BCN....AND RNY...

Hey Everyone....I am in the process of getting things in line for my RNY @ Henry Ford. I have BCN, and I was wondering if anyone has been denied with BCN, and what were the reasons? Did you appeal? I'm concerned because I have no comorbidities, but my BMI is way over 50.  Any ideas on that?  Thanks in Advance any and everyone!

Lisa

Hi Lisa,

I am in Muskegon and also have BCN. I am having surgery this Wed.  I believe,  if you have a BMI of over 50 (mine was 50.4) I know you get to skip the waiting period of 6 months,  I am not sure what it says about co-morbidities( I have them all)  I will tell you to watch for riders a few of them surprised me.  Like the one that says they pay for all hospital stays, mine has a rider that says for WLS specifically they only cover 50%, also make sure to check into the coverage for your pyschological exam, mine covered half.

I hope this is of some help, remember to keep in contact with the insurance specialist at the Dr.'s office they can be of great help and reassurance.  I know the one at my office is wonderful!

I wish you the best of luck, I will pray for you peace of mind through-out the process.

God Bless,
Julie

Hey Julie....CONGRATS ON YOUR UPCOMING SURGERY!!! Thank you for responding....I have checked the riders....mine says they cover the stay, and the psych exam. Thank God. I'm going through Henry Ford, and the people there are awesome. Im so excited for you!! Keep me posted! Good Luck Girl!! Sending my very best to you.

-Lisa

I had BCN.  I was denied twice they said it was the 6 month diet thing.  The doctor's office handled the first appeal.  So i'm not sure what they sent in - but denied again with the 6 month thing. Our union president got involved and suddenly without a second appeal, it was approved.  I had a BMI over 50, but it was before the change.  From what I have seen, you should not have any problem.  You do not have to have co-morbidities if your bmi is over 50.  I think.

good luck and keep us posted

Thank you so much for your response. I'm hoping for the best with this situation. Thank you very much for the information, it was very helpful. Im praying that everything turns out alright, and they just approve me.