Rhonda Williams

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Here is my Letter of Appeal to BCBS:
Blue Cross Blue Shield of Tennessee
Dear Review Committee:

This letter comes in response to my recent denial for surgery on April 13, 2005. I am writing this letter to appeal your decision. I will use this letter to tell you about myself and my history as well as give you some insight on benefits of Weight Loss Surgery.

My name is Rhonda Williams and I am a 46-year-old wife, mother and grandmother. It's a scary thing to live your life wondering if you'll wake up when you go to sleep. It is to the place that I can no longer do ordinary things due to my health. When I walk from my car to my house, my heart is pounding and racing. I am so out of breath. I can’t walk for long periods, and it is near impossible to do my own grocery shopping. My lower back is so painful and I have to stop and rest. Things that a NORMAL person takes for granted.

I suffer from Hyperlipidemia, Hypertention, Type II Diabetics Mellitus, Obstructive Sleep Apnea with the sleep of a c-pap, Chronic Lower Back Pain, Severe Osteoarthritis of knees and feet, Incontinence, and Major Depression. It has been documented that all of these types of problems can be helped, if not cured, by losing weight. I have tried many, many diets. The most weight I was able to lose was 50 pounds. My BMI is 56.5, which makes Gastric Bypass Surgery a medical necessity.

I am very well educated in the area of Gastric Bypass Surgery. I have been researching for five years. I belong to a support group of over 5000 members, both post-op and pre-op. I have learned a tremendous amount from all these people. I know what this surgery is and what it will do for my life and me. That is why I want and need to have this surgery. After receiving my family medical history, you will probably agree with me to not have this surgery will surely lead to more severe medical problems in the future.

Here is my family medical history:

My father and mother had diabetes and my mother was insulin dependant. Both parents had Heat Disease and both suffered from Heart Attacks, before my father had Open-Heart Surgery. Both of my parents died from Morbid Obesity and Diabetes. (See attached death certificate) I have a brother and sister, both insulin dependant. My grandmother on my father’s side had diabetes and died of heart failure. Obesity runs on both sides of my family.

My PCP, my surgeon, all agree that this procedure is the right option for me. I also agree with them. I want this surgery. It will save my life, and give me back what life I have left. I will not give up on having this procedure approved.

There has been a lot of misconception about this surgery, so I have taken the liberty of going to the American Society for Bariatric Surgery (ASBS) website and gathered this information for you. Clinically severe (Morbid) obesity correlates with a Body Mass Index (BMI) of 40 kg/m2 (or higher) or with being 100 pounds overweight. Being overweight is associated with real physical problems, which are now recognized. The most obvious is an increased mortality rate directly related to weight increase.

Obesity is dangerous to health because of the associated increased prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, hypertriglyceridemia, hyperinsulinemia and low levels of high density lipoprotein (HDL) cholesterol. Statistically significant improvements have been observed in both diabetes and hypertension, with >10 percent weight loss, and in cardiovascular conditions, with 5 percent weight loss. Data from the Framingham study support the estimate that a ten percent reduction in body weight corresponds to a twenty percent reduction in the risk of developing coronary heart disease.


The risk for diabetes has been reported to be about twofold in the mildly obese, five fold in the moderately obese and tenfold in the severely obese person. The risk of developing diabetes also increases with age, it is a family history is present and if the obesity central.

Surgical treatment is medically necessary because it is the only proven method of achieving long term weight control for the severely obese. Surgical treatment is not a cosmetic procedure. Surgical treatment of severe obesity does not involve the removal of adipose tissue (fat) by suction or excision. Bariatric surgery involves reducing the size of the gastric reservoir, with or without a degree of associated malabsorption. Eating behavior improves dramatically. This reduces calorie intake and ensures that the patient practices behavior modification by eating small amounts slowly, and chews each mouthful well. Success of surgical treatment must begin with realistic goals and progress through the best possible use of well designed and tested operations. These have been worked out over the last thirty years, and are now standardized, clearly defined procedures, with well recognized and documented outcome results.

Prevention and secondary complication of severe obesity is an important goal of management. Therefore, the option of surgical treatment is a rational one supported by the time honored principle that diseases that harm call for therapeutic intervention that is less harmful than the disease being treated.

The option of surgical treatment should be offered to patients who are severely obese, well informed, motivated, and acceptable operative risks. The patient should be able to participate in treatment and long-term follow-up. A decision to elect surgical treatment requires assessments of the risk and benefit in each case. Increased abdominal fat or “central obesity” (apple shaped as opposed to pear shaped) is an important risk factor associated with the major complications of obesity.

