Twenty pounds...

Twenty pounds is what is keeping me from my DS! Apparently my insurance has a restriction on the DS. It is only available to patients who have a 50+ BMI, regardless of comorbidities. My surgeon is going to do a peer to peer to try and change their minds and I've gotten with Diana to start the appeal paperwork in the event that the peer to peer doesn't go my way. It's just SO FRUSTRATING. Especially when I figured out that my pre WW weight would have qualified me, no questions asked.

Anyone have any words of wisdom on how to remain calm during this process?

Thanks,

Maghan

I would start eating. i could gain 20# in no time flat.

 

GL

That was my first thought. I too could gain that 20 in nothing flat!

But I hated myself at that weight and I'm afraid if I gain it, then there will be some other absurd obstacle and then I won't get the surgery and will be back on the same upward trajectory. In other words, I'm freaked about it...

Appeal their decision!!!  I had to appeal my insurance companies' decision and was approved after the first time.  The process took about a month.  Look into all of the reasons why you need the surgery...your co-morbitities, have your Drs sign a letter for you etc.  The more "power" you have behind your letter the better chance you will have of getting the surgery.

Good Luck

Deena

How long do you have to wait for the "peer to peer"?  If its going to be a long time, I would think about starting eating myself.  So sorry this is happening to you. 

I'm going to call the my insurance on Monday and see what they say and then I'm calling my surgeons's office. Ya'll are right, it would be infinitely easier to gain 20 pounds than to not have the surgery and never be able to have the operation for my endometriosis.

Find some heavy boots, load em with quarters, roll quarters and put em in your pockets, undies, and bra, wear a few layers, get bean bag weights and tape them around mid section, etc.  Voila.  20lbs.  (PS_ keep in mind this is, technically, insurance fraud.  Sometimes though, the insurers truly dont have the patents best interests or even their OWN at heart because in the end, the surgery is a one time fee of "x", but the comorbids are a lifetime fee of a hell of a lot more).

I remember jumping through the hoops when I first started trying to qualify for the DS. 

I had leg weights that have 4 of 5 lb sacks in each of them.  I unzipped the leg weights and pulled those sacks out.  I stuffed them in my pockets, my bra, my underwear, etc.  Then I went to see my doctor and got weighed in.

And I did put on another 20 lbs in 3 months. 

Once I started digging into it with my insurance company, I found out that I had to be at 50 BMI or higher for 2 continuous years or longer to qualify.  I was at BMI 42, so it was going to be a long road.

So call and get a copy of the terms from the insurance company.  Make sure you know the rules of thier game.

Good luck.  Don't give up.

Put some small weights in your pockets.

If you've contacted Diana, you're in good hands. I don't know a lot about insurance, but she knows more than anyone on this site. Do what she says, in the order she says to do it. I think you gain wait that long to gain weight or commit fraud.