NEED HELP!!!!/DENIAL LETTER/FOUND OUT REASON

Hi Everyone, I got the letter from my insurance carrier and they say I don't meet the criteria because I have not had a BMI of over 40 for 5 years. I think I am 1 years short. What I want to know is this, please excuse my grafficness here: Besides this do they take into consideration that I am in horrific pain due to osteoarthritis in my back. I have a bi-lateral fusion in my back 5 years ago which restrains my mobility and I am to a point where I almost cannot clean myself after going to the bathroom. I was in the ER last night in horrible pain due to my back because my PCP is on vacation. I can only be on my feet literally for 20 min max and can only walk at a normal/slow pace for 10 min at a time w/o getting completely out of breathe. 1 flight of stairs does me in as well. The final thing I am not sure of is this, my blood pressure used to be 107/77 last night at the ER my blood pressure was 146/98. It has never been that high in my life EVER. It really scared me. So I need imput, anyone with experience in this any suggestions please. The one thing I do know is that I Serve a Might Big and Awesome God that can open any closed door no matter how tightly shut. I have to keep telling myself that because I am so scared. The only other option aside of them taking these things into consideration and the fact because of them I may lose my job, is gaining 30 more lbs so my BMI goes over 50 then I don't need the 5 years history. I love you all for the prayers and support thank you for being here. In His Grip Always, Trish

Hi Trish, I am sorry to hear of your pain.  And yes, appeal that decision.  Most insurance co's want two other co-morbidities.

Trish,

Sorry to hear you were denied.  Don't give up the journey, as some insurances always deny the first time.  I am constantly amazed how many different requirements there are even within the same insurance company.  Things seem to vary based employer, as well as carrier.  My wife Jodell, had RNY in March of this year, and had a pre-surgery BMI of 38, and no co-morbidities.  She was approved under our plan in a few weeks with no supervised exercise plan.  I had one co-morbidity (sleep apnea) and was approved in a few weeks.  We both had our surgeries in March. All the best- Dave

I sent you something in your email.   JackieBel