for only BMI over 50 :(

yourstruly
on 10/10/10 5:45 pm
I can't seem to find where I saw it, but my Minnesota Medicaid (GAMC) says it approves Duodenal Switch, but with a BMI 50 or over. I am not at 50, is there a way I could bypass that? Has anyone successfully done this in my cir****tance?
I have no HMO, so it's just General Assistance Medical Care, Medicaid..
Sigh..

(deactivated member)
on 10/10/10 6:59 pm
you can try and then do an appeal. What is your bmi right now?
yourstruly
on 10/12/10 10:56 am
My BMI is 45. I could try an appeal..
goingforit
on 10/12/10 1:43 am
I don't believe that is correct--did you hear this from your insurance company? Call them. I was told incorrect info from the surgeon's office! (I don't have the same insurance as you)

Also you might get more results for this question on the other board---for DS. They have experience with this kind of thing.
Diamond Girl
on 10/13/10 3:43 am - Ham Lake, MN
That policy language is probably written for a BMI at or above 50, yes. Very typical.

I had a BMI at 44 and had BlueCross Blue Shield, appealed twice and won - actually it wasn't even about the BMI...it was purely based on wanting the DS.

However, we do have other DS members in MN that have had your same insurance and have had no issues getting approved. And if it does deny coverage for the DS based on the BMI, you do have the right to appeal.

We also have a company in MN that assists potential weight loss surgery candidates with appeal assistance, or general questions regarding the insurance coverage, etc. The lady who owns the company has had the DS and understands our fight. I used her company vs. the surgeon's office for both my appeals. If you need the information, please let me know and I will forward that to you.

        
yourstruly
on 10/13/10 2:05 pm
 Thank you! 
I think I am going to start the process, and see what happens. 
With the help of all you nice people on here, I think I have a chance :)
(deactivated member)
on 10/14/10 6:32 am
Total BS!!!!

Get connected with Tammy Bishop- she posted recently about a guest speaker at her support group meeting on Monday.  She's awesome, and she helps people appeal and win.  You can do this!  Good luck!
yourstruly
on 10/15/10 1:52 pm
 Thank you, I will look for her!
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