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06-26-2007, 09:20 AM
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#1 (permalink)
| | Newbie
Join Date: Feb 2007
Posts: 4
Height:
|  So discouraged, I want to crawl in a hole and never come out!
Ok---after 12 months, I finally get BCBSIL to say that I have "fulfilled this component of the criteria" (meaning 6month non surgical weight reduction program...note it took 13 months for them to accept 6 months). So I thought great....I am on my way.............NOT
Now they say that I do not have "uncontrolled comorbidities" Yes...I have SEVERAL comorbidites...but they are all "controlled" that is because I take 9 pills a day (on a good day).
(
● 90-100 pounds overweight
● Metabolic Syndrome
● BMI 39
● History of Depression and low self esteem related to my weight
(on medication for aprox 13 years)
● History of Hypertension (on medication for over 10 years)
(very high family history of hypertension)
● Adult Asthma (Sept 05)(taking medication)
● Urinary incontinence
● Heartburn/acid reflux (taking medication)
● Menstrual irregularity/heavy bleeding (on medication)
● High triclycerides (one time 1400, currently 525) (on Medication)
● High cholesterol (bad kind) (on medication)
● Low cholesterol (good kind) (27)
● Blood work shows HsCRP very high (11.49)
● Family History of diabetes and coronary disease
● Family History of Stroke, poor circulation
● Sleep Apnea
I am ready to give up. What do I do now??? Any suggestions?
Anyone else have this problem??
Any suggestions, would be greatly appreciated.
Thanks in advance.
Vickie
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06-26-2007, 09:45 AM
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#2 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: NY
Posts: 10,174
Weight Statistics 4/19/2007 Surgery Date:
5' 9"
Height:
260 lb Start Weight:
152 lb Current Weight:
165 lb Goal Weight:
108 lb Weight Loss:
-13 lb Lb Left to Lose:
41.5384615385 % % Lost:
Body Mass Index38.3910943079 BMI Start:
22.4440243646 BMI Current:
24.36357908 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Wow. Im sorry this is happening to you. While I wasnt in the same boat I just wanted to pop in and offer some kind words and support. And say this: if your insurance company offers an appeal process, and of course you feel this is the right choice for you, please dont give up. Fight it.
__________________  KenyaR.  Lap RNY 4/19/07
Last edited by Kenyar; 06-26-2007 at 10:20 AM.
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06-26-2007, 09:46 AM
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#3 (permalink)
| | Newbie
Join Date: Feb 2007
Posts: 4
Height:
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thank you!
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06-26-2007, 10:09 AM
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#4 (permalink)
| | Super Moderator
Join Date: Nov 2005 Location: Tokyo, Japan
Posts: 24,793
5' 5"
Height:
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Appeal!!!
The way things are these days, you get denied first round. Insurance companies expect you to appeal, and probably don't think you are serious about this unless you are willing to go through appeals.
Good luck.
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06-26-2007, 10:19 AM
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#5 (permalink)
| | WLS Master Guru
Join Date: Apr 2007 Location: Near St. Louis, MO.
Posts: 961
Weight Statistics 04/17/2007 Start Date:
April 30, 2007 Surgery Date:
5' 5"
Height:
296 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
136 lb Weight Loss:
10 lb Lb Left to Lose:
45.9459459459 % % Lost:
05/21/2008 Goal Date:
Body Mass Index49.2515976331 BMI Start:
26.6224852071 BMI Current:
24.9585798817 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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((((((((Vickie))))))))
I'm so sorry it seems like you're fighting a losing battle. But like Doc says, APPEAL!!! Let them know you are NOT giving up!!
__________________
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06-26-2007, 12:54 PM
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#6 (permalink)
| | Guru In Training
Join Date: Sep 2006 Location: currently Texas but it's not my home
Posts: 227
Weight Statistics 08/16/06 Start Date:
08/16/06 Surgery Date:
Height:
290 lb Start Weight:
199 lb Current Weight:
166 lb Goal Weight:
91 lb Weight Loss:
33 lb Lb Left to Lose:
31.3793103448 % % Lost:
12/31/2007 Goal Date:
Body Mass Index46 BMI Start:
33 BMI Current:
26 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I used to work for a division of BCBSIL ... appeal appeal appeal!
__________________
Bren
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06-26-2007, 06:20 PM
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#7 (permalink)
| | Seasoned Veteran
Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 9,445
Weight Statistics September 19th 2007 Start Date:
September 19th 2007 June 18,2012 Surgery Date:
5' 10"
Height:
363 lb Start Weight:
226 lb Current Weight:
170 lb Goal Weight:
137 lb Weight Loss:
56 lb Lb Left to Lose:
37.741046832 % % Lost:
When I get there again Goal Date:
Body Mass Index52.0793877551 BMI Start:
32.4240816327 BMI Current:
24.3897959184 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Honestly it sounds like to me somone checked the wrong box? Dont laugh. They probally asked that question and was told they were controlled. Your Triclyglicerides are still to high. Your good cholesterol is way to low. I dont count them as controlled. That is a key point. They can TRY to contoll them but there still not in good range. The Triclyglicerides are supposed to be under 150 mg/dl. If they call 525 under contol there NUTS! Honey if you have any joint pain tell them! If nothing else have them document that you are. I dont mean lie but if your have a joint that is bothering ou let them write that down.
Did you get an denial or did you just get you still dont have enough? If its an denial appeal it!
The insurance compnaies let people die each day from being overweight. It just makes me sooo mad !
__________________ Remember Tough times never last Tough people do... This Ribbon is for our Lady Lisa and all the women that fight this ugly disease. RIP Jerry my friend
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06-26-2007, 06:46 PM
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#8 (permalink)
| | Seasoned Veteran
Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,809
Weight Statistics June 1, 2005 Start Date:
5' 5"
Height:
310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index51.5810650888 BMI Start:
27.7872189349 BMI Current:
26.4560946746 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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DONT GIVE UP as the others suggested ((((APPEAL))))
and i would like to add sorry your going thru this!!!!
((((HUG))))))
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06-26-2007, 07:40 PM
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#9 (permalink)
| | Guru In Training
Join Date: Apr 2007 Location: Maryland
Posts: 341
Weight Statistics 6/14/2007 Start Date:
6/14/2007 Surgery Date:
5' 4"
Height:
330 lb Start Weight:
198 lb Current Weight:
150 lb Goal Weight:
132 lb Weight Loss:
48 lb Lb Left to Lose:
40 % % Lost:
June 2009 Goal Date:
Body Mass Index56.6381835938 BMI Start:
33.9829101562 BMI Current:
25.7446289062 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Appeal!!!!!
((((((((((((((((good Luck!!!!)))))))))))))))))
__________________ Cindy  | |
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06-26-2007, 08:20 PM
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#10 (permalink)
| | WLS Master Guru
Join Date: Mar 2007 Location: Louisiana
Posts: 899
Weight Statistics 4/23/07 Surgery Date:
Height:
385 lb Start Weight:
257 lb Current Weight:
190 lb Goal Weight:
128 lb Weight Loss:
67 lb Lb Left to Lose:
33.2467532468 % % Lost:
Body Mass Index62 BMI Start:
41 BMI Current:
Weight Loss MethodRoux en Y Gastric Bypass
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I agree with previous posts appeal! You have a lot more going on than I did! APPEAL!
Roz
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