XP: Insurance will not pay for a DS unless my BMI is 50
If you work for a larger employer and they are self-funded, IMMEDIATELY go to your HR (if you are comfortable with them knowing your plans). When I worked at Aetna and a self-funded account came forward and said "we want to change this policy or make this exception" we made it right away.
Appeal away, you'll get it covered! If not, put a bunch of weights in your pocket during your next weigh in!
Appeal away, you'll get it covered! If not, put a bunch of weights in your pocket during your next weigh in!
My insurance BCBS tried pulling this one on me. I had my policy in hand and it stated in plain english that '35+ BMI w/comobidities or 40+ BMI'. Then they came back to me and said sorry DS is done only with 50+BMI. I totally called their BS card and called them back and got a smart representative. She said 'no certain surgery requires a different BMI'. In their in-depth policy it said 'suggested and prefered weight loss surgery for a 50+ BMI is the DS' It said nothing about it requireing it, just said that it was a good option for 50+BMI.
You need to get you full policy in hand and stick it to them! No 'one' procedure is to be singled out! Makes no sense! Stick it out and fight that mother! Try to get you doctors behind you as well!
You need to get you full policy in hand and stick it to them! No 'one' procedure is to be singled out! Makes no sense! Stick it out and fight that mother! Try to get you doctors behind you as well!