beginning the journey!

Hi everyone,

I just recently attended the seminar at Theda Clark and have submitted my history form to Midwest Bariatrics for them to go over and get me through the pre-approval process.  I received my pathway letter and it seems I am in for a fight.  My insurance provider tends to be a p.i.t.a.

I have been working with my pcp on a low carb/exercise diet for the last 3 months and have been getting weighed at each appt.  I still need to have him write a referral letter to the insurance co. and order my pulmonary , nutritionist and psychologist consults.  I see him next Thurs for another weigh in and am apprehensive.  At the last appt. he expressed dissatisfaction with the fact that I had only lost 2 lbs.  Well, I wanted to cry.  I had a hysterectomy/bso in November and have been battling alot of hormonal changes, one of which is my weight.  He put me on metformin because my blood sugar levels were pre diabetic and said it would help me lose weight.  I have gained 2 lbs, lost 2 lbs, gained 2 lbs, over and over.  I exercise 45 min a day on my eliptical, eat low carb, and still I get on the scale this morning and I am up 2 lbs.  What the heck is he going to say that I gained 2 lbs!  I can't even lose weight on Met!  Truthfully it seems the more I exercise, the hungrier I get.  I keep track in myfitnesspal and seem to eat 1500 calories per day.  The bariatric clinic said I need to lose 5% of my weight before I will be approved.  I am not a slug.  I run a restaurant, home school my 12 year old and maintain a home.      I do not know what to do and am afraid he won't write me the referral because he doesn,t think I am trying hard enough.  25 years morbidly obese, lost 60 lbs on Atkins 13 years ago, I can and do know how to lose.  I just tend to gain it back unfortunately, which led me to this decision of surgery.  I know I shouldn,t worry about what may or may not occur, but I am at a very fragile state.  One more dissatisfied comment and I will probably bawl.  If I change pcp,s I will have to start the diet over.  Also afraid I will do all this and be denied.  BMI is 41.6, high blood pressure, triglycerides and blood sugars.  I have everything but the last 3 to 5 years of weight records.  2006 was the last time weighed since 2012.  6 year lapse due to no insurance coverage. However I do have previous records before that with my pregnancies that show my weight.  Am I looking at a denial here?  I have Molina hc through Badgercare.  Sorry, I,m a mess.

I hope everything goes well for you. My thing is, if we could lose the weight on our own, we wouldn't need surgery! Maybe change up your work out?? Our bodies get used to doing the same thing.

Thanks Brenda,

I am waiting on all of this snow to melt and the weather to warm up so I can get out and hike in the woods again.  The eliptical is kind to my knees and ankles.  Pounding on them all day at the restaurant is hard on them especially with the extra weight.  I think I am going to try cutting back some more on calories instead of increasing my exercise.  Hopefully I will get some results. Good luck with your upcoming surgery :)

I have Molina hc of Ohio - so it's probably different for me. But I had to have two years of weight history. At least one weight per year. There was no way around that. I was missing one year and since I did happen to go to the ER that year I was able to get that record and use that weight. And I wasn't required to lose any amount of weight by the insurance either. Unless you have two comorbidities, than your bmi has to be over 40 with my insurance. It can't fall below that at all.

Of course, I would call your insurance and speak to the pre-authorization department to find out specifics.

Thanks Misty,

I talked to Molina and got their specifics last month before I attended the seminar.  That,s when I found out about the 3-5 yr weight history.  No ER visit here.  We didn,t have health insurance for us because of the cost.  We bought it for the kids but because I am obese, couldn,t afford it.  Pretty ironic, hugh?  Badgercare was a Godsend when we qualified.  We pay an affordable premium and have piece of mind.  Molina HC  said 5% weight loss and 40 without co-morbidities, 35 with.  I can,t understand why the ins co. would not believe I have been obese all of these years when my older records show I have.  I guess we will see.

Insurance companies can make it difficult. I don't know if this will work with Molina, but a friend of mine also didnt have her weight history and was able to submit date stamped pictures for those years and they accepted them. Maybe call and explain the situation and ask if you can do something like that? I hope it works out for you.

Thanks Misty, that is a great idea.  I don,t have too many pictures of me because I HATE the camera.  But I should be able to come up with a couple group ones.