My insurance has denied me twice! Changing criteria...

delvalle5
on 10/4/09 11:33 am - Vancouver, WA
So now I'm not fat enough! I've been trying to get weight loss surgery for three years. I have a BMI of 47.84, pre-diabetes, mild sleep apnea, chronic achilles tendonitis, heart arrythmia, among other things. Mostly I just want to be thinner. The last time I was thin I was 12. How can 47.84BMI not be fat enough? They said I need to have a BMI of 50... are they telling me to gain weight? I was denied a couple of years ago, I was denied a few months ago again... I appealed and lost. They had my chart reviewed by a misc. MD who has never seen me. I'm 5'2" and most of my weight is in my midsection and my face. People are constantly asking me when I am due. I am so frustrated. My insurance says they promote wellness..."THRIVE" is the motto. I guess that would be for skinny healthy people. Anyone who needs real treatment gets denied. Tried to get a second opinion for my son-- denied.  How do you get an insurance company to do the right thing?
allformykids
on 10/4/09 12:52 pm
Who is your company? I would start to demand that I see a copy of their requirements and start to talk law suite.... Fear never hurt anyone :)
delvalle5
on 10/5/09 3:22 am - Vancouver, WA
I have Kaiser Permanente northwest. I asked for the requirements. The requirements are now 50BMI or 40BMI with comorbidity- and none of my issues- including prediabetes- qualify as a co- morbidity according to kaiser. They would rather wait until I have full blown Diabetes and maybe a heart attack and some degenerative bone issues before helping me. Of course, I could always gain weight, then re-apply- but I shouldn't have to do that!
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