kaiser of VA denial - advice needed

bunnicule · January 30, 2009

I've been lurking here for over a month, this site has been really helpful to me in terms of what to expect and all the little details that aren't mentioned on webMD and the like. So my first order of business is to thank everyone! Second order of business: I got a PCP referral and was called later the same day to set up my first two appointments, I couldn't believe how fast it was and how nice the gentleman on the phone was. Well today I went to my nutritionist appt and it was jarring to say the least.

The first thing I was told is that I'm not eligible for the surgery because my BMI hasn't been consistently high enough, and that I need to change what I eat. This is before I even had a chance to even tell her what I eat. I had written up an outline of my past weight loss efforts and she didn't even want to see it. She was very dismissive and offered to give me a diet plan, which I accepted. I was there, and need to lose weight, so why not. What she gave me was practically the exact same thing that I was given about 2 years ago by my old ob-gyn (the one who diagnosed me with PCOS and switched me to a different pill and I will <3 him forever for improving my life) and that wasn't too successful. She didn't even acknowledge me when I told her this, just handed me some paperwork.

I have only been with kaiser about 3 years and my BMIs from previous physicals were under 40, which is why I do not qualify. According to her (and she's on the approval board) kaiser of VA requires you to be over 40 for a 3 solid 3 years OR you need 3 co-morbidities that cannot be controlled with medication. My most recent weight-gain has led to high blood pressure but they haven't started medication yet, I have to get it monitored for a bit first.

She pointed out my lower BMIs, I explained that I have struggled with my weight since I was 15 (developed PCOS and blew up) and while I can lose some of it I've never been able to lose it all or maintain. I have only been successful in losing weight eating 1000 calories or less (and being hungry all the time), and hitting the gym at least 10 hours a week for running, elliptical, and bodypump classes. I have it all written up, the different caloric restrictions, weight watchers, Atkins, etc etc. I was told to do it again.

I am just blown away by the fact that I exercise being used against me, when in the next breath I'm told that the surgery won't do the work for me. So, I'm not qualified because I've worked really, really hard in the past, but they don't want to operate because you have to work really hard to make the surgery a success. WTF??! I cannot believe that if I had sat on my butt for the past few years instead of trying to improve my health it would have allowed me to have this procedure and thus improved my health in the long-term. I'm beyond frustrated.

I was told that my name would be brought to the next approval team and would be denied for sure. Then I can appeal. Those of you who have been successful getting kaiser VA to approve, how did you do it? I really believe that the difficulty shedding weight is related to PCOS, should I emphasize that, or my past efforts, is there something else I should do? Help!