I was denied Too :(

[Lynn Smith]

Yes they did do a starting weight? So its bad to have the medicince work?

 

[Lynn Smith]

I think I am up to almost ten different ones to try and find ones that will work.

 

[DianaCox]

Not sure what you mean by the last comment, but yes, hypertension controlled by medication is not considered a serious comorbidity that qualifes you for bariatric surgery with a BMI <40. Neither is high cholesterol which is controlled by medication. Type 2 diabetes, obstructive sleep apnea are, and sometimes osteoarthritis on weight-bearing joints.

Did your doctor log a starting weight that is a BMI >40 at the intake appointment when you requested a referral for bariatric surgery? That should be your starting weight, regardless of subsequent weight loss.

 

[Lynn Smith]

So this is probably a horrible question it is better then to not be on the blood pressure medicine or the ones that dont work to help qualify? I am not sure what the doctor logged but will look when my file comes.

 

[DianaCox]

That ship has sailed - your meds work, and that's in your medical record.

Why do you want a DS if you don't NEED one?

 

[Lynn Smith]

I would like to DS to get my quality of life back. My back hurts all the time. My knees hurt and my heel spurs constantly bother me from the extra weight. I get out of breath going up the stairs. I constantly have yeast rashes in the folds of skin that hurt and smell bad. I have five kids under the age of ten and want to be there for them. It is getting harder to take care of bathroom issues as well.

 

[DianaCox]

4K: If her BMI is over 40, she should not need any co-morbidities. If her insurance plan says otherwise, they are wrong. NIH guidelines, ASMBS, CMS - all say BMI >40 is automatic qualification for bariatric surgery (including DS); BMI 35-40 requires at least one serious comorbidity.

Lynn: You can't cheat this - you qualify or you don't. If you want surgery without meeting these guidelines, you will likely have to self-pay. None of the issues you mentioned are serious comorbidities according to the controlling guidelines followed by the insurance companies. But there are plenty of bariatric surgeons who willingly take your money for surgery at a non-qualifying BMI.

Or you could just eat more for a while.

 

[DianaCox]

4K - we are saying the same thing - when I was responding to your post I thought you had said if her BMI was under 50 she needed a comorbidity.

 

[Glam]

What about Gerd? Have you ever been diagnosed with it? It is a comobility that can qualify someone with a 35-39 BMI

 

[KathyF]

Have you been checked for diabetes? Chronic yeast rashes could be a symptom of high blood sugar levels.

 

[Lynn Smith]

I had all the blood testing that the surgeon wanted and no one said anything about diabetes so I am assuming that I am ok in that area. There are times when I feel like GERD could be a possibility but never had it checked. I will look into that thank you. Please keep the advice coming.

 

[Spiky Bugger]

I had all the blood testing that the surgeon wanted and no one said anything about diabetes so I am assuming that I am ok in that area. There are times when I feel like GERD could be a possibility but never had it checked. I will look into that thank you. Please keep the advice coming.

Kicking this poor dead horse...I still think that the document that I call a policy but Diana, who is right on these things, calls Evidence of Coverage or something AND the EXACT WORDING of your denial are what you need to start.

MANY TIMES, an insurance company's written documents will say that they will cover you if you meet Condition A or Condition B plus Condition C...and then they deny people for not meeting Condition J, which is something somebody pulled out of their ass and has NOTHING to do with what they MUST cover.

Just sayin'..

 

[Lynn Smith]

Ok been out of comission for awhile. Feel at work and got a bad sprain. I got all my paper work now from insurance and doctors. What is the best way to proceed?

 

[DianaCox]

Sent you a PM.

 

[Sheanie]

Just wanted to add that with GERD, sometimes the only symptom is a cough. Or a sore throat in the mornings. From reflux during sleep.