Approval

I have gone through everything with flying colors.  The nurse sent all my stuff into insurance company, they denied it because my BMI was too low and they needed a 2 year record from my Medical Center.  The nurse said she will appeal until the insurance comes through.  The nurse faxed that in last Monday, my question is will this take along time?

What does your insurance company require? You may need to know that. My BMI was too low, too. I had to gain enough weight to meet the minimum BMI. Plus I needed 2 have 2 co-morbidities. There was talk about needing a 3 year record of documented tried and failed weight loss but for some reason that neverr did come up.

So, what exactly does your insurance require? Have you talked to them yourself?

I have BCBS.  BMI of 40 or more, mine is 36.5 and 1 co-morbidities for 2 years.  I have high blood pressure for the last 2.5 years.

Would a second co-morbidity give you an edge? Like high cholesterol? Or sleep apnea? Or gerd? Just trying to help. It's awful to need/want this life affirming surgery and have the insurance company deny it. 

 I have BCBS as well and my BMI was 35 when I got approved.  I did have 2 co-morbidities but also had separate letters from my physician and my surgeon stating how losing weight would dramatically improve my life and that the surgery would benefit me.  Did you have any doctors write letters for you to the insurance company?  I have also heard that writing a letter yourself to the insurance company can help too.  I truly hope it all works out for you.  Keep us posted.

Jessy

Hi Jessica:

I see you had the RNY done with BCBS...do you know anyone that has had the sleeve done and approved with BCBS? I'm searching everywhere before I have the dr. submit my paperwork. I think I might have a better chance at approval since I have a lap band now and that needs to be removed. If you have any information, please let me know. I live in Florida, but the company I work for has our policy out of Minnesota, since the headquarters are in Center City, MN. Kinda a wierd situation, but anyway. Drop me a line when you can. How are you doing with the surgery you had? I don't want that surgery, but at this point and time, I will be glad to have anything. Thanks so much...Janine

Thank you for all your advise.  I had my doctor send a letter as well.  I will just hang in there.

I do have 2 co-mobidies, high blood pressure and thyroid problems, but the insurance company said they only consider 1.

I don't think they consider thyroid a co-morbidity because weight loss does not resolve it.  I had plenty of co-morbs pre-op - diabetes, high BP, elevated triglycerides, back pain, yada yada yada...  All of those have resolved, I no longer take meds for any of them - but I'm still on levothyroxine and probably will be for life.

Check your insurance requirements, find a gap somewhere - and if you can't, although this is NOT 'good' advice, you would not be the first person to gain weight in order to qualify for WLS...

Hi:

I'm new to this site, but not too new to WLS. I had the band put in in 2004, I now need the revision for many reasons, one being the band just did not work for me and now it's really bothering me and my GERD is awful also with a number of other issues. I was just wondering if someone could possibily give me some clue as in and if BCBS of Minnesota will approve the sleeve??? My policy reads "investigational", but I've read some people have gotten them to appprove it. I don't know if I should send the paper work in for a sleeve or a bypass (which is really my second to last resort) I really don't want that, but at this point in my life I will be happy with anything. I'm so dissappointed with the band and now it's not even working due to scare tissue and errosion around the stomach. I need it out so bad, but want the sleeve at the same time. If anyone can give me a aray of hope, I would greatly appreciate it. If you or anyone you know has had this approved with bcbs, please let me know. Thanks so much! Janine

This is a good question  Janine.  Have you tried posting this on the VSG FORUM?  If not you should try. I am in NC an just happen to read yr post. I have the same INS. you have.  Tried getting a direct answer from BCBS MN. could not get one.  I do know they cover the BAND and the RNY.  So, I will prob. go with the RNY.  Good luck