Dr.K will do revision but BMI too LOW for DS?

I posted this also on the DS forum. Dr. K said he will do my revision, i have a $0 copay.  He has a $4000 program fee but CIGNA will not approve it if I don't have a BMI of at least 50????? Its at 45 now.  Im getting ready to eat up some stuff and wear heavy clothing the next time i get weighed anywhere.

Hi,

I do not think they will cover any portion of a program fee regardless of your BMI. You should check this carefully and get it in writing as you may have to pay the Dr. up front. and then not be compensated when you submit for payment.

Good luck

Whitney

I know the program fees I will have to pay out of pocket $4000 but my issue is that the lady said CIGNA requires that you have a BMI of 50 to get a DS.  I have a zero copy on the surgery and hospital stay.

That's a bummer you may be able to fight that as I think for a medically necessary revision there is no BMI minimum. One thing that is a bonus is Dr K's office staff is fantastic confirming Insurance. I did not do a thing but give them my cards to copy they verified everything.

Good luck

Whit

 

Simple, appeal it.  Don't gain weight, that's not bright.  Just appeal it and look on the ASMBS website for studies showing  DS is good for BMIs under 50.  Go to the DS board and they will direct you to another board where most of the vets are posting and they can help you through the appeal process.  Cigna is backwards, they always have been.  So, you play by their rules and appeal.

It has not been submitted to cigna. The lady from Dr K office told me that. I told her I knew people that work with me had a ds and bmi under 50. Plus i think if i need to be revised to a DS from RNY dr k will know how to get me approved. Im not going to worry about it until i get denied. No since in worrying about something that hasnt happened yet. Since i hadnt heard that i just wanted to know had anyone else experienced that thats the reason i posted

I've just started thinking about a revisions. What is a program fee? $k? That sounds like a ton! What is it for?

 

To be honest I'm not exactly what it includes but when you are the best or one of the best people from all ovef the world are more than happy to pay it. Lol I would assume it covers after care stuff