Looking for input...on letter to include in approval submittal packet
I am trying to think ahead and want to submit a package to insurance that is as complete as possible the first time, hopefully demostrating medically necessity. To my knowledge I have now co morbidities, at my last check up in February :
* my blood pressure was very good,
* total and bad cholesterol was good, good cholesteral was a little low,
* no eveidence of Diabetes or pre diabetes, etc, but that was based on glucose from fasting bloodwork, I actually just had an A1C performed and am waiting for that. I did have gestational diabetes when I was pregnant
Statistics show that having gestational diabetes makes me 7 times more likely to develop type 2 diabetes so I will incorporate that into my letter and package. The other thing is I bust my butt 5 days a week to exercise becaue I know that that helps lower risk for diabetes and all those other co morbidities but heres the deal, its really hard on a 5' 260 lb body to vigourously exercise. Added to that the knowledge that with age that ability to exercise at that level will diminish. Also, inujuries have set me back, I twisted my knee on an airplane last year, putting me out of commission for 6 months etc. I have recently developed terrible hip pain, and of course my knees are not the same. I also suffer from sever migraines on a fairly regular basis. I am trying to gather fodder for a letter to include in my package. I will have Fed BCBS which only has the BMI of 40 requirement and I have not heard of too many people having proble s getting approval here in Texas, but I also knwo this is insurance and I want to ahve everything lined up in the event of a possible appeal etc.
Sugestion for such a letter or ideas for appealing a decision when no co-morbidities exist.? Anyone had any exerience with that?
* my blood pressure was very good,
* total and bad cholesterol was good, good cholesteral was a little low,
* no eveidence of Diabetes or pre diabetes, etc, but that was based on glucose from fasting bloodwork, I actually just had an A1C performed and am waiting for that. I did have gestational diabetes when I was pregnant
Statistics show that having gestational diabetes makes me 7 times more likely to develop type 2 diabetes so I will incorporate that into my letter and package. The other thing is I bust my butt 5 days a week to exercise becaue I know that that helps lower risk for diabetes and all those other co morbidities but heres the deal, its really hard on a 5' 260 lb body to vigourously exercise. Added to that the knowledge that with age that ability to exercise at that level will diminish. Also, inujuries have set me back, I twisted my knee on an airplane last year, putting me out of commission for 6 months etc. I have recently developed terrible hip pain, and of course my knees are not the same. I also suffer from sever migraines on a fairly regular basis. I am trying to gather fodder for a letter to include in my package. I will have Fed BCBS which only has the BMI of 40 requirement and I have not heard of too many people having proble s getting approval here in Texas, but I also knwo this is insurance and I want to ahve everything lined up in the event of a possible appeal etc.
Sugestion for such a letter or ideas for appealing a decision when no co-morbidities exist.? Anyone had any exerience with that?
Have you had a sleep study done yet? I never imagined I could have sleep apnea but I did the study anyway and much to my surprise, I was diagnosed with severe obstructive sleep apnea. Talk about being blind sided. However, there is no better comorbidity than sleep apnea to get a quick approval so it may be worth your time and effort to get one done.
As for a letter, I believe they have a good one on dsfacts.com.
As for a letter, I believe they have a good one on dsfacts.com.
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I had my surgery done in LA and I just about froze to death. I have never been so happy to be home where it is toasty warm and sunny.
I thought I slept well too. I went along with the sleep study to humor my doctor. He suspected I had apnea and I was certain I did not. He won that one. The real reason I suggest it though is because it is probably the best comorbidity to have as far as getting an approval, although I think you are going to get approved based on your BMI alone.
Also, the pain in your hips and knees are a comorbidity so you do have at least one.
I thought I slept well too. I went along with the sleep study to humor my doctor. He suspected I had apnea and I was certain I did not. He won that one. The real reason I suggest it though is because it is probably the best comorbidity to have as far as getting an approval, although I think you are going to get approved based on your BMI alone.
Also, the pain in your hips and knees are a comorbidity so you do have at least one.
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Melissa Mermaid has deleted this message.
Let's try this again: www.mermaidonline.net/thestruggle.pdf ... Good luck and God bless.
& {{{HUGS}}} & 
Dare to dream & have the courage to act. Success is yours with persistence and believing you deserve it. melissamermaid.com (c) 2004-2013
Hello,
On the Sleep Apnea note...
If you have any one or more of the following signs...snoring, wake up in the middle of the night to pee, feel the need to nap in the afternoon, have acid reflux, swollen ankles, large abdomen, chances are you have it. Any one of these symptoms are pretty good indicators of the disease. When I was diagnosed in sometime back in either 1993-4 my Doctor (at Stanford Sleep Clinic) told me that somewhere around 40% of the population have undiagnosed sleep disorders. The one symptom of snoring alone has about a 75% chance of a positive result.
I definitely think a sleep study is a good idea.
Oh, and just so ya know, most PCPs know diddly about Sleep Apnea.
Good Luck,
S~
On the Sleep Apnea note...
If you have any one or more of the following signs...snoring, wake up in the middle of the night to pee, feel the need to nap in the afternoon, have acid reflux, swollen ankles, large abdomen, chances are you have it. Any one of these symptoms are pretty good indicators of the disease. When I was diagnosed in sometime back in either 1993-4 my Doctor (at Stanford Sleep Clinic) told me that somewhere around 40% of the population have undiagnosed sleep disorders. The one symptom of snoring alone has about a 75% chance of a positive result.
I definitely think a sleep study is a good idea.
Oh, and just so ya know, most PCPs know diddly about Sleep Apnea.
Good Luck,
S~
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