denial update

After spending wayyy too much time on the phone with the insurance company and my bariatric office, I found out why I was denied.

I know you guys see my weight and think I'm "tiny" but I'm not.  I'm only 5 ft 2.  I'm a roly-poly.  Or I was when I started.

1.  My starting BMI was calculated at 37.9---which was wrong for two reasons.  First, my height was incorrectly measured by 1 inch.  Second, they accidentally used a weight from after I lost 8 pounds under their supervision.  DUH.  So, if the math is done correctly, my starting BMI was 39.3.  So I asked the PA at the bariatric office if I could come in and get remeasured for my height (I have two other official measures from outside offices that have me measured legitimately at 62").  I was hoping I could get measured again and my paperwork could get resubmitted with the correct information. The PA said, "Sorry, there's nothing I can do."  What?  Why???

I'm an occupational therapist and when I made errors on insurance claims I fixed them and resubmitted.  Why can't they??!!  I want to know!  I'm seriously considering emailing the surgeon directly.  What do you guys think?

I am not trying to fudge numbers.  I am five foot 2!  This makes a big difference.  Perhaps it was my ponytail that day that caused the measurement error, I don't know.  But I'm not 5 ft 3.

2.  I need to have a BMI of 35-40 plus 2 co-morbidities OR a BMI of 40 to qualify outright.  The doctor at the insurance company who reviewed my chart and denied me said my co-morb of high BP and high cholesterol weren't "serious enough."

Yes, I got a copy of the denial letter and that is what it said.  Word for word!

I'm really frustrated and feel it's unfair.  I did some calculations and if I'd weighed only FOUR POUNDS MORE when I started this process, I would have had a BMI of 40 and would have qualified outright (been fat enough!) and no doctor could have sat behind a desk and judged the "seriousness" of my co-morbidities.  That seems hugely unfair to me!

It was summer time!  I should have worn jeans instead of those super light weight capri pants!  I should have gone in the afternoon instead of morning.  I should have eaten a big gigantic meal.  Or two or three.  And drank a lot of water.  Maybe even have cheated and worn a 5 pound ankle weight to be really really sure.  What the heck??!

But I'm an honest person.  Unfortunately for me.

My PCP is working hard on an appeals letter.  I also have a bladder disease called interstitial cystitis (IC) which she believes contributed to my weight gain because of all of the medicines I take to manage my symptoms and pain of that disease.  I went to see her on Friday and she pulled out journal articles that support her stance that the medicines I need (for the rest of my life) all cause weight gain but are necessary to manage my symptoms and allow me to work and have a life.  (This is a serious & very painful disease.)  She is going to base my appeal on that.  The insurance company feels if my blood pressure were "really serious" I'd have been on "triple therapy" to manage the BP instead of one medication.  She is also going to base the appeal on the fact that I wasn't on "triple therapy" for the high BP because that would aggravate the symptoms of my IC to be on diuretics and whatever else triple therapy entails.  Even when I was on Procardia for my BP, it still wasn't in the optimal range for BP, it was still about 130/85, and wasn't treated further, b/c of the reason I just said.  

I'm hoping it will work.

But I'm getting used to the idea of being a little chubby forever....and trying to learn to love myself as I am.

I'll still working out but.......I know I have an appetite problem that is beyond my control..... and too many calories is too many calories no matter how high quality the food is.

Thanks for listening to me complain and I promise to get off this topic eventually.