Patients whose BMI exceeds 40 are potential candidates for surgery if they strongly desire substantial weight loss, because obesity severely impairs the quality of their lives. They must clearly and realistically understand how their lives may change after operation.

Weight reduction surgery has been reported to improve several co morbid conditions such as glucose intolerance and frank diabetes mellitus, sleep apnea and obesity associated hypoventilation, hypertentsion, and serum lipid abnormalities. A recent study showed that Type II diabetics treated medically had a mortality rate three times that of a comparable group who underwent gastric bypass surgery. Also preliminary data indicate improve heart function with decreased ventricular wall thickness and decreased chamber size with sustained weight loss. Other benefits observed in some patients after surgical treatment included improved mobility stamina. Many patients note a better mood, self-esteem, interpersonal; effectiveness, and an enhanced quality of life. They have lessened self-consciousness. They are able to explore social and vocational activities formerly inaccessible to satisfaction existed before surgery.

I appreciate your attention to this appeal. If you have any questions or need any further documentation, please call me.

Sincerely,

07/15/2005
After exactly thirty days from the day I sent in my Grievence Form TO BCBS, I received a reply back from BCBS and my answer again was NO! DENIED FOR THE THIRD TIME!

Now it is time to FIGHT with the Human Resourse Department where hubby works!

11/06/2005
It has been a while since I have updated my profile. Since I last posted, hubby has lost his job and now there is no fighting with the Insurance and HR department. But I thought since I was not going to be able to have my surgery for a while, I would try and help myself and I went to the L A Weight Loss Center to sign up. You are NOT going to believe this. After I filled out all the papers, I was informed that I could not do the program because I have been subscribed Nitro tablets by my doctor. We faxed a paper to the doctor and he stated that I had to be on these. So that is shot in the foot... Imagine that!

Been a long time since I have been here!! Wow ObesityHelp, you've come a long way! Nice Facelift!

05/05/2006
Hubby is still out of a job. He is going to school and we are looking for a job with Great Benefits! There has been no changes in myself... Still Hoping to Have Surgery

05/17/2006
Here we go again... Hubby was just called today with an offer from a company and it sounds that he has a JOB! The insurance looks and sounds good. So,looks like I am back in the race for surgery again. One problem, I hear that the surgeon I wanted to preform the surgery is relocating to TX. So, now I have to attend another Seminar and see another DOCTOR. More Money.. G-d Help!

05/24/2006
Last night I attended a Seminar for the second time, this one was with the Parkwest Comperhensive Weight Loss Center in Knoxville. The reason I attended this seminar, is because I have been told that Dr. Husted is leaving and going to Texas, so I want to find a doctor closer home. I felt that the seminar was very informative and the staff were excellent. I look forward to hubby getting a new job and Insurance that cover WLS. Just wished I could get this surgery done and stop the long battle of fighting for it! Sometimes I get so fustrated and so depressed that I just want to sleep my days away.

03/05/2007

Hubby started a new job and thank GOD we have insurance from day one. 

03/08/2007

Going to another seminar this evening to hear Dr. Colquitt out of Blount, TN.

The meeting was really good and I thought Dr. Colquitt was very informative. He was very knowlegable and professional. The staff were really nice as well. There was a Support Group Meeting after the seminar and I hung around to listen. I enjoyed the Support Group as well as I did the seminar.

03/13/2007

Received the insurance cards in the mail today! There is a website insurance members to register. We registered so we could see what our policy has to offer. Low and behold the doctor that I last went to hear a seminar was listed on the web page. So, I sent an email to the Customer Service asking if I am eligable under our plan. I wait to hear back!

03/22/2007

Had my consultation with Dr Colquitt today. He explained the procedure and the risk. Meet with Suzanne, whom was very helpful and friendly. Set up a time to meet with the dietician and will meet with her on April 4.

03/27/2007

Meet with the Psychiatrist today. Was given some paper work and will have another appointment on April 4 after meeting with the dietician.

04/22/07

Things have been going really smooth for the last few weeks. I have lost 12 of my 15 pounds I am suppose to loose.  I have a stress test, and a sleep study test scheduled for this week, and as far as I know that is all I have left to do. All the blood work and ultra sound of the liver and gall bladder are done. Just a few steps closer to getting this procedure done. Thank you God, You are so Good!!!

06/06/2007
PRAISE GOD!!! I have been accepted from my insurance for surgery! I am so happy and beside myself! 

06/18/2007
Today I pregistered at the hospital, had EKG, X-rays, Blood Work done. Just a few more days to go.

06/22/2007
Three more days and counting... Sunday should be an exciting day... Clear liquids and a bottle of MAFNESIUM CITRATE.   Ohhh that should be fun!