I am getting discouraged

I was so excited the nurse called today to set up my nurse consultation, my psych test and psych appt.  So I thought here we goooooooooo.

I call my insurance just to see what is required before they approve WLS-  She tells me 60 BMI... I never expected that as everyone had always told me 40 BMI, She also said 12 months doctor directed dieting... I have been dieting for YEARS, many times Doctor recommended but never did a monthly check in.

I have seen my PCP many times in the last 3.5 months as my blood work has been off since my physical in Oct.  I don't suppose that will count and now I have been classified as diabetic.

I don't know if I should keep these appointments just to be told my insurance will not approve me or if I should talk to my PCP about a 12 month diet- Problem is my husband's employer changes insurance almost every year and who knows if we will have Prefered One in 2009

Ughhhhhhhhhh What to do ?!?!?!?!?

A lot of insurances require one year of doctor monitored weight loss.  And a BMI of 40 usually also requires a co-morbid which diabetes is.  60 bmi sounds like a bit much, but that may be without co-morbids???? Also, double check if your psych stuff is good over a year later....as they will make you do the the one year of weight loss if your doc can't document it for you already.  Some won't take the psych stuff after 12 months old. Don't get discouraged.   This process is very expensive for the insurance companies, which is the main reason for the hoops.  Plus, you are re-arranging your internal organs and changing permanently how your body will function the rest of your life....it may take a year, if you are dedicated it will be worth it in the end.  Keep your eye on the prize!!!

Just to let you know that you are not alone with "bumps" in the road!  I would recheck with your insurance as being a diabetic has different "requiremente".  BMI of 60, wow!  40 is the norm for most insurances.  I would also check out the insurnace forum as they have great information!  Hang in there dear and keep us posted!  Sometimes ones journey has several challenges.

I had preferred one insurance last year and at that time it was a 35 BMI w/at least 2 co-morbs or a BMI of 40 with no or any co-morbids.

That said, I wonder if the 60 is something your husbands employer put in as a stipulation.

On the plus side of Preferred One - they approved me the day they recieved my request :)

 

GOOD LUCK!

Well, that stinks.  BUT, I have BCBS and they told me when I called that I had to have one year of nut visits before anything could be approved.  My surgeon's office told me that was bologna.  They seemed to think that insurance companies tell people that to deter them from pursuing the surgery.  I only ended up having to do six months!!  I'd call back and check on that BMI, too.  That seems high.  Best of luck to you darlin'!   Jeanne PS.  Keep us posted on how it goes!

Don't give up....they love to put you through this kind of hassle. I have never heard of a required BMI of 60. I would let them know you are now diabetic. That changes things quite a bit...it did for me!! I agree you could need the 1 year medically supervised diet. They are getting stricker about that. They are hoping people will give up  and they won't have to pay for the surgery. Keep checking and be persistent!! Hopefully your PCP can document a few months to help towards the 1 year wait. We are all here for you...ask for help anytime. Keep us posted okay. Hugs, connie d

Thank you all for your comments- I am going to continue as I want this so much.

I just hope I do not have to wait too long! My son is a Junior in HighSchool and I so want to be healthier and able to do stuff with him before he graduates and moves on to college and a life seperate from our family...

I am going to start journaling now and keep praying! Also I emailed my insurance company and asked them to send my requirements- I want them with me when I go talk to the nurse next week!

I totally say keep fighting! If you feel this is absolutely what you want, then keep fighting, don't give up on yourself!! Also, I agree with you - get those benefits in writing. You may see a loop hole in there somewhere! You never know.

Sometimes you have to fight to get what you need.  This is worth fighting for.

First of all, you need to read and study that policy.  One word at a time.  Make positive sure you understand what it says.  Don't rely on what someone tells you over the phone.  Apply for insurance coverage and let them deny you.  Then appeal.  There are also lawyers who specialize in this and overturn denials all the time.  The BMI requirement is odd.  The ASBS guidelines are BMI of 35 with comorbidities and 40 without.  They may cave in if this is questioned because it does not agree with established medical guidelines. In the meantime, read what is required for the 12 month diet.  If you don't have what you need, start now.  Follow the policy EXACTLY.  If it says you have to see a doc, do so.  If it says NUT, see a NUT.  Again, read the policy, don't listen to what someone tells you. All the tests you have cost money and aren't good forever.  Do just enough to file for the insurance.  Nothing extra. Remember, the insurance company is not your friend.  They want to make it so difficult for you to get surgery that you will just go away. Good luck! 

I agree, keep moving along, I've heard of ppl who have had to apeal and appeal and appeal but finally get approval... Good luck hon!