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Getting so depressed

Well, here I am wandering aimlessly in appeal land. The girl
handling my appeal is very sweet, but doesn't think that I have a
chance in getting this approved. I am 5'8" and approximately 350
lbs. What is so hard to understand about this? The appeal girl
tells me that if if was based on weight alone it would be no problem,
but unfortunately they are looking for some sort of comorbidities
before they will approve. It is like they are waiting for me to have
a heart attack or develop diabetes.
I am a 32 year old single mother of a beautiful boy and I can not
die. I am all he has.
I am getting so depressed over this and am finding it hard to crawl
my butt out of bed and function every day.
Please, if there are any words of wisdom that any of you can give me
to help me along in this process, I would be eternally gratefull!
Stacy

2006-10-22 19:20:50 | Author debora800

Comments

5 Responses to Getting so depressed

  1. jae_130 on 2006-10-23 04:40:06.012465

    Stacy,
    Did your pcp write a letter of medical necessity? Did you document
    your weight history for more than five years? Has your doctor watched
    your weight go up and down? I had my pcp write a letter of medical
    necessity, and in this letter I documented all of my weight history
    since I was 14 (i'm 30 now). my doc was very nice in doing this. I
    could email you a copy of the letter if you'd like. I also have
    copies of appeal letters etc.. I was ready for a fight. Also, get
    medical necessity letters from every doc you got, gyn, pcp, etc..
    It'll help. You do have comorbities if you are of that size hun.
    Edema, do your legs ever swell? ankles etc..?? Heavy breathing, rapid
    heart rate etc... We will get you approved girl. :)
    shelly in Ohio

  2. debora800 on 2006-10-23 03:26:39.700216

    Thanks Shelly!
    My pcp was of NO help at all. I have always loved this dr, but I am
    so disappointed in him right now.
    Yes, I have heavy breathing and rapid heart rate, but I have never
    told a dr about it, because I just figured as long as I was fat,
    there was nothing they could do. I guess it is time to become the
    pesky patient!
    I would love to see any appeal letter you may have, and thank you!

  3. lou_900 on 2006-10-23 20:42:41.493136

    Back about 6 months ago when I first considered this surgey, I did a google search and came up with two diaries written by people who had had the surgery. One was for more than two years. Anyway, one woman had trouble with her insurance company and she posted all the appeal letters she wrote. She was finally successful. If I can find that URL again, I'll post it.

    I guess I was really lucky with getting approval easily. Keep up with the appeals - can't hurt.

    Katie

  4. joe_9 on 2006-10-24 06:42:27.857151

    Hi Stacy,
    It is more than likely that you have comorbidites, it's up to your
    PCP to document them. I have PPO, so I don't have PCP. I went
    directly to the surgeon. He asked if I had any comorbidities. I
    said no. He nodded. Breifly examined me and wrote dyspnea
    (difficulty breathing), exercise-induced asthma, and edema. I can't
    say this is why I was approved so quickly (took less than 2 weeks on
    the first request) but I'm sure it didn't hurt. Not saying your PCP
    is bad, but he/she might just be thinking that these are standard
    problems with being overweight and not considering them as seperate
    co-morbidities, which they are.
    Tracy
    401/372/199

  5. debora800 on 2006-10-25 02:44:33.917417

    Thank you Tracy, I am thinking more and more that I just need to get
    to my pcp and have him start documenting every little thing that is
    wrong with me.
    Thanks to everyone who has such great ideas, and please keep them
    coming!

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