[SlimmingDown]

It looks like I will not be getting WLS this year. Apparently you have to have a 2 year documented history of a BMI of 40 or above. Over the past year this hasn't been a problem.

4 days ago my insurance company (aetna) changed their policy. Originally they required 5 years at 35 or above and a current BMI of 40 or above, I fell into that category. Now it is 2 years of 40 or above.

I see a lot of doctors but they are all psychologists and psychiatrists and don't ever weigh me. Last time before that I went to my OB/GYN and was over 35 but under 40.

I talked to Aetna and whatever policy is in place when you submit your paperwork for approval is the policy that applies, so even though I had started the process before the change, it's not good enough.

I wonder if I can fight it because I had already started the process and that has been documented.

I guess I'll just have to keep on my current course which reminds me of a dog chasing his tail.

[mistymed]

well at least you know they will cover it in the future. it seems like a long ways away but you know time keeps marching on. you will lose the weight, one way or the other.

[whitelion30]

Sometimes insurance companies will take a lower BMI if you have any co-morbidity issues. Sleep Apnea, Diabities, high blood pressure things like that. I am sure you already checked this, but I wanted to make sure.

[GrammyRN]

Also I would think that if you already started the process when they changed their requirements that you might could appeal and get it covered even without co-morbidities if they don't take forever to go over the documentation! But if you have ANYthing else going on physically (like Whitelion said) that should really give you a good chance of not having to wait another year. GOOD LUCK!!
Carol

[missangelaks]

DON'T GIVE UP! I fought it all for years before they (medicare) finally gave in! I say that you push the "I started my process before you changed your policy" line! If it's there policy to stick to the policy that was in place during the first line of paperwork, then they should abide by it.

Remember, if you think that this procedure is your last chance for change, you are worth all the work neccessary to get it. I went on and on fighting for 3+ years and I am so glad I did.

Angela

[SlimmingDown]

Thank you for all of the support guys. I have thought long and hard and have decided not to fight this. I will be eligible in 2009 and am going to take that time to REALLY give it my all. One more year of research can't hurt. I still have a lot of issues that the surgery won't help with necessarily, I am going to go into therapy to address my food issues so if I opt to have the surgery next year (hopefully I won't need it) I will be better equipped.

I plan on sticking around and hearing about how everyone here is doing!

[nanj]

I'm sorry about your WLS stay until 2009, but get yourself ready. Going to counseling for food issues is one smart thing. Read everything that you can about the WLS and life after WLS. I'm reading "Exodus from Obesity" by Paula F. Peck, RN right now. I've read "WLS for Dummies" which is also a good read. There is a reason for everything in this life, don't always know why, but there is. Start thinking about what food plan you want to have after WLS and you might even start on that one now. Start a good exercise plan, so that when your big moment comes you will be as healthy as you possibly can. I'll be thinking about you this year. Remember this is the middle of February already. Please keep in touch with us.