rtptjd

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It's almost one year since I first joined OH, and I had my first visit with a bariatric surgeon in September 2010.  Now, I have jumped through the requisite "hoops" for insurance purposes and submitted my paperwork June 13, 2011.  Predictably, back came the word: denied.  Aren't insurance companies lovely?  Frankly I'd rather deal with the Mafia.  At least they do not convey the impression that they have your best interest at heart.

The problem seems to be my BMI.  Right now it is at 36, but over the last 2 years it has fluctuated from 34 to 33 and then finally up to 35 and 36 neighborhood.  The co-morbidities?  Oh, they've been around for about the past SIX years.  Type II diabetes, hypertension, arthritis, reflux.  Doesn't matter, I guess.  All insurers seem to relate to is the numbers game.  My surgeon is planning a "peer to peer" phone call this week, which I am feverishly praying will do the trick.  But, I am also preparing my written appeal, which will include several medical articles proclaiming the value of bariatric surgery for individuals with a BMI less than 35.  Some researchers, in fact, have recommended insurers lower their BMI criteria to 30.  Their rationale is that heart disease and other co-morbidities don't sit around and wait until the BMI hits the magic number of 35 to start doing their dirty work.  If only we can get the insurance company docs to pay attention to that...

So, hurry up and wait.  It's tough but I've got to keep my chin up and keep plowing ahead with this.  The nasty insurance people would love for me to give up and finance this surgery myself.  Then, of course, they would gladly reap the benefits of my better health, e.g. less $$ every month for prescriptions, fewer doctor's visits, etc.  Sorry, Aetna, you're not getting rid of me that easily!