Anyone been denied because your BMI was too high???

musicalmomma · May 13, 2007

Our insurance (Anthem BC/BS) denied my husband because his BMI is 60. The policy states they only approve lapband for patients with a BMI of 50 or less! Ludicrous!

I was wondering if this has happened to anyone else? If so, did you appeal? What was the result? The LapBand company is taking up his appeal and we're wondering what the chances are of the appeal being approved.

Lab Rat · May 13, 2007

<p>My sister had a BMI of 51 and was told by her surgeon that she had to lose enough weight to get down to a BMI of 50 to be covered by insur. Good luck!</p> She lost the weight and got the surgery so we didn't have to appeal.

musicalmomma · May 14, 2007

<p>My sister had a BMI of 51 and was told by her surgeon that she had to lose enough weight to get down to a BMI of 50 to be covered by insur. Good luck!</p> She lost the weight and got the surgery so we didn't have to appeal.

If his BMI was 51-53 or so, the surgeon would have told him the same thing, but he'd have to lose 100lbs to get to a BMI of 50...that would take a LONG time as he's a slow loser as it is.

jukebox · May 14, 2007

I was denied because my BMI is 61. I am currently appealing that decision. (Empire BC/BS).

KarenB · May 17, 2007

This is just a thought...perhaps they deny because the band has a slower INITIAL weight loss amount than other weight loss surgeries? They all equal out after 2 years (I think it's 2, but they do eventually equal out.) Again, just a thought, but who knows what these companies' ratioanale about anything!

Good luck in your appeal process,

Karen