My insurance is requiring that I have 2 year history with my BMI being over 40 and I just went back to an appointment from last year in may and it was only 38. I was extreme dieting at that time, I have been for the longest basically starving myself. and I did not go to a doctor unless I had too. So I am officially counting myself out. What else could possibly help me? smh. Sorry for the pitty party.

@@hudjess Do you have any co-morbidities? Do you the insurance requirements in writing? Think back to see if you went to any other Drs during that time.

@@hudjess Do you have any co-morbidities? Do you the insurance requirements in writing? Think back to see if you went to any other Drs during that time.

No I don't have any other then that I am pre-diabetic. And I have been in IA for 5 years and I either went to the ER and the its been 2 places that I have been that has my weight and such.

I wouldn't give up until they actually deny you. Submit it anyway. At the very least make sure that you're getting the necessary weight documentation now going forward, until you have the 2 years you need.

My insurance is requiring that I have 2 year history with my BMI being over 40 and I just went back to an appointment from last year in may and it was only 38. I was extreme dieting at that time, I have been for the longest basically starving myself. and I did not go to a doctor unless I had too. So I am officially counting myself out. What else could possibly help me? smh. Sorry for the pitty party.

I had that problem as well, my surgeon wrote a letter to insurance and it worked. Took 15 months to be approved, but I'm here now

@@hudjess That's a bummer. I would talk to the insurance coordinator at the surgeon's office and see if they have any recommendations. I'd also make sure you get the requirements in writing. The best thing you can do for yourself is establish care with a Primary Care Provider and go for preventive/routine care so they document your weight but also weight loss attempts and discussions. I wouldn't just give up either.

The surgery was an exception for my insurance, meaning they wouldn't cover it at all. My surgeon checked me for a hiatal hernia (which I had, and he says most obese people do), and the insurance paid for that surgery, including hospital visit and anesthesia. It ended up being about half as much, and I was able to get right in with almost no waiting. I don't know if this is an option financially for you, but it seems to me that saving the money to self-pay is never discussed here, but is always an option, and may take less time. Just a thought.

I may not have been clear on my last post. They combined the two surgeries, so that the hospital visit, anesthesia and meds were covered for the hiatal hernia surgery, and my only out of pocket was the sleeve part.

The surgery was an exception for my insurance, meaning they wouldn't cover it at all. My surgeon checked me for a hiatal hernia (which I had, and he says most obese people do), and the insurance paid for that surgery, including hospital visit and anesthesia. It ended up being about half as much, and I was able to get right in with almost no waiting. I don't know if this is an option financially for you, but it seems to me that saving the money to self-pay is never discussed here, but is always an option, and may take less time. Just a thought.

Insurance companies are getting hip to this tactic and a lot of them are going out of their way to make sure it doesn't happen, some even view it as fraud. More than a few people have posted about it lately.

And people self pay all the time on here. In Mexico and the US. A few of the most vocal long time members that post here were all self pay, I can name 3 off the top of my head that are vets and self paid. There are more long term successful people that self pay than people that had insurance, and that just speaks to motivation.

@@hudjess

Honestly for what you spend out of pocket on co-pays and co-insurance, you can just self pay in Mexico for about the same amount, and when you add in that you don't have to waste a lot of time, on visits, you really come out ahead.

Edited September 22, 20169 yr by OutsideMatchInside

The surgery was an exception for my insurance, meaning they wouldn't cover it at all. My surgeon checked me for a hiatal hernia (which I had, and he says most obese people do), and the insurance paid for that surgery, including hospital visit and anesthesia. It ended up being about half as much, and I was able to get right in with almost no waiting. I don't know if this is an option financially for you, but it seems to me that saving the money to self-pay is never discussed here, but is always an option, and may take less time. Just a thought.

Insurance companies are getting hip to this tactic and a lot of them are going out of their way to make sure it doesn't happen, some even view it as fraud. More than a few people have posted about it lately.

