Got my denial letter today! Yeah!

OK, I know this sounds crazy but I am pleased to see exactly what it says. It seems they stopped looking after seeing my BMI was at 38.66, not 40. Furthermore, they have me listed as having "a comorbid condition of type II diabetes mellitus", so this will be useful info, I think.  I suppose I could cry because 38.66 is so very damn close to 40, but whatever. Drive on, girl.

Get this, the reviewing doctor is a specialist in Plastic Surgery.

I have a doctor's visit this week and one of the things on my agenda is to get a current weight (last one was before Christmas and I have lived it up since then) and official height as it has bounced around in my charts. According to my BMI calculator, I need to have gained about 6 pounds since December 1 to put me over the top for 40. That might not be a problem. Thanks, Christmas cookies!

One thing I have learned: if you are on the borderline for your insurance requirements, start the process by having your doc document an official height, preferably on the lower side of accurate. This isn't a time you want to aspire to be tall, and you'll benefit from having an official answer on which to base your BMI determination.

I am betting that the next fight is going to be this requirement: "the covered person must have documentation of a diagnosis of morbid obesity for a minimum of 5 years from a physician." I noted tonight it doesn't say the word *consecutive* here. This might be my saving grace or it might not. Wondering how strict they'll be on the precise phrase "morbid obesity" or if they'll be able to figure out that if bmi is over 40 it = morbid obesity. We'll see. The one weird thing is that my next appeal is to go to my husband's employer. I suspect this is the person who holds the checkbook on my husband's employer's self-funded insurance plan. 

I'll be sending all my stuff over to Walter Lindstrom's office at the end of this week so they can take on the appeal. Oh yeah, bring. it. on.

Onward and upward, right?

 

I've gotta laugh that the reviewing physician is a plastic surgeon. What, no chiropractors were available?
I hope you and Lindstrom wipe the floor with their asses. Go get 'em!

My denial from NALC was, in part, due to me self-reporting my height as 5'7" since high school.  I had my primary actually measure twice at 5' 6.25", and NALC denied because of the "discrepancy." Thank goodness it was open season and was able to get a better insurer.

Just a thought...

I wonder if you might not want to find out who, where your husband works, will be reviewing your file and make contact with this person ahead of time for the purpose of not only informing them what they will be receiving from the insurer, but also to discuss your specific case and what you might do to assist with the approval process.

I'm thinking if you could "friend" this person to some degree, the chances are more likely that they may take a personal interest in your case and want to help you move it along.

Again, just a thought.

Hope to see you on the losers bench real soon!!!!

There is a name listed on the paperwork. My husband is going to look her up tomorrow. The address is the same as my husband's office, which is sort of strange, because I thought their North American HQ was elsewhere. But, he says there are a lot of HR and payroll people on the floor below him, so that does make sense.

When I had my consult with Lindstrom's office, I asked specifically about the risk of retaliation on my husband because he's the policy holder. She said 1) it's illegal and 2) we are just following what is available to us in the due process of the policy and the laws that govern it.