Frustrated

Spoke to my coordinator on Friday...she has had my information for months now and is only NOW telling me that she looked through my file and is worried that I don't have enough "wrong" with me to make qualification for surgery.

Cigna states that a BMI is excess of 50 or less than 50 with 2 co-morbities.

I currently have a BMI of 53, with severe knee and joint pain, but that is all (fortunately).

Honestly...am I doomed? 

 

I'm so nervous now...feeling really down.

Good vibes please that I hear something soon...

 

 

I don't understand? It's over 50. You need co-morbids with a BMI OF 53?
And you're damn lucky or have good genes with no cholesterol, BP, or A1C issues with a BMI of 53! My BMI IS 53 and I have all 3. Yippee. O.o

Good luck!

I KNOW...I don't understand it either.

I've been very fortunate but for how long???? That's what I wish they would understand...if I keep going with this, it's not always going to be a comorbidity free life I lead.

 

thanks for the good luck wishes...hoping cooler heads and common sense prevail...

 

First of all I would be concerned that they have had it many months and are only NOW talking to you...with a BMI of 53 it should be a no-brainer.  Have to say if that is the coordinator from a surgeon's office I would be looking for a different surgeon or at least checking them out.  Sorry, but that's how I feel.

I think most offices are prepared for the harder approvals from insurance and immediately look for the laundry list of things to include on the claim, even when the insurance company doesn't require it. Send her a copy of your policy and ask her when will she submit bc you're anxious to get this done...you are her customer after all. Also, if you have cholesterol issues that's usually considered a co-morbidity, so that may be an easy 1 for her to list. Tell her to get off her ass and find the other one that qualifies, lol

I agree. My surgeon is very conservative yet cleared me for surgery with a BMI of 40 and no comorbitities. I would seek another opinion or a clearer understanding of "not enough wrong"...

You may have a fatty liver.  That. Is common with obesity.  That is a comorbitity.  You need an ultrasound to find out.

Here's my take. The coordinator needs to do her job. She's the one who needs to step up and get this show on the road. You are ready and qualify. She needs to make tracks. You pay her. She's not doing you any favor by doing this. It's her damn job.

If you don't get satisfying results quickly, talk to the office manager. If still nothing, write the surgeon a nice letter explaining why you and your insurance money are going elsewhere.

Crap like that really chaps my hide! Can you tell???

What he said!

I know it would probably feel like you'd be taking a step back..but I'd be shopping for someone else if it were possible.  I can't really comment on your insurance qualifications.  I just know..at my highest weight, at 263, 5'6"..I had a bmi of 42.4.  I have hypothyroidism and diabetes and joint pain.  Still.  I had the band and now, my weight is 230, my bmi is 37.1 with those co morbities.  My surgeon said that my insurance should approve having the band removed and having the sleeve done and if they don't they'll fight it until they do.  So, it worries me, for you, that it's like they give up too easily.  And I have to question what else would they give up on.  So, time to find another surgeon.  At least that's what I would do.  And, don't give up.  One door closes and another one opens.  It'll all work out for the best in the end, right?  Right!! :)