Question:
HELP?!?! I'm healthy!!

I'm a 5'6" female who weighs 330 lbs (probably more by now) and am 100% healthy other than pain in my joints and the fact that I can not walk anywhere without being completely out of breath. My insurance denied me and I'm currently working an appeal with my human resource department. I've been to many many doctors in the last 2 to at least try to find something wrong with me to shut up my insurance and (thankfully? maybe, maybe not) there is nothing wrong. I'm 22 years old and my father had his first heart attack at 31. I don't want to be approaching 30 and be terrified of my health which is why this surgery is the only option for me. My BMI is over 50, you would think thats enough! Does anyone have any suggestions on this "underlying disease/medical necessity" thing? Has anyone had the surgery with still being healthy? I was hoping they would look at this as a preventative measure and also see that morbid obesity is a disease. So far, no luck. Any suggestions would be greatly appreciated!!!! [email protected]    — Christie N. (posted on June 25, 2002)

June 25, 2002
I have a BMI of 53 and for the most part am healthy. I have weight bearing joint pain, asthma, depression and acid reflux. I think my approval was based in part on my family history, which includes heart problems, stroke and diabetes. In the letter of medical necessity, my PCP stressed that it is necessary for me to lose weight and included the family history as part of it. If you like, I can find a copy of the letter when I return from vacation next week. Good Luck to you and I hope this helps.
   — Kathy M.

June 25, 2002
I too was healthy. At least that's what the doctors told me. I was 5'6" and 258lbs. I told him my weight was depressing me and the fact that I couldn't lose it, was even more depressing. My family history was a key factor, plus my aches and pains for which I went for consultations. If you have not seen any physicians for ANY medical needs...good luck. Stay positive and don't give up your dream. Show your weight loss attampts and how your blood pressure increased. Show state of mind as the attempts failed and how you started NOT attending social scenes, or missing days of work due to embarrassment...ot whatever. Don't give up the fight. IT's worth it.
   — Elizabeth P.

June 25, 2002
I was almost 300lbs... 5ft11... size 24/26... and healthy... I think my family history nailed it for me... I was the 35yr old 'baby' of 7 kids... My dad passed of a heart attack... My eldest brother had a stroke at 46... One of my sisters had to have 2 knee replacements... Another brother has sleep apnea... and another has high blood pressure... plus I had a diet history of failures covering over half my years... The medical cards I was dealt were on the table and I think they looked at me as someone who is healthy and we want to keep me that way... Now I am a 2 1/2 year post op... wearing size 14s... and healthiER :-) I wish you the best of luck... Fight the good fight Honey... You are worth it!!!
   — California J.

June 25, 2002
I'm 5'6.5", and weighed 325 at the time of my surgery. I, too, was fortunate enough to have almost no co-morbidities. (Which may seem like a "problem" now, but if you read what many people on this site have to deal with, you'll feel grateful.) I had pain in weight-bearing joints and almost constant yeast infections, but a family history of heart disease and diabetes. My BMI was 52, and I was approved the first time around, no questions asked. (My insurance company was United Healthcare.) So yes, it can be done; I guess each insurance company is different, and you may have to appeal, but definitely don't give up.
   — Roxanne M.

June 25, 2002
I had the same situation regarding the lack of co-morbidities... but I did have significant urinary stress incontinence, Pain in joints, decreased mobility, became out of breath very easily especially on exertion, extreme fatigue, depression, and a very long history of weight loss accompanied by significant weight gain. Why doesn't the insurance company understand the concept of PREVENTING other comorbidities while treating the problems that are causing quality of life issues? Another thing, I don't have children but if you do, you may want to appeal to their wish to help you be around to care for them?? Best of luck. You WILL succeed but you may just have to work a little harder. I know that it was worth it for me and it will be for you as well. Best wishes,
   — Ann B.

June 25, 2002
Your family history should help. Don't you think that pain in your joints and being out of breath is a health problem? Maximize those little "annoyances". What you have (termed in a way insurance likes) is major joint stress with impending arthritis and shortness of breath. Do you wake up at night breathless? You could have sleep apnea. What about urinary incontinence? It's so frustrating that insurance carriers don't think the 50 BMI alone is unhealthy enough, isn't it? I'd suggest reading the profiles of others who were initially denied and checking out their tactics for reframing their health history in a pro-insurance light. Good luck! :)
   — PT LawMom

June 26, 2002
Hi. I had no significant co-morbs before surgery either. I am 24 years old and I was 5'6, 269 pounds before surgery. I took a lot of the information on the "Your Journey" part of this website to put in my letter. It has a lot about what WILL come if obesity is not treated. Email me if you would like a copy of my letter.
   — emilyfink