 8,322]

I HAVE BEEN APPROVED! AT 100%

@@caracream

holy moly girfriend

i'm so happy for you!!!!

good for you on writing/speaking up for yourself

hope your date for surgery is sooner, than later

you might be becoming a loser...........

but you are a winner in my book

kathy

congrats

Edited April 11, 2014 by proudgrammy

[thicvik 50]

Congratulation that was quick you just talking about your denial and couple weeks later you approved! Good things come to those who wait!!