Insurance DENIED because BMI is under 50??? WTH :(

[healthyliving 0]

OMG.....I can't believe my insurance denied me because (for the sleeve) your BMI has to be more than 50 to get approved!!! I am BEYOND devastated. Trying to keep a calm mind about it but darn it, I need help.....I have already purchased my post-op food and all of my Vitamins. Has anyone ever experienced this before?? If so, did it get appealed? I would love to hear your story....anybody? :(

[AutumnLily 77]

Ahh sorry to hear about your insurances rule. What is your BMI at?

Have you thought of self pay? I could of had my surgery covered but I would have had to wait at least 2 years to get in. So I bit the bullet and paid for it myself. Hope you find the answers from others that you are looking for.

[kellyw74 258]

OMG!! that is awful. That seems really high. Do you have to have comorbities with it too?

I would see if you can appeal that. 50 is outrageous!

Best of luck to you!

Kelly

[healthyliving 0]

Thank-you all for your concern. It really is a bummer and my husband thinks It's a sign that I should not get it. Feeling pretty bummed about all of it. Unfortunately, right now I am not able to self pay. If I could I would get it tomorrow. My BMI is 40.9.

[kids05 4]

Mine was denied the first time around. I was devastated as well...I was crying one minute a zombie holed up in my room not wanting to do anything the next! My doc appealed it and I GOT APPROVED! It literally happened so fast! Once they had a physician to physician review, I was ok! My BMI was just under 40 with no co-morbidies (yet...borderline on just about everything!!) and there is NO WAY I can afford to even consider self pay...so I had to have ins cover it Your doctor should be able to tell you pretty up front if he thinks your ins will cover it, they deal with these ins companies all the time. Stay positive and maybe even call your ins company yourself...the squeaky wheel and so forth! I am a nurse and I was a surgical coordinator for a long time a patient is their own best advocate! I have my fingers crossed for you!

.

OMG.....I can't believe my insurance denied me because (for the sleeve) your BMI has to be more than 50 to get approved!!! I am BEYOND devastated. Trying to keep a calm mind about it but darn it, I need help.....I have already purchased my post-op food and all of my Vitamins. Has anyone ever experienced this before?? If so, did it get appealed? I would love to hear your story....anybody? :(

[morethan 4]

I would have that appealed. Usually the standard is 40. You should fight that.

[Rootman 1,101]

I would have that appealed. Usually the standard is 40. You should fight that.

Yeah, fight it! I've never heard of a lower limit of 50, you are very, very dangerously obese at that level - I know because I was over 50 myself. I've heard of a limit of 40 but 50 is way, way too high of a requirement.

[Virginia S 13]

OMG.....I can't believe my insurance denied me because (for the sleeve) your BMI has to be more than 50 to get approved!!! I am BEYOND devastated. Trying to keep a calm mind about it but darn it, I need help.....I have already purchased my post-op food and all of my Vitamins. Has anyone ever experienced this before?? If so, did it get appealed? I would love to hear your story....anybody? :(

You may know this, but the sleeve used to only be done as stage one of a two-stage process for Duodenal Switches on very obese patients. Most of the rules about 50 BMI date back to this. Sleeve only got approved for standalone by most insurance companies last year (2010). My insurance change their policy until November 2010. With that change, most (but obviously not all) companies changed their standard BMI down to 40 or 35 with co-morbidities to match the RNY or band. Sounds like your insurance is behind the curve.

NIH approves it for BMI of 40; an appeal by your surgeon might very well be successful. Don't give up - fight for yourself and your health.

Good luck!

Va

[healthyliving 0]

Wow, thank you all so much for your words of encouragement. I am trying not to get too down. They are going to appeal it and I should know in another week or so. I thought 50 seemed pretty high too but I think Virginia S. hit it right on the nose. That is exactly why they denied me. Either way I have to lose the weight....so I will keep meditating on it and please feel free to send any prayers and meditations my way. I will also continue to send out positive vibes to all of you

Peace & blessings

[NJMOMof2 17]

Insurance Companies deny the first time around in many instances. My friend who had the sleeve and had a BMI in the 40"s was denied 3 times before approved. I had exactly a 40 BMI and was approved first time. So keep fighting..