Hopefuln08

I also am in NC and have BCBS State Health Plan and have recently been denied because my BMI was over 50 and they consider it investigational. My surgeon said that he wants to pursue talking with the lawyers that work for the Lap Band manufacturer and see if they can help so we will be doing an appeal. I got my letter today and if I am reading it correctly iif they can show documentation of the Band working in people with BMI's over 50 then I think I might have a chance! Crazy thing is when they denied me the lady on the phone said but you can resubmit and they would probably approve you for gastric bypass, ok that makes no sense, why will they pay for a surgery that has lots of complications and a longer hospital stay, etc and not for the Lap Band?? The best I can tell it looks like they haven't revised their policy for Lap Band since January 2007. I hope my surgeon will make sure they have the most up to date statistics on how well people do with theBand:rolleyes2:

JJsmiles and Mrsflipflops- I am wondering if either one of you had any problems getting approved by insurance? I was denied last week because my insurance company said my BMI was too high at 56.5 and that the Lap Band procedure was for people with BMI's below 50. Anybody else have any problems like this? Thanks for any feedback!

I am just wondering if there is anyone who has a BMI over 50 that has been denied by their insurance company, I was denied and after reading all of the fine print for my policy which is NC State Health Plan(which you would think would want what is best for their patients) it says that if your BMI is greater than 50 then the Lap Band procedure is considered investigational. My surgeon's office is looking into this more but I wanted to see if anyone has any thoughts or has had this happen to them.

I am just wondering if there is anyone who has a BMI over 50 that has been denied by their insurance company, I was denied and after reading all of the fine print for my policy which is NC State Health Plan(which you would think would want what is best for their patients) it says that if your BMI is greater than 50 then the Lap Band procedure is considered investigational. My surgeon's office is looking into this more but I wanted to see if anyone has any thoughts or has had this happen to them.

I started checking into Lap Band surgery in March as I have been overweight since I was about 12 and and now 38. It had been smooth sailing with the referral getting made promptly and getting my nutrition and psych evals and then getting in for the consult with the surgeon! Roadblock came last week when I called my insurance company after them having put me off for two weeks and found out that they denied me, they said is was because my BMI wass over 50 and it was considered investigational. Has anyone else had this happen to them? I have been reading the posts and finally am taking the time to post myself. Please let me know if anyone has any advice. Thanks!:wink2: