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.
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