After Long days they denied me
SO SORRY!! Here is my advice:
Get your PCP AND WLSurgeon to write letters that WITHOUT gastric bypass even tho your co-morbities "may" be under control now, it will get worse AND cost them more AND make sure they point out how having gastric bypass WILL improve if not take away your co-morbitities!!!!!
BEST TO YOU AND GO GET 'EM GIRL
Get your PCP AND WLSurgeon to write letters that WITHOUT gastric bypass even tho your co-morbities "may" be under control now, it will get worse AND cost them more AND make sure they point out how having gastric bypass WILL improve if not take away your co-morbitities!!!!!
BEST TO YOU AND GO GET 'EM GIRL
~Sandie~ 
-147!!WLS:12-12-06:Preop 268,Ht.5'4",BMI 44.9
Click on link to see my journey!!!
http://www.onetruemedia.com/my_shared?z=2bfaca5561a1d558fceb
87&utm_source=otm&utm_medium=text_url
"Do unto others as you'd have done to you"~ The Golden Rule to Live by!
You are what you EAT and WHO you hang out with! Choices=Outcome~ what's YOUR choice??
I'm not perfect but I am going to die trying!!!
Man, that sucks! I had the same fear, and everyone has been saying not to worry, that I still have the diagnosis of HBP and high chol. I have not been convinced, and here is your story to enforce my fears.
I have BCBS of MN and their policy also requires co-morbids not respond to meds if your BMI is <40. My BMI has been just above 40 for the last 3 years, but at my first appt with my PCP it was 39.75 because I had just lost 10 lb on Seattle Sutton. Well, that was the appt I was diagnosed with HBP and High Cholesterol and put on meds. I was afraid that I would respond to meds and no longer qualify, so I stopped trying so hard to lose weight and gained 5 pounds. That put my BMI just about 40 again, so no question about qualifying
My intake appt with PNC was the "official" BMI that they send to BCBS and it was over 40, so anything I lose from now on is OK and won't affect qualifying.
Wow, maybe there is a way to appeal and win your case - has your BMI ever been above 40?
Good luck and I hope things turn around for you.
I have BCBS of MN and their policy also requires co-morbids not respond to meds if your BMI is <40. My BMI has been just above 40 for the last 3 years, but at my first appt with my PCP it was 39.75 because I had just lost 10 lb on Seattle Sutton. Well, that was the appt I was diagnosed with HBP and High Cholesterol and put on meds. I was afraid that I would respond to meds and no longer qualify, so I stopped trying so hard to lose weight and gained 5 pounds. That put my BMI just about 40 again, so no question about qualifying
My intake appt with PNC was the "official" BMI that they send to BCBS and it was over 40, so anything I lose from now on is OK and won't affect qualifying.
Wow, maybe there is a way to appeal and win your case - has your BMI ever been above 40?
Good luck and I hope things turn around for you.
Your initial denial is just an obstacle. Don't take your eyes off the goal - you know WLS would make things WAY better for you, and truthfully, HP probably knows that, too. They just want to avoid paying for costly surgery, without factoring in costly meds over the long term.
Let us know how things go!!
Let us know how things go!!
Imperfect does not = unsuccessful
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