Denied surgery for a BMI of 34.9 with comorbidities

Eggface
on 1/27/16 1:44 pm - Sunny Southern, CA

Was it your current weight that was the issue... if it was a weight from the past... maybe find other sources... 1 pound can be the difference of TMI pooping that day or the scales not being accurate: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497726/pdf/1613 4566.pdf  maybe another weight from that year can be submitted with your appeal... something from your gynecologist, another Dr's appt that year, urgent care. 

I went to Mexico. It was a great experience for me but it's not ideal for everyone... I'd be concerned about leaving the country with a heart issue (I'm assuming since you were referred by your cardiologist) not all the hospitals are equipped for secondary health issues. Be sure that your Dr. facility in Mexico can handle are aware of any potential issue. 

Best,

 

 

 

 

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(deactivated member)
on 1/27/16 1:55 pm

My issue is that my weight from 5 years ago was one pound short of meeting the required BMI.  I lived in Canada during 3 of the last five years and while my doctor weighed me at every visit she didn't document it in my chart, so I have almost a year of records with no weights on them so even though I was at the required BMI during that time, I can't prove it. The insurance company is saying I won't be eligible to have the surgery until December 2016 and I honestly don't think I can stand to wait that long!

 

KLE
on 1/27/16 7:02 pm
RNY on 02/01/16

Start by appealing the decision.  Have your cardiologist call your insurance carrier and ask for a peer to peer review. (I work for a ON/GYN she has done several peer to peer reviews with probably a 40% approval.). I would exhaust ALL possibilities before going out of the country.  Good luck!

(deactivated member)
on 1/27/16 7:53 pm

Thank you very much for the information. I will definitely try that! :)

Oxford Comma Hag
on 1/27/16 8:25 pm

Peer to peer is for the requesting physician. Did the cardiologist submit the request for authorization? If not, he cannot do a peer to peer. 

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CerealKiller Kat71
on 1/28/16 3:08 pm
RNY on 12/31/13
On January 27, 2016 at 9:55 PM Pacific Time, Sharonkshea wrote:

My issue is that my weight from 5 years ago was one pound short of meeting the required BMI.  I lived in Canada during 3 of the last five years and while my doctor weighed me at every visit she didn't document it in my chart, so I have almost a year of records with no weights on them so even though I was at the required BMI during that time, I can't prove it. The insurance company is saying I won't be eligible to have the surgery until December 2016 and I honestly don't think I can stand to wait that long!

 

That's 11 months.

I had to wait 10 months for my surgery -- and I was at a 57 BMI. 

I understand.  You don't like to wait to meet requirements like the rest of us do.  You're special.  

Good luck with that.  

"What you eat in private, you wear in public." --- Kat

(deactivated member)
on 1/29/16 3:42 am

You don't know anything about me or how long I've already waited. As far as waiting another year, that was from the date of my denial , not today!  And yes I am special thank you for noticing!

White Dove
on 1/27/16 4:09 pm - Warren, OH

Weight loss surgery is not a life or death decision.  It is just a tool that makes it easier eat smaller portions.  Why do you believe you cannot wait until December?

Real life begins where your comfort zone ends

(deactivated member)
on 1/27/16 5:04 pm

Because my body hurts and I don't want to live in pain

(deactivated member)
on 1/27/16 5:09 pm

Furthermore, it can be a life or death decision for someone with breathing and heart issues. Not to mention not being able to walk because your feet hurt so bad. I think it's presumptuous for you to automatically assume I should wait. I could have a heart attack and die during that year. Also if it is just a tool why is it so much more effective than other weight loss methods? 

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