Has anyone been denied with a BMI of over 40?

[NewAshes 232]

Just curious

[makemyownluck 785]

Well, I'm sure there are people with high BMI that have been denied, but not for their BMI... over 40 BMI means you're a candidate... but an insurance company can deny you for other reasons (like not meeting their criteria for NUT consults, psych eval, etc).

Unfortunately, I think many insurance companies like to deny people the first go around. They want to deter people from doing it, if they can. So even if they do deny it, they have to give you the REASON you are denied, so you can work on getting that "reason" cleared up. If you are denied, you can always appeal!

[NewAshes 232]

I can see failing the psyc part but how do you fail the NUT part? Lol

[makemyownluck 785]

haha, not fail - but maybe the NUT doesn't give you all the info you need (per the insurance company), or the psych eval didn't cover enough... I don't mean fail like you'd do something wrong - I mean the insurance company will look for some minor detail to say you didn't meet the requirement is all.

Make sure your surgeon has a good support staff. They should already be well aware of what the insurance companies are looking for, so they should be able to guide you through it all. My surgeons staff is really good - but this is my 2nd surgeon. The first office didn't even bother to check my benefits (and I ended up having to switch insurance coverage, otherwise I'd be waiting a whole year or more with my prior plan) - plus the doctor was a total B.I.T.C.H. I'm glad I went for a 2nd opinion because I feel like I'm getting the level of care I should have been getting in the first place. Try not to stress yourself out too much about the insurance part, it will work itself out.

[NewAshes 232]

Oh gotcha! I am trying to prepare my self cause I have state insurance that comes with ssi...I plan on a full on war with them lol I'm still on step 1 with talking to my doctor to refer me..can't see me till April 11th

[makemyownluck 785]

I don't have a lot of knowledge on the state insurance. i had a girlfriend of mine who had the lap band while on state insurance as well (she was also on SSI), and I know she had to jump a LOT of hoops. A LOT. classes, testing, more testing, she was in the process for over a year.

Mind you, this may have nothing to do with her insurance. She also had a long history of drug addiction (tho she had been sober for 10+ years), so I'm pretty sure her providers were also requiring a lot of her as well. And she had ongoing psych treatment that she had to get stable with as well. Also making matters worse, she had significant medical history of osteoporosis (diagnosed in her 30s) and TWO pulmonary embolisms in her life. So she had a lot working against her. I can imagine that Medicaid required a lot simply because it's publicly funded. But her experience may be more of an extreme example, just based on her other history.

Unfortunately, 2 months after having her band, she passed away. Not due to the band or surgery complication, though. Her prior drug addiction took hold when she could no longer substitute food for drugs (which she had done because she gained 200 lbs in the 10 years she gave up drugs). She passed away in her sleep of an overdose. It was really a very hard thing for me to deal with (she was really like a sister to me), but it just goes to show that none of these surgeries are "the easy way out". We all still have to deal with our inner selves and keep our heads clear about what our goal is. She had her addiction controlled for many years, and then the stress of post-op life messed with her in a severe way. No one even saw it coming -- she got the drugs from someone in her narcotics support group. We thought she was taking care of herself, but instead she ran into the very thing she was trying to avoid... Very sad story... sorry, got a bit off topic on that one.

[Hannah55 79]

My BMI is over 50. I was denied because I have no health problems. I have appealed but haven't heard back yet.

[Fiddleman 4,376]

My BMI is over 50. I was denied because I have no health problems. I have appealed but haven't heard back yet.

That's just not right...

[NewAshes 232]

Yeah I hate when people say surgery is easy. It's not you still have to work out and diet, the weight doesn't just fall off and it can easily come back on..those people are just ignorant. I have ohp plus (Oregon health plan) which is covered by trillium. I'm told you need a BMI of over 40, 6 months of NUT and psyc and you need to show you have been over weight for a few years I think oh and mandatory seminar lol. I tried calling my insurance and they just told me to talk to my doctor and have her refer me..so this is just based off of what 2 others who have the same insurance told me.

[NewAshes 232]

Sorry to hear about your friend.