Back trouble, will this help with insurance?

[pigletmik 0]

Let me fill you in a little about my past. I tried gettin my insurance to pay for lap band last year, well they denied me because my BMI wasn't high enough. So I've been trying my hardest to lost weight, and have acutally gained 15 pounds, how, I don't know! In that time have I had my back looked at. I've had accident when I was a kids, falling outta tree, off horses, ya know kid stuff. But this was the first year I've had back pain like this. I had it checked out and come to find out that my lower vertebrae(sp?) is slipped about 10%. They put me on Celebrex to help, which it did. Well last weekend went for a ride on my mule, and for some reason he reared up, and I flew off and landed on my tailbone hard, of course! Gimped around for a few days, but was doing really well, to the point where I was doing some light

exercise! Until this morning, when I replanted some plants, and now its REALLY sore! I mean it hurts to stand and walk again! Do I dare go through all the heartache and emotions of trying to get my insurance to pay, just to get denied? Or should I just heal and keep trying to lose weight? My husbands work had a healthfair acouple days ago, so I went in and had my blood work done, I get that this next week. Any imput will help! Thank you so much for your time!!!

[OnTheWay to Thin 0]

You need to get all the information you can, what BMI does your insurance require, what BMI are you at now? Do you have any other comorbities, diabetis, other problems from your weight? it is always worth a try, but you should be able to get the medical policy from your insurance and be able to tell from that if you have a shot at coverage. Good luck.

[Band_Groupie 3]

What your insurance policy probably won't spell out is which comorbidities count; generally it's only the big 5: high cholesterol, high blood pressure, type II diabetes, sleep apnea, and obesity related heart problems...AND you have to show treatment/medication for these problems.

It's not likely your back will help, but it's worth asking the insurance specialist at your surgeon's office. I have osteoarthritis, slight scoliosis, and severe lordosis in several sections of my spine, had xrays done this year and attended physical therapy. My back didn't count at all as a major comorbidity. I also have other 'minor' obesity related comorbidities; asthma, incontinence, etc. and these won't get you approved, but they'll help your case if they're on the fence.

You didn't say what your BMI currently is, but the general rule is you need one or two of the 5 biggies I listed if your BMI is 35-40, and usually none if it's over 40 so get a copy of your policy.

I'm glad you said you already had blood work done (I'd also ask for a diabetes test and a sleep study) as many here had comorbidities they didn't even know about (I didn't know I had hypertension until I started this process).

Good luck to you, and don't give up yet...for most of us this is a battle and lots of hoops to jump through...but look at me...I just got banded 3 days ago and I didn't think I'd qualify when I started.

[BeautyLocs 0]

Hi--

I was banded in February. In addition to high blood pressure, depression, and acid reflux, I have spinal stenosis, spondiolythesis and a large disk herniation that compresses nerves on my left side. My internist noted this in his support letter to the insurance company. I don't know if it helped, but he felt that weight loss would significantly improve these conditions and that it was important to let the insurance company know. I had no problems getting approved.

Something else I'd like to share--after three unsuccessful rounds of physical therapy and painful and upsetting steroid injections, I started having acupuncture treatments to control my back pain. It has worked wonders! While you're going through the insurance application process, this might be something to consider to bring you some relief.

Good luck to you!

BeautyLocs

[ParrotheadCathy 0]

It can't hurt to give the appeal process a shot. You're 15 pounds heavier. Your back is causing you problems. Have you been to an orthopedist? If not, go. After the evaluation ask if he/she thinks weight loss would help and if so, would he/she consider writing a letter to support your appeal process. And have a physical. With 15 more pounds, you might have other problems that are undiagnosed, like HBP and high cholesterol or even Type II Diabetes. Just cover all the bases. Some insurance requires a BMI of 40 or higher by itself or 35 and at least 2 co-morbities. So see if the 15 pounds and a year made a difference in anything. And follow up on the back problems.

[pigletmik 0]

It can't hurt to give the appeal process a shot. You're 15 pounds heavier. Your back is causing you problems. Have you been to an orthopedist? If not, go. After the evaluation ask if he/she thinks weight loss would help and if so, would he/she consider writing a letter to support your appeal process. And have a physical. With 15 more pounds, you might have other problems that are undiagnosed, like HBP and high cholesterol or even Type II Diabetes. Just cover all the bases. Some insurance requires a BMI of 40 or higher by itself or 35 and at least 2 co-morbities. So see if the 15 pounds and a year made a difference in anything. And follow up on the back problems.

I think my BMI is at 40, but just barely! And I had insulan resistants when I was at this weight after having my son, and then it went away after having my daughter! So thats why I went to the health fair at my hubbys work!

I went to a chiro first, and told him all the problems I have, and all the things I've done, and that I was scared to death of him, but was desperate to get some relief! He tried to align me, I cried the whole time, it hurt so bad! He also told me if what he tried didn't work that he would do x-rays, and then send me else where! While paying for it out of pocket, cause they don't do insurance! So I didn't go back, I called the orthopedic. I saw a hip doctor(cause I thought it was to do with my hips!) and he's the one that said my disk was slipped, but he didn't do lower back and referred me to one of his colleeges that did non-surgical back problems! They wanted to give me a cortizon shot! I have always had backproblems, always, but I couldn't deal with having a shot to possible make it worse! I canceled my appt when I heard from several people that he was a quack and that he was gettin his license revoked!! I would rather deal with the pain, than to have that done! I don't know, these doctors are 1 hour drive north of me, and more orthopedic 1 hour and 30 mins drive south of me(I live in the mountains of wyoming, so we're in the middle of no where!) Its just at the frustrating point again, where I don't know where to turn, or what to do, or who to go to! But it's not gettin better! I just wish there was a big arrow to tell me where to go!:laugh:

[Band_Groupie 3]

Most insurance will cover physical therapy. I did it the first time this year and it helped my upper back/neck a lot. The lower back, not as much, but it did help some- I have curvature there though (you can take your xrays to them and they'll go from there). If you're at a 40BMI, then GET a copy of your policy...statistics are that you won't need anything else. All it takes is a simple phone call to insurance (mine showed me how to print it out online). GETTING THE WEIGHT OFF WILL HELP A LOT!

[pigletmik 0]

Most insurance will cover physical therapy. I did it the first time this year and it helped my upper back/neck a lot. The lower back, not as much, but it did help some- I have curvature there though (you can take your xrays to them and they'll go from there). If you're at a 40BMI, then GET a copy of your policy...statistics are that you won't need anything else. All it takes is a simple phone call to insurance (mine showed me how to print it out online). GETTING THE WEIGHT OFF WILL HELP A LOT!

Thank you so much for your help! I know getting the weight off will help! It's just hard to do when its hard to excersice and move! I'm gonna call my insurance today and find out again, what all I need to get this done! Thanks again!