New member! Please help!!

 Hey guys! I am new to this site and I must say that I really do love it! Everyone on here is such an inspiration! So I need your advice and I am a little embarrassed to talk about this, but I figured that this was probably the least likely place to get judged. :D

I have been looking into weight loss surgery for a while now (3 + years) and finally got some insurance that had a program for bariatric treatment. I had my consultstion yesterday and I am really pumped. After talking with him and my surgical options and obviously much research I think I have decided on the VSG procedure! I am a little terrified, but I really feel this is what is the best option for me. Here is the problem....

I have Empire Blue Cross Blue Shield (Husband works and Time Warner Cable) and the only information I can find on the coverage is 2 paragraphs in his insurance packet. (I couldnt even find anything on the website!) What it says is they will cover it if you have a BMI of 40 or higher OR below 40 with atleast 2 comorbid conditions. When I had the consultation I found out that my BMI is 38 and that I am on 13 pounds away from a BMI of 40. And being that I am pretty healthy I have no co morbid conditions that I am aware of.  I have bad asthma due to my weight, joint pain and SEVERE SEVERE depression. 

The fact that I am only 13 pounds away from what I have wanted and not only needed for so long is terribly frustrating too me. And unfortuatley I cant afford a surgery that is 25k. I know that when I talked to the Insurance Specialist she said that the hospital can maybe do assisting or some sort of financing but here is the other problem...my husband and I are filing bankrupcy due to loss of jobs.  

If ANY of you have dealt with a similar situation please please please tell me what your outcome was and also maybe some information that you found with the insurance. I know it sounds absurd and I am rather embarassed to say this but, do I gain 13 pounds to get to the BMI of 40? (Im sure that is wrong, but it is very important to me!!)

I am a bit afraid of proceding with the Psych/Exercise/Diet evaluations because I am scared of being denied, and then my health and happiness go down the tubes. Please please help me!! I appreciate it so very much!

Speak with your primary care physician and explain the problem. You may have co morbidites that you are unaware are even there. Sleep apnea, elevated blood pressure, high sugar, family history of any of these.  I've known people that gain 30 lbs to be approved. Good luck with it. This is the best thing you can do for yourself.

I agree 100% with the previous comments. I've known women to wrap ankle weights under the bootleg cut jeans to add pounds to the scale, or even hunch over to lose an inch off their height. One lady hid rolls of quarters in her bra and pockets because she was just a few pounds short. Not the most ethical thing in the world, but I've yet to meet an insurance company that is ethical. I'm not advocating cheating the system, but you gotta do what ya gotta do.

Get with your primary doctor to write you a letter of support, get some bloodwork done, and find out what co-morbidities qualify for your insurance company. Typically, high blood pressure, choloesterol, diabetes/pre-diabetic, joint/back pain, sleep apnea, PCOS, thyroid issues are the top ones I can think of off the top of my head.

makesure your height was accurately measured also..if you are a little shorter (1/2 to 1 inch- talk to your doc, they usually understand!) than you thought you will be closer to a bmi of 40...as far as the 13lbs..dont quote me..but i wouldnt let 13 lbs keep me from this surgery. thats just me though.

I'd put on 13 lbs before I'd pay for surgery. Hell, I could do that in a good week. Eat a bunch of salty food & drink alot of water before your next appt. Go when it's your T.O.M. & you're bloated. Insist that you get measured for height bare-footed, maybe even slouch a little. Ankle weights, rolls of coins in your pockets, whatever...

Like was said earlier, insurance companies are full of dirty tricks. Don't be afraid to use a few of your own.

Your surgeon's office should do some sort of pre-cert to determine what your insurance requires....like 6 months supervised diet and/or 5 year history of weights. My insurance rep suggested I get my PCP to re-check my height and weight at the very beginning to make sure they were using the most recent and accurate numbers to calculate BMI.

If your insurance requires 5 year history of weights you may have a problem if you have been significantly smaller in the last 5 years.

I have a friend that did not have high BP or sleep apnea or diabetes...but she wrote a letter to the insurance co. describing the other medical issues she had related to weight (like pinched nerve and GERD) and the approved her.

Good Luck with whatever you decide....

I really like all of these suggestions! I just had blood work this morning so I will see what the results of those are here soon. I just got a new PCP (he ordered the bloodwork), but I will be switching because he made some snide comment about how us women "should be barefoot, pregnant and in the kitchen cooking" when we were discussing birth control methods. Not to mention him watching ESPN News DURING the exam. (Who puts tvs in exam rooms anyway??) 

Now will my surgeon go by consult weight? Or if I gain the weight will they go by the highest they have recorded me at? Questions questions.

hmmm just did the math. If I shrunk an inch and gained 7 pounds I would have a BMI of 40.3. If I gained 14 pounds I would have a BMI of 40.2. Sorry I just thought of that. Totally do-able. I think I will go back to a physician I saw a few years back that dealt with my weight alot, she would know more about my background I think.

Sorry about all the posts, I just get all excited! :P

-LeeLee

I'm just wondering - how is Asthma not a comorbid condition? I would feel confident your Dr. can walk you through...

Oh yeah I know! Stupid huh?? I was even told high cholesterol may not even be considered co morbid. I thought "you're joking right?". Amazing though how you can get coverage for substance abuse but you get the run around for WLS. X(