Twenty pounds...

During my 10 years as a dental insurance coordinator, I've been asked many times by various employers to commit insurance fraud, even faced with losing my job, i never sacrificed my moral belief that insurance fraud is wrong. I'm not about to start breaking the law now.

I know everyone here was only suggesting the weight additions with the best of intentions and that adding ankle weights, etc doesn't seem to *hurt* anyone but I'd know that I was being dishonest and wouldn't be able to live with the consequences of knowing I'd broken the law when I could wait a little while and legally get my desired outcome. A criminal I have never and a criminal never will I be.

If it comes down to it, I'll gain the weight. But I hope the peer to peer or some kind of legal alternative will stop me from having to gain 20 pounds.

I appreciate everyone's efforts to help and I honestly believe you are good people with good hearts and just looking to help me get my surgery as quickly as possible. Insurance fraud is just not an option for me.

(y) I need a like button!

 

Just read this thread. Good luck with your appeal. You are in good hands working the appeal process with Diana. And, I believe Laura has done some great work helping others with appeals.

After reading all the comments I agree with you, I would never commit insurance fraud or so anything else criminally.....even if it takes a little more time to get approval do it the legal way.

I've never understood people making those type of comments on a PUBLIC board yikes.

Check your height. If you haven't checked for a few years you may have to round down to the next inch. Measure at the end of the day as you'll be shorter then. That may be enough for you to quality when you recalculate your BMI.

I had a similar situation when I was trying to get approved for VSG.  At the initial weigh in with my surgeon, my BMI was 39.4.  I needed a 40+ or comorbidities to qualify.  (I didn't realize I was so close to 40---I had always thought I was 5'6" but they measured me at 5'4" so I was just a couple of pounds from 40 BMI).  During the few months I had my psych eval, sleep studies, etc. and during that time I gained 12 pounds.  My surgeon's office submitted all my paperwork with the 39.4 BMI and I was denied.  My surgeon then did the peer-to-peer and the insurance doctor said my comorbid conditions were "not bad enough" and were "responding to maximum therapy".  I was denied a second time.  I called my surgeon's office and explained that I had gained enough weight to be over the 40 BMI mark.  They told the insurance company this and they wanted me to weigh in officially at the surgeon's office.  I drove up to the office the next morning and weighed in with a BMI of 41.8.  They faxed this to insurance and within a week I had my approval.   It's a good thing because this was my last appeal and if I had not been approved I don't know what would have happened.

My advice: gain the weight to get to the BMI they require. But first find out if there is an exclusion for how long you had to be at that BMI.  GOOD LUCK!!