XP: Insurance will not pay for a DS unless my BMI is 50

I've already posted this over on the lightweights board as well.  Anyway, this morning, the surgeon's office informed me that my insurance requires a BMI of 50 before they will cover the DS.  My BMI is 42. I'm not really certain how or if I should proceed here, any thoughts on this? I'm kinda taken aback and a little distraught over this. I knew it could happen, but now that it has, I'm kinda out of sorts about it.

Appeal.  Their policy is not based on evidence, and there is PLENTY of evidence in the form of published papers that the DS is superior for BMI < 50.  Even Medicare doesn't limit it to an particular BMI - if the patient qualifies for ANY bariatric surgery, the DS is an equal option.

Roger that, Diana! I'm on the case.  I'm wondering if I need to get HR involved so that that requirement might be removed altogether for next year's policy?

Would it pay for a RnY with your current BMI?  If so I think you have a pretty good chance to win an appeal.

~Becky

Becky, yes, my insurance would pay for any of the other three procedures since my BMI is high enough.

I don't see how you could lose an appeal.  Get the insurance gurus like Diana Cox to help you.

Good luck!!

~Becky

Thanks, Becky! I'm just now gathering my arsenal of info. instructing me on how to appeal and what to include in my appeal.

Medicare paid for my DS and my highest recorded BMI was 39.8.  I lost weight so my surgery date BMI was even lower.  I have faith.  You are going to win an appeal.  I am rooting for you.

~Becky

Becky, thanks so much.  Swing some critters for me! That makes me feel so much more confident knowing that Medicare covered yours as a lightweight.  I am not going away easily and will certainly fight for this.

I was just thinking about you.  Sorry to hear the bad news.  The good news is that Diana Cox knows the insurance stuff better than most.  She won't steer* you wrong.

*Edited to correct spelling.  I don't think anyone would "stir" anything but coffee, or other fine drink, but will "steer" people in the right direction.