rargirl
Here is a copy of the letter I was required to submit for insurance approval:
To Whom It May Concern:
My name is XXXXXXXXX, and I am an Anthem Blue Cross Blue Shield PPO member. I'm a 35 year-old Married executive working for a Fortune 5 company in the telecommunications industry. I live in Anaheim, CA and life would be pretty good if it weren't for my declining health problems due to super morbid obesity.
I have struggled with excessive weight problems since age 5. For more than 30 years, I have tried every diet, health plan, eating philosophy, and life change suggested by doctors, exercise and healthcare professionals. I, followed many weight loss plans through for months, sometimes, more than a year. I would always lose weight, sometimes, large amounts (70+ lbs). But each time, I regained the weight I lost and more.
My motivation to lose my excess weight has always been to get healthy, prevent medical problems and extend my life. As a younger person when I failed at dieting, it didn't seem too bad and life went on. I always "had time" and would soon try again. Now, I am 36 and obesity-related health problems are creeping into my life.
I have high blood pressure, and high cholesterol. I have chronic pain in my back, knees, ankles and feet from my excessive weight. I am less mobile than I was in prior years. When I get out of a chair, rise from the commode or take the stairs, I find myself supporting my weight with my arms until my legs are extended. I have developed varicose veins in my legs and struggle with peripheral swelling.
My mother, a type II Diabetic died from complications of Obesity and type II Diabetes in 2008 at age 63. She had completely lost mobility, had rapidly deteriorating eyesight, sleep apnea and multiple amputations of her fingers and toes due to poor healing abilities, a Diabetes complication. A few months prior to her death, she was on oxygen around the clock. Throughout my mother’s life, I watched her yo-yo diet with great determination and limited success. At her untimely passing, she had been Morbidly obese for many years but at my age, she was in better physical condition that I am now.
This, in conjunction to family medical history, was my "wake up call." Other family members display a similar medical history. My father had high blood pressure and high cholesterol, heart disease and type II Diabetes. He had a massive heart attack and heart bypass surgery at age 60. His mother, both of my mother’s parents and several of her siblings suffered from Diabetes.
I began to research obesity to understand this disease I suffer from. I learned there are different stages of Obesity based on Body Mass Index (BMI): Obese, Morbidly Obese, and BMI of 45+ is Super Morbidly Obese. My BMI at 53 places me in the highest risk Super Morbidly Obese category. A high BMI combined with high blood pressure and cholesterol and a family history of heart disease and diabetes, makes premature death just a matter of time.
My risk of heart failure and Diabetes are far greater than a person with an average BMI. In research I learned being Super Morbidly Obese is an immediate threat to my life. I also found the National Institute of Health (NIH) has recognized that only 2% of people who accomplish weight loss will keep it off for a period longer than five years. The NIH has published that surgery is the only permanent solution to keep weight off and avoid death and disease associated with obesity. After reviewing my 30-year diet history, surgery is the only permanent solution to prolong my life.
The surgery I am requesting is medically necessary to aid in prevention of multiple diseases that would lead to more extreme medical expenses. I need to permanently lose weight to greatly reduce the high risk of premature death, and eliminate my existing co-morbidities.
Death is inevitable. However, I would like to live for more than 2-5 years and in a state of declining health. I would rather have this surgery and enjoy 30+ years of happier health!
Available literature and my surgeon advise this surgery could improve and eliminate both my high blood pressure and cholesterol and orthopedic pain eliminating the need for other surgeries and medications. The evidence suggests it is cost-effective to have this surgery rather than paying for multiple medications and surgeries down the road.
Approving this surgery will save my life, reduce your cost for my medical needs over the coming years, and will give me a quality of life I have never known. My family and I thank you for supporting us in this endeavor.
Sincerely,
XXXXXXXXX
Attached: history of weight loss attempts
History of Weight Loss Attempts:
|
Age |
Program |
lb loss |
start weight |
end weight |
|
age 5 |
very low calorie diet (VLCD) |
25 lbs |
90 |
65 |
|
age 16 |
very low calorie diet |
90 lbs |
280 |
190 |
|
age 22 |
Jenny Craig |
60 lbs |
330 |
270 |
|
age 24 |
Reduced calorie/exercise |
60 lbs |
340 |
280 |
|
age 26 |
Very low fat |
70 lbs |
350 |
318 |
|
age 27 |
Phentermine |
95 lbs |
375 |
280 |
|
age 31 |
Meridia |
60 lbs |
330 |
290 |
|
age 33 |
Weight Watchers |
30 lbs |
310 |
280 |
|
age 34 |
Medifast/VLCD/Phentermine |
50 lbs |
330 |
280 |
