This option closed for me
Oh, how I can sympathize. I am reading the "Mexico Forum" because I have been turned down by 2 different insurance companies.
I have a BMI of high 30's (varies between 35-39) and have Type 2 diabetes. I thought I'd be a shoe-in for surgical approval.
The first insurance company (an HMO with one of the Blues) had a requirement that I had done a "physician supervised" weight loss program for a minimum of 6 months within the previous 2 years. No probem - I had done that, I thought! Well, during that 6-month diet program, you had to fill out weekly progress sheets. During the 2 weeks before Christmas the week I was on the weight-loss program, I reported that I did not exercise. Fast forward 2 years....and the Blues refused me for WLS because I had been "non compliant" for those 2 weeks (out of 6 months) on the medical weight loss program.
Fast forward a year - now a different insurance company. This one requires that my BMI be 35+ for 5 years. Well, because of that time on the physician-supervised weight loss program, when my BMI had dropped to 32.....now *THIS* insurance company has refused me. (Of course, I've rebounded mightily and my BMI is now higher than it's EVER been before.....) Yes, I'm appealing, because I can document a BMI of 35+ 5 years ago, then 2 years where it dropped below 35.....but one would think that I have proved the "spirit" of the 5-year requirement (which I assume to be that one must prove obesity is a long-term problem I've been struggling with), that to refuse me because of temporarily dropping BELOW 35 due to the short-term success of previous weight loss efforts seems ridiculously punitive, yes?
I'll keep you posted - but if my appeal doesn't work, I have two choices: (1) wait another 2.5 years to full the 5 year requirement; or (2) take a Mexican vacation. As I don't anticipate my overall physical health (let alone my mental health) will improve by being morbidly obese for another 2.5 years, I'm thinking I'll be a health-care tourist before the end of the summer!
I have a BMI of high 30's (varies between 35-39) and have Type 2 diabetes. I thought I'd be a shoe-in for surgical approval.
The first insurance company (an HMO with one of the Blues) had a requirement that I had done a "physician supervised" weight loss program for a minimum of 6 months within the previous 2 years. No probem - I had done that, I thought! Well, during that 6-month diet program, you had to fill out weekly progress sheets. During the 2 weeks before Christmas the week I was on the weight-loss program, I reported that I did not exercise. Fast forward 2 years....and the Blues refused me for WLS because I had been "non compliant" for those 2 weeks (out of 6 months) on the medical weight loss program.
Fast forward a year - now a different insurance company. This one requires that my BMI be 35+ for 5 years. Well, because of that time on the physician-supervised weight loss program, when my BMI had dropped to 32.....now *THIS* insurance company has refused me. (Of course, I've rebounded mightily and my BMI is now higher than it's EVER been before.....) Yes, I'm appealing, because I can document a BMI of 35+ 5 years ago, then 2 years where it dropped below 35.....but one would think that I have proved the "spirit" of the 5-year requirement (which I assume to be that one must prove obesity is a long-term problem I've been struggling with), that to refuse me because of temporarily dropping BELOW 35 due to the short-term success of previous weight loss efforts seems ridiculously punitive, yes?
I'll keep you posted - but if my appeal doesn't work, I have two choices: (1) wait another 2.5 years to full the 5 year requirement; or (2) take a Mexican vacation. As I don't anticipate my overall physical health (let alone my mental health) will improve by being morbidly obese for another 2.5 years, I'm thinking I'll be a health-care tourist before the end of the summer!
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