Setback So Early in the Process...

If you want to get somewhere you have to know where you want to go and how to get there. Then never, never, never give up. -Norman Vincent Peale

When I called my insurance company a couple of days ago to inquire about their criteria for bariatric surgery for the morbidly obese, the customer service representative wasn't very helpful. She kept telling me to look on the insurance company's website for a document called "Surgical Management for the Treatment of Morbid Obesity". I looked and looked and wasn't able find any such document, but I did find an FAQ about their criteria for the procedure. I was browsing the website again this morning, and I was able to find the document that I had been referred to a couple of days ago.

I started reading through it, and I got to a certain part that made my heart nearly stop. (Not literally) In order to be approved for the surgery, you have to have medical documentation that shows that you have had a BMI (Body Mass Index) of at least 40 (35 if you have one or more co-morbid conditions) for the last three years. My husband and I have been married for three years and twenty three days as of today. I didn't have insurance before we were married, so I didn't go to the doctor often- if at all. I know that I have been morbidly obese for more than three years, but I am not sure that I have the medical documentation to prove it.

I'm pretty sure that by the time I complete the required six month (actually seven, as the first month doesn't count) physician supervised diet and exercise program I will be able to obtain medical documents showing morbid obesity, but I can't be sure. If I complete the six month physician supervised diet and exercise program, I have to have the surgery within the following six months according the my insurance company's website. (It says that the diet and exercise program must be completed within a year of the surgery). Patients that are trying to have WLS have to jump through hoops to gain approval from insurance companies as it is, and for me to complete the hardest and most time consuming step toward approval, only to have to do it over again would be devastating.

As I've mentioned before, I've been looking into this for well over a year, and have only made the decision to proceed in the last couple of months. To have this type of setback so early in the process is seriously discouraging. When I read that I felt like crying. I know that they are asking for the documentation that they ask for because of the need to demonstrate medical necessity. I get that. On the other hand, who in the world would go through something as life-altering and as painful as having WLS if it wasn't absolutely necessary? Who would put themselves through this?

Instead of crying, I am going to call the doctor that I saw before the one that I am seeing now and ask for a copy of my medical records. I don't think that they can keep them from me, and if they try I will do more research as to my rights as a patient regarding my records and proceed as necessary. Please, pray for me. I need all of the help that I can get right now.