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on 9/20/10 12:31 pm, edited 9/20/10 1:28 pm
Hello, just a little background info on me first.
I am 23, female. 5'9", 360lbs. Size 22/24. BMI of 53.X.
I have gained 180lbs in the past 8 years. I've had thyroid testing twice, that's not the problem.
I tried gym/home dieting from 2005-2006. I've tried medically assisted weight loss 3 times with one facility between 2006-2007. I tried Medi-Fast in 2007. I tried Metabolic Research Center for 4 months in 2008. I talked to a psychologist re: emotional eating for 6 months in 2008. I tried hypnosis in 2009. I then tried medically-assisted weight loss in 2009 for a few months again. I also tried the HCG fad in 2010. I then got a dietitian in 2010. I've lost, at a most, 15lbs, but put it all back on and then some. I've been on prescription drugs for anxiety/depression due to this personal failure since 2005.
I don't have diabetes, high blood pressure, high cholesterol. I do have depression, anxiety, skin problems, and underwent a sleep study and was diagnosed with sleep apnea this year. I sleep with a CPAP machine. I do it faithfully as I know without it, I will fall asleep throughout the day. But because of my extremely sensitive skin, I have switched facial masks 3 times, but I am getting horrible skin reactions on my face from it. I have put fabric barriers over the plastic pieces to stop irritating my skin, but my skin is still irritated and I've had to purchase very expensive creams for my skin to relieve the irritations as they are the only things that work.
My gynecologist referred me to a bariatric surgeon two weeks ago. I went to a seminar that outlines the obesity information, types of surgeries performed, etc.
It all sounds great. I'd like to proceed with a RNY Gastric Bypass. However, my insurance is with BCBS Arkansas Advantage and it specifically excludes any type of weight loss treatment, surgery, medication, etc. for obesity and morbid obesity.
My insurance company is so ridiculous that when I went to the doctor for my depression, when the doctor had put one of my diagnosis as "obesity" (which he always does?); the insurance company denied the bill. Citing they do not cover charges relating to obesity. I wrote a letter back informing them that 33% of people in my state are obese and if every one of their bills was denied simply for the fact they were overweight, then they should be informed of such when they were accepted as a member and their money should be refunded. They paid the bill.
So, therein lies the problem.
1. My insurance doesn't cover the surgery.
2. I applied for a loan through CareCredit to self-pay for the SX ($18,500 inclusive of surgeon/anes/asst. surgeon/pathology/OP facility). I was denied. (Probably because I have two car loans.)
3. I don't have a house to refinance to get extra money?
4. What can I do now? What are my options?
Thanks. :)
I am so confused...
Maria
I HOPE IT WORKS FOR YOU, THE WAY IT HAS WORKED FOR ME!!!



Hello... My name is Rachel, I am 5 feet tall.... sign in BMI 40.4... pleased to meet you!!!
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
In January of this year, I called to determine whether it was a covered benefit, and they said that my procedure (sleeve gastrectomy) was. They cover this procedure if your BMI is over 40, OR if it's 35-40 with two comorbidities. My BMI was 42 when I entered the bariatric program I eventually chose. However, the 10% pre-operative weight loss put me at a 38.2 with no comorbidities.
So I was declined. Twice. Now, I have to go through an internal appeal and an external (state insurance board) appeal process. This is SO unfair!!! I've become SO committed to this as a lifestyle choice that when my surgeon nudge-nudge, wink-wink hinted that he wouldn't hold me back from surgery if I regained the weight to get over a 40 BMI, the idea (if not the compassionate, sympathetic way it was presented) was distasteful to and angered me.
Anyone have any words of wisdom about fighting insurance companies?
I know this is all crazy, but switching insurances won't help if the employer has rejected Bariatric surgery from the plan (because of cost) another insurance company with the same employer will most likely exclude the same benefit.
If one of your parents is employed with another company, it may be worth trying to see if that insurance company has Bariatric surgery covered. If it does, you can try switching to that parent;s plan. If not.....you need to get a job with insurance coverage yourself or start saving!! I hope this information helps. Good luck to you!
i haven't been approved yet (although everything's being sent to cigna this week!), but my cigna plan required me to do the 6 month diet, a nutrition apt, and a aquire psychiatric approval. my surgeon also made me have an edg. my only reccomendation is to get all of the other appointments overwith before the end of your 6 month diet, so that way when you're done with the 6 months, your PCP can write a letter and send it off. good luck :)
Dorian