Anyone told they don't weigh enough by insurance? Appeals, weight gain and more.

[OldMomOf3 52]

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Edited January 31, 2015 by MomOf3InOC

[Pepper123 320]

I was told i did not weigh enough...but i had all the co morbid conditions...i was denied but not for my weight so i did what was missing and appeal and was approved...

[OldMomOf3 52]

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Edited January 31, 2015 by MomOf3InOC

[Pepper123 320]

@ a week!!..my chemical blood work was missing so i had to get it done and resubmitted it..

Edited January 24, 2015 by Pepper123

[pinkbunies 359]

I was denied by my insurance because they don't cover it. I tried to have the surgery done locally and they told me I wasn't heavy enough, gain 30 more lbs then try again (this was me paying cash and they still said no) I went self pay, spent $4k and had it done in Mexico. I scheduled one week and was in Mexico the next. I'm inpatient and didn't want to wait. Arrived Tuesday, Surgery Wednesday, home on Friday, back to work on Monday. I'd do it all again if I had to.

If you have 4k on a credit card, go that route and get it over it. There is a link on this forum for a place that does it for $3200.00.

[peteyrulz 82]

@@pinkbunies Great turnaround time! May I ask who was your surgeon?

& Congratulations!

[pinkbunies 359]

tbh I'll have to look at the paper work again as I don't remember the surgeons name. The one thing I hated hearing was... your not big enough, this is for people who need it. It made my blood boil and made me more determined.

Sometimes, no matter how hard you try you just can't lose the weight. One day the ignorant insurance companies are going to realize that they will benefit more by having this surgery done vs. letting the person continue to have health problems.

[Jersrose43 837]

Usually an jnsurance company looks at revisions differently than straight new surgery.

Have you asked for their medical criteria in writing? I would. Or Google bcbs name of your state and gastric sleeve it should have the revision guidelines in it.

I have cigna and they have it couple pages after new surgery

Remember bcbs is different by state so make sure you get that state name In there

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[dfinaldi 6]

How many many pounds were you..I had bsnd removed and now im getting the sleeve. Dr wanted to wait 2 months for healing from band removal. Same thing with me i was t l d to gain about 10 pounds as i am 52 180 pounds...i did gain those 10 pounds in 2 months..just ate eveything and had lots of milkshakes lol...now im approved and going in for sleeve mid February.. Cant wait..just finished all my pre op test done with everything just waiting for my day.

[dfinaldi 6]

Im not patient..if they would od declined it would of went to Mexico as my friend did for 3300 .had it done on monday was back home Thursday back to work Monday feels and looks amazing. She paid because insurance wouldnt have paid since she is only 5'2 179....its been 4 months and she is 138..looks wonderful 15 pounds ftom goal...now she is losing about 1pound a week

[CountryGirl5584 115]

Are you having issues? That's ludicrous to not weigh enough if you are having issues. I would appeal

[OldMomOf3 52]

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Edited January 31, 2015 by MomOf3InOC

[Ann Fielder 19]

I heard several of the people actually put half pound weights in a couple of the pockets to give them additional weight

I had my lap band removed December 3, lived with it for four years because I lost my insurance . I was allergic to the band I spend a lot of time throwing up, my surgery date should be in March for the sleeve. I am at month five for my six-month diet I've lost 26 pounds....

Edited January 28, 2015 by Ann Fielder