Update from DMHC appeals and could use ideas

Well an update to my appeals with the DMHC, some good , some totally not good. Feel free to just skip to the DS portion if you just want to hear about that.

A review-
I had submitted the following referrals that had gotten denied by my insurance:
-Pain Management Clinic (is now approved, should hear something in 5 days)
-Sleep Study (approved, had it, they didn't put me on cpap, said I will get the result in 4-6 weeks)
-Endocrinologist (is now approved, should hear something in 5 days)
- Referral for a consultation for a DS (?)
- Referral for a wheelchair (denied)

I don't understand about the wheelchair being denied. The lady on the phone at the DMHC was reading about what their doc doing the review said. Apparently, according to them, there is nothing wrong with me and I can get around fine and even wrote that I just need some diet and exercise since there is no reason I can move around just fine. Um what? When I submitted for this, I included hospital records, doc records and a paragraph about how I have to depend on a caretaker (husband) because I can't walk, I fall often, and I get short of breath easily. I even submitted xrays, ct scans, etc showing there was injury to the area and on my last visit to the doc ( a new one) he prescribed something for nerve pain. I even mentioned how I had to be carried to the bathroom sometimes. I guess I will ask the doc again for a referral/prescription but I doubt the insurance will do anything different this time.

As for the DS referral for a consultation, here is the biggest part where I am confused. I was told that according to the IMR doctor I did not qualify for any weight loss surgery.

I had gotten a phone call one morning when I was sick, hadn't slept in 5 days due to a bad reaction to a med, and of course had to answer the phone, where it was this lady from the DMHC telling me if I didn't withdraw my IMR for the DS/bariatric surgery that it would be automatically denied and I could submit it later after I get a sleep study. I was really out of it, she was pushy, I didn't have the energy then to ask questions so all I heard was withdraw or be denied and never get surgery (since DMHC is last resort). Well actually I tried to ask questions but she ignored them and kept bringing me back to point. So I did in an email like she said but worded it carefully so as not to sound like a permanent withdraw. I had the sleep study and she tells me they need the results. I ask so that's it all I have to do is submit the results and we can go forward with an IMR? She says no, that I still don't qualify.

I told her for a consultation, according to the policy I had in front of me says, just on BMI or higher I qualify. The policy stated BMI of 35 or higher with comorbids or a BMI of 40 or higher, for all surgeries. At the time of the appeal my BMI was 49, it is now 50, I informed her of that as well. She shoots back with a well if you qualified your insurance would have approved you and you wouldn't be here in the first place. As far as comorbidities they admit to me being high risk of cardio disease (high triglycerides, cholesterol, Blood pressure, etc). It almost sounded like they were denying I had diabetes. They say my A1C is 5.6. Well duh I am on medication to control my diabetes and it is working. Also I supplied them with records from my doctor showing it was 316 at one point and a failed glucose tolerance test but I guess this "doctor" thinks that is normal too.

They apparently even have the medical records from the only bariatric surgeon in the network (the bypass surgeon) who told me I was too high risk of DVTs/pulmonary embolisms because I can't walk *** wheelchair doc did you see this?) This bypass doc only operates on "healthy" people and doesn't do high risk which I told the lady at DMHC and that Dr. Crookes does operate on the high risk and performs the DS and is the only one to take the medi-cal (medicaid) portion of my insurance and how I just wanted a second opinion with a DS surgeon. Again, she said, I didn't qualify, now with a tone in her voice.

So am I missing something? How do I not qualify with a now BMI of 50 with comorbids? I wanted to resubmit the IMR but she says it will be automatically denied. i don't know what to do. I am thinking of calling the DMHC lady back again but perhaps it is too soon.