An insurance question

(deactivated member)
on 11/15/11 5:46 am - TX
 I'm totally out of my depth on this, can anyone help me help this pre-op?  She's here in TX, using Dr. Stewart.  She wrote me today:

 I have EVERYTHING in order for DS, as far as I knew, all records had been looked over and all was good, I just had to go to my last dietician visit Tues and they were sending for approv and surg date and we would receive in 3 days. Because I had been calling pretty much a couple times a month to make sure we were all on track and they were receiving everything. Talked to Kathleen today and she actually looked at my medical record for my weight history. In 2009, I am short 4 pounds on my bmi. Weight showed 260 and she just told me it had to be 264 since I had no co morbidities! I called my pcp to check their records and they aren't showing any above 260 in 2009 either but 281 in mar 2010. So, now I am a few days away to what I thought was a GO and now I find out Im 4 lbs short?? Excuse my language but this sucks dirty monkey balls!! So, my question is, is there any other way around this 4 lbs or am I just SOL?? I am DESPERATE and will do just about ANYTHING!! So, are there any hidden tricks of the trade or ways around or anything I can do at this point to have this done in 2011? My insurance is changing from Aetna to United in Jan and I don't want to have to start over...PLEASE o PLEASE, ideas?? Seriously 4lbs? 
shellemac
on 11/15/11 7:07 am
Hi,

Just saw this and thought I could help.  My BMI was too low for a year and my doctor did a peer to peer without any problems.  I was approved at that time.  It was a VSG and not a DS, but it seemed pretty easy to overcome a past issue with weight history.
provolisa
on 11/15/11 9:50 am - Provo, UT
Would drinking a LOT of water and sucking on milkshakes all day till just before the last minute and then weighing real quick help? This is a serious question. I can gain 4 lbs by just drinking too much and munching on high calorie stuff.

Lisa
               Recovering from the Duodenal Switch~
                HW - 495 / CW - 382 / GW - 175    Joanne B. is my Angel 
                  
nightowl
on 11/15/11 2:01 pm - Topeka, KS
The patient in the post weighs enough now -- some plans require proof of 5 years (for example) of being over a certain BMI.  The patient was four pounds under the requirement two years ago.
determineddanni
on 11/16/11 2:02 am
I have been over 40+BMI for the past 2 years. I have also been below a 40 BMI for the past 2 years. Yes we can have both! I have been on so many diets over a 10 year period that my weight did fluctuate. So of course I am going to have some weigh-in's that are below requirements of 40 BMI. So when they say you have to be morbidly obese for the past 2 years, that is so subjective because they also want to see weight loss attempts. So you can't always be morbidly obese when you are yo-yo diet as well! I honestly think you can fight this. I know if my insurance brings this up I will fight it because on my wedding 2008 I was morbidly obese. Then I joined weigh****chers and lost 20 or so lbs. Then I had to have my gall bladder removed and I weighed in below 40 BMI in 2010. It took me over a year to lose 20lbs! When I was recovering from my gallbladder surgery I was not allowed to work out and just in a months time I gained back 30lbs! Now I am back to morbidly obese. I wouldn't get to upset yet, I would find pictures and dieting history that you might have been doing at that time. If they fight me that I haven't been morbidly obese for past 2 years I will just show them my lovely wedding pictures and white is not so flattering lol

Good luck hun, I hope that helps ease your mind:)
(deactivated member)
on 11/16/11 2:19 am - TX
 Thank you!!

I'm copying your response and sending it her.  I think it will help her a great deal.

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