35 BMI, two months history, Am I crazy?

I have asked this question in many forms on different forums.  No one can possible know how things will turn out.  But, if any of you had to make a somewhat educated guess, what would you say?

I have maintained my weight below 35 BMI for a few years.  Usually between 33 and 34.5 ish.  I manage this because I manipulate my diabetes meds to lose weight.  When I approach 35 BMI, I stop taking my meds until I lose some weight.  Sad but true. and it works. Need to get into my jeans for a special occasion?  then skip your diabetes meds for a week or so and you will pee out the extra sugar.. you won't be able to use a lot of it floating around in your blood.  Very sad but true.  And very unhealthy.  I know, and I've decided never to do that again. 

OK...so back in April I decided that if I wanted to live I had best start taking my meds and gain the weight anyways.  My Endocrinologist had suggested WLS 2 years ago, when I was only 31 BMI, to deal with my diabetes.  But...you need to be 35, duh.  So I forgot about it until this June when I noticed I was up to 35 BMI.  So, mid June I opened a case with my insurance co for WLS.  At this time I had only been 35 BMI for like 1 month if that.  Now I am in my 6 month diet and still gaining weight due to my meds.

1. With almost no history of being over 35 BMI without going back 4 years or so, do you think I am crazy to even attempt approval? Won't they just tell me to lose 10 pounds and forget it?
2. Nurse says I can back date my 6 month diet since I have been seeing my PCP since April and at each visit we discuss diet, exercise and weight.  But what she doesn't know is that in April I wasn't quite 35 BMI yet.  So...If I back date to April...it will show me at 34 BMI.  But if I start when I hit 35 BMI I lose a month or so of this diet term I am already annoyed with. 
3. AND...I want a DS.  I will not settle for a RNY.  Some insurance and surgeons prefer to do DS on MO's...but I am only a light weight.  So I am fighting both the insurance co and the surgeon.  But there are many DS'ers on the lightweight forum.  DS IS the Platinum Standard of WLS in my opinion.

So...I am insane to even try this?  Am I double dog stupid to even add the DS demand?  Dear BCBS, I am 37 BMI, hit 35 BMI only two months ago AND I demand a DS!!  Are they likely to say "Oh, OK" or just laugh in my face.   
I know I can stay this road and wait until they decide yea or nay, but that could take up to a year with appeals.  In respect, I know many of you HAVE had to endure this and survived.  I applaude you!  But I just can't see devoting this time if it has a very low chance of approval.  I already feel much sicker with the extra weight.  I don't want to stroke out while I'm waiting.  My diabetes is telling me "enough is enough"

Any opinions or experience will be appreciated.  Even if it's just to tell me I'm spoiled and misguided.  Especially if that's what you think.

Lastly, should I talk to my insurance case nurse about this, or should I lay low?  I really hate the idea of waiting my six months, then being denied and going through appeals ad nauseum.  If my chances are very low, I may decide to fore go all this and self pay with either Ungson or Marchesini or Dr. Antelmo.

I need someone smarter than me to give me some advice.  Should I call the insurance office af a surgeon?  Would they give it to me straight?

Thank you so much!

Honestly I do not know what to tell you, I know that my Insurance requires 2 years of doctors records. Also you have to have 2 or more comorbids with a BMI of 35 No comorbids you have to have a  40 BMI. I would contact your insurance and ask them to send you the requirements for there program. it will tell you exactly what you have to do in order to be approved.  I called my insurance and asked them to send me all the info for WLS. They sent me the whole enchilada. Skye

I do meet the basic criteria.  However, I could see them denying based on medical necessity. Surgury not being necessary when in their opinion, I diet would be sufficient.  Also DS not being necessary because a RNY should suffice.

I know no one can say whether they will or they will not. I'm just trying to get a feel for my chances. I am not required to have a weight history...but that doesn't stop them from using it against me when it comes down to appoving or not.  I would think they will be looking for any angle to deny me.


Thanks!

There are absolutely studies that show the DS is the best when it comes to curing type 2 diabetes. RNY is good, but DS is best  when it comes to diabetes. If insurance denies your request, I would push this argument like nobody's business!

Thanks Jill..you are so right about the DS.
I hope you find out lots of goodies when you go to the Johs Hopkins seminar,  Yes, I looked at your profile.  It sounds like a sure thing to me with your five year history and diabetes.

The best of luck to you!!!

Me..I'm not sure I have it in me to wait so long and fight so long.  I am so tempted just to self pay and be done with it.  Of course my husband would prefer he didn't have to foot the bill.  so..I'm seeing my PCP tomorrow for my second weigh in and pep rally.  I wish I weren't so negative all the time.  I'm a worrier. I tress about everything not working out.  I need a major attitude adjustment!!

Well, anyways...it was nice to hear from you!
Rock on!

My insurance has standards for WLS and if you meet them, you can have a RnY, a band or DS. They don't have different standards for the different surgeries -- it's between you and your surgeon.

Have you found the bariatric surgery policy for your insurance company yet? They are often online and can be downloaded. A lot of the info you need is in there. Some policies are vague, but some are very specific. If it's specific, you will know one way or another.

I looked at mine, It was vague.  I've decided not to give up yet.  Guess I will stick it out till the end.

thanks!