Question about 5 year medical history??

I had my consultation yesterday with Dr Moran. I did all the things that I needed to, to prepare for the consultation like having my medical records sent to the office. The only office that I haven’t been able to get my records from yet is a doctor’s office that I went to for 2-3 years when I lived in NH. Unlike every other doctors office, they wouldn’t fax my records over to Dr Moran’s office, they told me that they would have to mail them to me. That was about 2 weeks ago. I’m hoping that I will get them in the mail soon so that I can fax them over myself. Normally I’m sure that it wouldn’t take 2 weeks to get something from NH, but for some reason it’s taking exceptionally long for this.

During my consult with Dr Moran I was talking to him about my weight history. He mentioned that of the records that he had in front of him that I have only been classified as “morbidly obese” since 2005. 2008 will make the 3^rd consecutive year that I have had a BMI over 40%. My insurance company, BCBS (of North Carolina), from what I’ve read and been told requires people to be morbidly obese for the past 5 years. I have 3 solid (might as well be 3 years). Please tell me that this counts for something!!! In the past 5 years my BMI has dramatically gone up, I’m talking from like 30/34ish to 44. My family has a history of hbp, diabetes, heart disease (which shockingly enough, I don't have any of those) etc. Dr Moran said that he would submit all this information to the insurance company with the hopes that they would approve me. I was just wondering if anyone else has been in this situation, and what the outcome was...or what you were told that you had to do before you have/had you got your approval. Have you had a BMI of 40+ for the past 5 years, or was your weight/BMI increased over a few years? Dr Moran told me what my ideal target weight was....as shocked (and sort of depressed) as I was, I was even more shocked to hear him say that I am 148 pounds over my ideal weight!! This has to count for something!

Unfortunatly, most insurances require at least 5 years of morbid obesity. But that includes a BMI of 35 or more, IF you have an obesity related illness that is serious. These co-morbids include High Blood Pressure (a precursor to Heart Disease), Diabetes, Congestive Heart Disease, or Obstructive Sleep Apnea. These are the most serious illnesses, although there are a lot of other obesity co-morbids. It seems like inusrances either want 1 from that list, or 2 of the more minor comorbids. So if you have any co-morbids with a BMI of 35+, that counts as well. But I guess your doctor knows that and would have advised you if you did. The 5 year history is really STALL tactics. However, thay don't want someone to have surgery if they haven't been Morb Obese for 5 yrs because they want you to try all other wl options. It is not fair, but that is the case. IF you can demonstrate that your life is in imminate danger if you don't lose the weight, you might have a chance. I'm a Preop for the Gastric Sleeve, and someone on our forum had Kidney Failure. She couldn't get onto the transplant list until she lost a significant amount of weight, so the need was URGENT. They still denied her, wanting her to go through the 6 month medically monitored diet first. She hired a lawyer and eventually won, and was excused from that 6 mo requirement. If she had not already had the 5 yr history of M.O., she may have won on appeal as well-- given the need to drop the weight IMMEDIATELY! Other than that, you may have to self-pay, or wait until you have met the insurance company's requirements. Yes, your 3 yrs have counted for something, but probabaly not enough for them to change their policy or make an exception just for you. They're in the business of denying people, even when they meet all their criteria. Sorry this is so negative, but I don't want you to get your hopes up. I'll be delighted if they approve you, but you may want to look into some other options. As a self-pay, you have to remember that the insurance also won't cover complications, fills, revisions, side effects, etc. if you get an "unauthorized" surgery. That's why I'm going for the Gastric Sleeve-- it's just "snip it and forget it." Rarely any complications/side effects, same wt loss as RNY and far more than the Lap Band. Safest procedure out there and happens to have people losing huge amounts of wt and keeping it off, becasue the part of the stomach that is kept is the thickest and least stretchy part of the stomach. RNY's pouch is made out of the stretchy part, and therefore many regain. There's Sleevers on the forum that have lost over 100 lbs in less than 6 months. Since the stomach won't stretch that much in time, your portions will always remain small, as will your waistline! Very few ever regain without trying REALLY hard to fail! Good luck, Kahlua