limbo

sunshinenh · November 21, 2005

Did hear back from Ins. Co. They denied me because of a BMI of 51. They feel that Gastric Bypass is best for me. I do not want Bypass. I have continued to lose weight and now have a BMI of 48.5, so we resubmitted. Now I am waiting again. Has anyone else out there had this type of problem - what results did you get. I just don't want to be forced into Bypass when I know that the Lap Band will be better for me.

the best me · November 21, 2005

Your personal medical decisions are between you and your doctor. Your insurance can dispense their protocol, but if you have a doc with a good insurance person, you will be able to fight. FIGHT!!! If they cover banding at all, it might take some time and be a bit of a hassle, but you can do it. There is NO reason a person with a BMI over 50 cannot get banded. Contact Inamed (www.Inamed.com) about getting some documentation for submitting an appeal. Go get 'em!!

Alexandra · November 21, 2005

Kathy is exactly right, Moonietunes. Lots of us have had initial denials overturned on appeal, so don't give up! Your insurance carrier CANNOT make your medical decisions for you, so stick to your guns. You can prevail!!

sunshinenh · November 22, 2005

Thank you for your kind words. I really feel overwhelmed by all the arbitrary rules. Not feeling like much of a fighter right now - but in the morning...we will see. My heart goes out to any of you going through this insurance hassle/game too. It shouldn't have to be like this.

ReneBean · November 22, 2005

Aw, Moonie - I am sorry for you. I have that same problem - but MY BMI is currently at 58. All I can say is do whatever you have to do to lose a few pounds and re-submit.

It will be faster and easier than fighting.... take if from me. I have been denied twice and I am submitting to the State Insurance Board to see if they will overturn the Blue Cross decision.

Of course, since you are SOOO close to 50, it might be easier to get them to overturn the decision, too. I would try both ways. That way, if they don't approve your appeal, you can re-submit at a lower BMI.

The end goal is to lose weight. You might as well start now...

Good Luck!!