And people self pay all the time on here. In Mexico and the US. A few of the most vocal long time members that post here were all self pay, I can name 3 off the top of my head that are vets and self paid. There are more long term successful people that self pay than people that had insurance, and that just speaks to motivation.

@@hudjess

Honestly for what you spend out of pocket on co-pays and co-insurance, you can just self pay in Mexico for about the same amount, and when you add in that you don't have to waste a lot of time, on visits, you really come out ahead.

Hmmm, interesting. I know a lot of the surgeons in this area (Dallas) still recommend the hernia option????

Also agree, a LOT of people do self pay, and many of them go to Mexico to do it. I may consider it if I don't get insurance approval (still waiting)

I have a 6k out of pocket - I think you can self pay for that without the hassle. Only perk is rest of the the year is "free"

Thank you, I can not stand the thought of giving up because I have been fighting for so long now. I figure I will just wait until I actually get denied and if the appeal does not work. I am confused as to what 2 years because at the end of 2014 I actually started going to the doctor and was diagnosed with severe sleep apnea and got my tonsils out in January of 2015 and I guess that's when it went away but technically as of 07/28/2016 I don't have sleep apnea anymore. so before that I had one comorbidity and then I had a baby in January of this year. But its been almost 9 months and im just getting heavier and heavier and I am pre-diabetic. Hopefully I am just thinking the worse and that's not what is going to happen.

I wouldn't give up until they actually deny you. Submit it anyway. At the very least make sure that you're getting the necessary weight documentation now going forward, until you have the 2 years you need.

I am actually thinking about self paying and going to Mexico when next year if this does not work out for me.

I have a 6k out of pocket - I think you can self pay for that without the hassle. Only perk is rest of the the year is "free"

My insurance is requiring that I have 2 year history with my BMI being over 40 and I just went back to an appointment from last year in may and it was only 38. I was extreme dieting at that time, I have been for the longest basically starving myself. and I did not go to a doctor unless I had too. So I am officially counting myself out. What else could possibly help me? smh. Sorry for the pitty party.

Write up a letter describing your attempts at weight loss, how the weight effects you physically and emotionally, family history of co-morbidities etc. It helped me get my approval pushed through... it cant hurt.

Thank you, would it be beneficial to do it now and then when everything is submitted to insurance have them send that as well? Or should I wait if it is denied?

My insurance is requiring that I have 2 year history with my BMI being over 40 and I just went back to an appointment from last year in may and it was only 38. I was extreme dieting at that time, I have been for the longest basically starving myself. and I did not go to a doctor unless I had too. So I am officially counting myself out. What else could possibly help me? smh. Sorry for the pitty party.

Write up a letter describing your attempts at weight loss, how the weight effects you physically and emotionally, family history of co-morbidities etc. It helped me get my approval pushed through... it cant hurt.

Thank you, would it be beneficial to do it now and then when everything is submitted to insurance have them send that as well? Or should I wait if it is denied?

My insurance is requiring that I have 2 year history with my BMI being over 40 and I just went back to an appointment from last year in may and it was only 38. I was extreme dieting at that time, I have been for the longest basically starving myself. and I did not go to a doctor unless I had too. So I am officially counting myself out. What else could possibly help me? smh. Sorry for the pitty party.

Write up a letter describing your attempts at weight loss, how the weight effects you physically and emotionally, family history of co-morbidities etc. It helped me get my approval pushed through... it cant hurt.

I would write it now and check with dr to see if they would send it with the official package. Why waste the time? It might take weeks for them to re-review your case. The appeal process is different for each company.

Go through the entire list of bariatric comorbidities. There are more than the commonly used ones. You might have a couple of the "second tier" issues.

I also talked about my family history, specifically things that are weight related. I described medical issues that were not comorbidities but that were effected by weight, such as the tendonitis in my elbows ive had for 2 years or how the combination of my osteoarthritis and edema in my feet make it almost impossible to exercise enough.

Equal parts sob story and medical facts.