Denied again.
I submitted my appeal letter a few weeks ago and I call my insurance company today to see if there was an answer yet. Sure enough they denied me again.
All I want is this fistula closed so I can start losing weight again. I am currently at a BMI of 39 and my insurance won’t cover gastric bypass surgery unless you have a BMI of 40. If you have a BMI of less than 40 they will only cover the surgery if you have co-morbidities like high blood pressure, diabetes, etc. I want to avoid going back on blood pressure medicine, having GERD, and all those other problems I had prior to my original surgery.
That SUCKS!!!!!!
Have you visited the lightweights board???
http://www.obesityhelp.com/forums/wls_lightweights/
Keep fighting & appealing!!!! Don't give up!!!
-Jamie
Have you visited the lightweights board???
http://www.obesityhelp.com/forums/wls_lightweights/
Keep fighting & appealing!!!! Don't give up!!!
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
On December 16, 2009 at 8:27 PM Pacific Time, louisianamamaof3 wrote:
Your Dr.s office wont add a couple pounds so ur BMI is a little over 40?Fraud?
They are going to weigh her at the hospital as well and that will be part of her medical records. If the doctor and the OP are caught they would likely have to reimburse the ins co for all costs they would have paid out.
You didn't hear this from me.. but when you are so close the magic 40.. I've heard of people putting on ankle weights under their socks to get them to the weight for the approval. It's stupid that they would let 5-10lbs keep them from approving you, but especially with the holidays if you go in say the first week of jan, the weight gain would be justified.
(Have them weigh you first, and after they put you in the room and leave, slip them off and put them in your purse).
(Have them weigh you first, and after they put you in the room and leave, slip them off and put them in your purse).
H/C/G: 298/170.4/160 (H=5'5) @ Dr's goal 5/23/2012. Revison surgery 5/26/2011 convert from band to bypass due to slipped band.
Well Most insurance uses the weight when you first go to the DR. so no matter if you lose some weight on the pre-op you should still get approved.....and if you are 1-4 pounds from having a 40 BMI yes some DRS will give u a few pounds or go on and play with your BMI and ur HEIGHT.......theres way around it....
If you are having a revision for medical complications (like a fistula), it's my understanding that you don't have to meet the qualifications for weight-loss surgery. I was denied for my revision for the same reason as you, low BMI, but my surgeon was able to call my insurance company and get me approved because he explained the medical need. Keep trying. I think you should be able to get approval on medical need.
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