Guest guest Posted November 9, 2003 Report Share Posted November 9, 2003 Hello all! I've been denied again. They said with a BMI less than 40, I'm don't show any evidence of " serious " comorbidities (I've got hypertension, cerebral palsy with severe joint pain, and fibromyalgia). Believe me I've sent everything I can think of, 2 letters from me, a letter and records from my doctors, information about cerebral palsy and aging from UCP, but BCBS doesn't seem to think it's serious enough. My BMI is 38, and I would need to gain 11 pounds to get up to a 40 BMI. So I may hang it up for now and I'm thinking about spending the first holiday season in years NOT on a diet. Has anyone reapplied after gaining a little bit more weight? I'm afraid that if it it " happens " that I gain weight over the holidays, BCBS (if they still cover wls in 2004) will give me a hard time about the weight gain or find some other hoop to make me jump through. I would never " purposefully " gain that much weight, but it always seems to be the natural progression of things to gain weight during the holidays . Has anyone else had to go through this? Congrats on all of the progress made here! Y'all are always an inspiration! W. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2003 Report Share Posted November 9, 2003 what a &^%#( nightmare, katie. did you include the NIH consensus? can you change ins comps? talk about frustrating! lori h. > Hello all! I've been denied again. They said with a BMI less than 40, > I'm don't show any evidence of " serious " comorbidities (I've got > hypertension, cerebral palsy with severe joint pain, and > fibromyalgia). Believe me I've sent everything I can think of, 2 > letters from me, a letter and records from my doctors, information > about cerebral palsy and aging from UCP, but BCBS doesn't seem to > think it's serious enough. My BMI is 38, and I would need to gain 11 > pounds to get up to a 40 BMI. So I may hang it up for now and I'm > thinking about spending the first holiday season in years NOT on a > diet. Has anyone reapplied after gaining a little bit more weight? > I'm afraid that if it it " happens " that I gain weight over the > holidays, BCBS (if they still cover wls in 2004) will give me a hard > time about the weight gain or find some other hoop to make me jump > through. I would never " purposefully " gain that much weight, but it > always seems to be the natural progression of things to gain weight > during the holidays . Has anyone else had to go through this? > > Congrats on all of the progress made here! Y'all are always an > inspiration! > > W. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2003 Report Share Posted November 9, 2003 Yeah, I quoted NIH in my letter and included footnotes. I even quoted and footnoted a BCBS study from this summer that stated that wls is the only proven method for losing weight and keeping it off. We only have the one BCBS policy available to us where I work. So I can't change insurance. My husband's insurance has an exclusion, although I'm not sure of the exact wording, and I wouldn't be able to switch to his until April anyway. I'm down, but not defeated...we do pretty okay financially and don't have a lot of outstanding credit, house payement and a couple of small credit card bills and no kids, so I'll self-pay if I have to. I've accepted that it ain't going to happen this year, so I figure I have time between now and the first of the year to weigh (pardon the pun) all my options. In fact I'm kinda relieved that I made the decision to do this one or the other. I'm now thinking in terms of " when " instead of " if " . I'm just figuring out the " how " . Thanks for the support, Lori! > > Hello all! I've been denied again. They said with a BMI less than > 40, > > I'm don't show any evidence of " serious " comorbidities (I've got > > hypertension, cerebral palsy with severe joint pain, and > > fibromyalgia). Believe me I've sent everything I can think of, 2 > > letters from me, a letter and records from my doctors, information > > about cerebral palsy and aging from UCP, but BCBS doesn't seem to > > think it's serious enough. My BMI is 38, and I would need to gain > 11 > > pounds to get up to a 40 BMI. So I may hang it up for now and I'm > > thinking about spending the first holiday season in years NOT on a > > diet. Has anyone reapplied after gaining a little bit more weight? > > I'm afraid that if it it " happens " that I gain weight over the > > holidays, BCBS (if they still cover wls in 2004) will give me a > hard > > time about the weight gain or find some other hoop to make me jump > > through. I would never " purposefully " gain that much weight, but > it > > always seems to be the natural progression of things to gain > weight > > during the holidays . Has anyone else had to go through this? > > > > Congrats on all of the progress made here! Y'all are always an > > inspiration! > > > > W. Quote Link to comment Share on other sites More sharing options...
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