XP: Insurance will not pay for a DS unless my BMI is 50

If you work for a larger employer and they are self-funded, IMMEDIATELY go to your HR (if you are comfortable with them knowing your plans). When I worked at Aetna and a self-funded account came forward and said "we want to change this policy or make this exception" we made it right away.

Appeal away, you'll get it covered! If not, put a bunch of weights in your pocket during your next weigh in!

Lynmarie, I would have to put 46 lbs. worth of quarters in my pockets! Don't worry, I'm going to appeal it.

That's a lot of quarters.  :)

Sorry, I read your 42 as 48 and was kidding too. 

But just think, with all those quarters, you could probably pay for the surgery!  ;0

You'll win on appeal.  Too much data out there supporting lower weight DS surgeries.  Saying a big prayer for ya!

Yes, I probably could pay for it with all those quarters! I'm staying positive about it.  I had a moment where I was thrown off balance by it, but I'm back in the saddle! Hi Ho Silver!

Who is the insurance company? 

UHC

 If UHC is your insurer then it is your employers policy that requires the high BMI, because I have UHC also and our BMI requirement is 35 with co-morbs and 40 without. So you do need to contact your employer about it. Not the insurance.

Inge those requirements-35 with co-morbs or 40 without-do apply for the other three procedures, just not the DS-the DS requires a 50 BMI.  But yes, I will contact HR first and see what they say.

 my insurance company wouldnt either...I guess "luckily" I was a lot closer to 50 then you. hell I could gain 20 pounds a month pre DS without trying lol 

Dont give up though do wahtever you need to do!  :) You will figure it out

My insurance BCBS tried pulling this one on me. I had my policy in hand and it stated in plain english that '35+ BMI w/comobidities or 40+ BMI'. Then they came back to me and said sorry DS is done only with 50+BMI. I totally called their BS card and called them back and got a smart representative. She said 'no certain surgery requires a different BMI'. In their in-depth policy it said 'suggested and prefered weight loss surgery for a 50+ BMI is the DS' It said nothing about it requireing it, just said that it was a good option for 50+BMI.
You need to get you full policy in hand and stick it to them! No 'one' procedure is to be singled out! Makes no sense! Stick it out and fight that mother! Try to get you doctors behind you as well!