Please help me convince BCBS NC that they should pay for a DS even though my BMI < 50

Unfortunately, I had to delete this post due to privacy concerns.

Hi Shelli- Thanks for your post. I'm also collecting ammunition. I'll send you a PM with some other sources attached that I've collected from this board.  

Very good of you to prepare for an appeal. It's most likely that the insurance will deny. Blue Shield of CA denied be for having a BMI under 50 and I won on appeal. Biertho is a really good one. I requested my insurance's bariatric policy and dissected it. There isn't any medical literature supporting their criteria. For articles they claimed supported their 50 BMI criteria I e-mailed the surgeon who authored it and asked his opinion (which did not support the 50 BMI criteria) and included a copy of that in my letter.

I also read all of the articles they used generally about the DS and showed them that 50% of patients in this study and 45% in this study had a BMI under 50 and that the outcomes were successful. It wasn't reported that patients with a BMI under 50 became underweight or had any worse vitamin deficiences.

Good luck!!

Remember too that you are asking for revision surgery. Show your BMI prior to the band and document your failure to lose with a focus on morbidities such as blood prssure, apnea, lipids, etc. Do as much homework as you can, sounds like you are off to a great start. Best of luck.....

I'm not a revision, but have a recent DS.  I have BCBS of MI, but I have noticed many BCBS policies often seem similar state to state although not always.  My policy also wanted a BMI >50.  My BMI was 45 when my paperwork was sent in for approval.  I was approved based on my co-morbidities, so if you have co-morbidities they may take a BMI of 45 for you too.  I know every policy is different, but there is still hope.  I hope you don't have to appeal a decision, but if you do there are a lot of people here that will help you fight BCBS of NC.  

I wish you the best of luck!!!!

~Roxy

Unfortunately, I had to delete this post due to privacy concerns.

 My BMI was 47 and I was approved on appeal with BCBS of IL.  I have my appeal letter on my profile, friend me and you can see it.  I also printed a sh*t ton of stats and studies (about 80 pages) and marked them up with a yellow highlighter.

I think letting them know that I well educated about the procedure I desired might have had an impact on my approval.
~GG

 Shelia,

Would you friend me as well so I can see your appeal letter? I've got the same issue about to happen to me with BCBSNC and I'm hoping to get it nipped in the rear fast.

Thanks!

Unfortunately, I had to delete this post due to privacy concerns.

Ugh, I am so sorry... fingers crossed that they approve you!!!  I'm at 46BMI, I better start stuffing my face before my meeting to get my weight.  Ridiculous that they base all of this on one little number.  I'll be watching your situation very closely!