Question:
Is this the beginning of a fight?

Good Evening- My current BMI is 35-36. I know I am considered a "lightweight" but I need this surgery to stay healthy and alive! I have several co-morbidities including hypertensions, diabetes, stress urinary incontinence, depression, fatigue, high cholesterol. Lots of family history of early strokes, heart attacks, and cancer. My surgeon's office sent the paperwork to Blue Cross for approval. They want more information before they approve or deny. First they want a sleep study done. I listed four of the symptoms associated with sleep apnea although I don't snore. So even though I don't think I have sleep apnea, I will gladly take the test at several hundred dollars out of my own pocket. Second, they want a letter from my personal physician giving details about how this surgery will help my "uncontrolled blood sugar". My blood sugar is controlled with oral medication. I didn't think if you had co-morbidities that they had to be "uncontrolled". So I have to wait until my I go into a diabetic coma or stroke out from high blood pressure? (Sorry, as you can tell I am frustrated.) Is the beginning of the one year "battle of the bulge" with the insurance company that I have heard other AMOS members talk about? Am I over-reacting and is this just part of the process. Thanks for your help.    — Joanie J. (posted on April 13, 2002)

April 13, 2002
HI I am going thru the same problems you are---I went for my initial consultation on Nov. 19--I had already had the psych eval. and nutritionist thing out of the way. My PCP had provided me with the necessary paperwork. We filed it with BCBS on Nov. 19. I called to make sure they had the work---but they replied that the dr and the surgeon had neither one stated my height and weight--DUH--we refaxed the same info. I would call on Friday of every week to check my status---they said I would need a thyroid profile in Feb. that would be the only holdup I had---so I rushed and got the profile and the results were sent the next day. March 15 I was denied---not enought medical records--we sent 3 years worth-so I went back and called other dr.s I had seen during that time--sent those records. Denied again on April 4(?). This time---I did not send a diet history---the nutritionist sent the one I gave her and my PCP wrote a letter that in effect said---I had been his patient for 7 years and during that time he monitored my diet in order to control my diabetes. Denied again April 12. It is now in 3rd level medical review...I have diabetes--and it is insuling resistant...high blood pressure...migraines...diabetic polyneuropathy and retinopathy---they just planked out 17k for laser treatments for my eyes---that will have to be done again... I am fighting this tooth and nail---and I have been in contact with obestitylaw.com---they haven't heard the last of me yet----itsn't it funny that if I work--and I am a drunk---they will pay to dry me out.....if I am codependent on drugs----they provide treatment----if I go nuts---they will treat me---Didn't Congress declare obesity a disease? What if I get cancer or another disease---is BCBS going to deny me treatment--(I have had insurance with them for 25 years---so its not like I just got the policy) Enough of my soap box---all I can do is say FIGHT---I have nothing to lose in this fight but my life---little by little everyday that my surgery is not approved!
   — Linda L.

April 13, 2002
You're not over reacting and you have the right to be frustrated. The fight is quite real but at least your insurance company is asking for more information and not just flatly turing you down. Keep your faith, don't give in, don't get impatient. Ask you PCP to get very very pacific concerning each indiviual co-morbidty. I've been sent 2 denial letters and I've now requested an appeal hearing. My BMI is 62 and I have the hypertension, asthma, stress uninary incontinence, depression, fatigue, GERD, arthritis, hiatial hernia and sinuritis, sleep apnea, and 1 artifical knee and need the other knee done. I also have the family history to worry about. I currently take 7 different medications daily and when the asthma flares I have to add 5 to that number.
   — gwendolyn M.

April 13, 2002
I'm in the middle of the same thing...from what my doctor said, yes it is part of the process. I have Cigna HMO, and my BMI is "only" 38. I hope that your doctors are as supportive as mine-it makes the whole process much more bearable:). My PCP ordered my sleep study early on due to my fatique, and it did not show sleap apnea, but did show sleep disturbances. My phsyc wrote that even though my agoraphobia and depression are controlled by medication, they are very much agravated by my weight problem. My PCP is very WLS friendly. He runs a weight control clinic as well as his family practice (I didn't know that until I asked for help) and he also beleives that the only way to cure obesity is surgery. He has given me documentation you wouldn't beleive about how obesity is genetic and only temporarily treated by diet, all of the studies that our insurance companies refuse to accept. I have found resources (like JAMA and other medical journals on line) and compiled a stack three inches thick of documentation that I am sending to my insurance company as well as a letter from my lawyer in case they deny me. I have written to my congressman as well and am expecting the letter he promised. I know this is all overkill, I may be approved first time out(knock on wood). but I plan on continuing my fight for fair insurance long after I have my surgery and lose my weight. I will never loose sight of the common goal that we all have here. Good luck, don't get discouraged, and keep your eyes on the goal. If you need any help e-mail me.
   — Laurie V.