Ugh - big setback today! :(

[SuzKelly 0]

My "journey" has come to a hault! I had my consultation today - only to be informed that BCN does not cover the sleeve in people with a BMI less than 50!!!! Mine is 43. What a bite in the arse~

Sigh. Guess it's not meant to be.

[Malaika 50]

My "journey" has come to a hault! I had my consultation today - only to be informed that BCN does not cover the sleeve in people with a BMI less than 50!!!! Mine is 43. What a bite in the arse~

Sigh. Guess it's not meant to be.

Are there options? Self-pay? Appeal? Gaining more weight (or putting weights in your pockets to up your weight?

[3636millie 3]

My "journey" has come to a hault! I had my consultation today - only to be informed that BCN does not cover the sleeve in people with a BMI less than 50!!!! Mine is 43. What a bite in the arse~

Sigh. Guess it's not meant to be.

Please, don't give up. I am currently banded but scheduled for the sleeve in December. Even with insurance, I ended up having to borrow almost 10,000 when I got the band as the surgeon I used had "fees" which were not covered (the "fees" included 3 years "support", etc Bull Shit). Anyway, I too felt I couldn't afford it but got a loan anyway and was worried about making the payments. HOWEVER.... I forgot that my grocery bill would be less as I was eating less. Then about 2 weeks after surgery was taken off all my medication which was costing several hundred dollars a month even with co-pay. Needless to say, from the savings I have been able to more than meet my monthly payments. In fact, instead of the 4 years to pay it off, I will be done this month which is 16 months.

Have you thought about going to Mexico? That is where I am going for the sleeve. It is going to cost me $12,500 for revision from the stinking band to the sleeve. If you are just sleeve, it is cheaper.

I will be borrowing all the money to have the revision. There are several loan companies who make medical loans. The one I used for the banding was Care Credit. They seem all right. They will not cover the surgery in Mexico. I am borrowing the money from family. I am still in the process of trying to have my insurance pay part of the proceedure as they will pay 70% out of network. It is alot of work but hopefully will pan out. Call your insurance (if you have it) and ask if they will pay for any part of the procedure to be done out of the country. They may do it if your physician will write a letter that the sleeve would be the best option for you and you can back his letter up with research on why the sleeve should not be considered experimental, etc etc etc.

JUST DON'T GIVE UP AND DON'T SETTLE ON THE BANDING. PLEASE,PLEASE, PLEASE.....DON'T GET THE BAND.

[SuzKelly 0]

Ohhh, believe me, I will NOT get the Band. NO Way!

Self pay - no way I can do that. I cannot put our family into deeper debt than we already are. I played with the idea for a fleeting few seconds yesterday, but, no I cannot do that.

My surgeon did suggest that I have the HR person at dh's employer contat BCN on my behalf to try to fight them to get them to make sleeve a covered benefit.

Ohh, and another thing. I heard that the Sleeve might be getting a procedure code in january. So maybe I really need to get my ducks in a row - start getting my documented weight loss attempt going...and by january I could half way done .......If not - maybe I'll have to look at RNY as an alternative.....NO BAND. NO WAY!

And lastly - for Vegas - I would have to gain 50 lbs to reach BMI of 50. There's no way in heck I am going to try to do that. I feel absolutely miserable now - I cannot imagine having 50 more lbs on this frame.

Edited September 27, 2009 by SuzKelly
added to post

[LAN2k 18]

Get your "ducks in a row" and be ready and stay focused. Time flies and before you know it, January will be upon us. Best wishes. Keep us informed.

[Malaika 50]

NO Suz I wouldn't gain the extra weight either - it was just an attempt to get you to look at all the options and not just throw in the towel. And January will be here before you know it, so get your ducks in a row an dbe ready when January gets here!

[Bob_350lbs 105]

I would have sold my house to get the sleeve. Dr. Aceves sounds like a great option.

Edited September 27, 2009 by Steph_123

[jsm 1]

Suzy, don?t give up hope. Call your BCN member services in the morning and ask them what their Medical Policy is for Bariatric Surgery. Make sure you get a copy of this policy and ask where this medical policy is located on their website. I tried to find it, but in my opinion their site is very generic. I do see that BCN has several Centers of Excellence for Bariatric Surgery, but not the procedures that it covers.

Take a deep breathe and keep the faith!

Hugs,

JoAnne

[SuzKelly 0]

The policy is not on their website. Their website is useless, in my opinion. They did mail me the info. The sleeve is mentioned so I assumed it was covered.

[LAN2k 18]

With low BMI, insurance companies are more stringent about coverage for WLS. My BMI was about a 35 but, I had well documented, (meaning I had to make it a point to see specialists and be sure I had records, x-rays, MRI's etc, of my number one complaint, weight related ailments), comorbidities, like, osteoarthritis in both knees, both hips, moderate sleep apnea for which I had to submit to two overnight studies with all sorts of wires attached to my chest, head and legs!! I also had to follow my surgeons requests to see many doctors for a number of pre surgery tests that needed to be documented for submission to the insurance company. It was a bit of work and in my case (and I prayed), I was approved. Had I not been, my surgeon would have appealed the decision. Best wishes, don't give up.

[SuzKelly 0]

Well I am hoping to do a sleep study. I snore really bad - according to my family. And my knees are hurting me so bad - it's VERY hard to go down my basement steps. Some days are better than others. Even so - Blue Care network absolutely requires documented 6 months of weight loss program. Pbbbbt. I don't know what to do. That's so great that your surgeon was willing to go all out for you. I wish I could find one like that. My PCP doesn't seem to want to go to any extremes to help me. I already asked him and he said there was nothing he could do, because BCN has to have the records. Whatever.

I am so digusted and depressed.

[Bob_350lbs 105]

My PCP didn't support me, neither did utilization review. My insurance did pay for my chest x-ray, labs, mammogram (yes, Dr. requires it) and pre-op physical. But that is because it was my yearly check-up. I purchased a pkg deal that included 2 weeks of supplements, the surgeon, psych & dietary consult, and a year of follow-up. And, there is monthly support group, not mandatory though.

My BMI was 39. I had no co-morbidites. But, the surgeon did find moderate sliding hiatal hernia (repaired it) and a fatty liver. All those extra calories in stored as fat in the liver too. So, actually I did have a co-morbidity that the stupid crappy HMOs didn't find, because the doctor loses money to refer me out for anything. According to him, because I am not a whiner in his office monthly, that I must be healthy.

Anyway, I know your dilema. It took me two years to finally do this. It was the money part that held me back.

Edited September 27, 2009 by Steph_123

[LAN2k 18]

Well I am hoping to do a sleep study. I snore really bad - according to my family. And my knees are hurting me so bad - it's VERY hard to go down my basement steps. Some days are better than others. Even so - Blue Care network absolutely requires documented 6 months of weight loss program. Pbbbbt. I don't know what to do. That's so great that your surgeon was willing to go all out for you. I wish I could find one like that. My PCP doesn't seem to want to go to any extremes to help me. I already asked him and he said there was nothing he could do, because BCN has to have the records. Whatever.

I am so digusted and depressed.

Follow through and keep records.

[SuzKelly 0]

OMG - 2 years!!! Sheesh.

Well I have an appt with my PCP on October 2 so I plan on talking with him about getting SERIOUS and aggressive with testing and what not. I guess that's where to start.. AND I have a second appt with the psychologist this coming Tuesday. Definitely going to keep that appt.

AND I will keep playing the mega millions - maybe I'll win some money so I can self pay. LOL.

[JudyJudyJudy 7]

Don't give up, can you get financing? Where I am going they offer financing.