DENIED DS - NEED YOUR HELP!!! LOW BMI

If you have been approved for a DS with a bmi below 50 and have BC/BS insurance (any plan - any state) PLEASE send me your vital info to include in my appeal letter for my husband.  He was denied because his bmi is 40 and our plan states they will consider the DS on a case by case basis for patients with a bmi of 50 -- so we're looking for as many people as we can to include in our appeal letter who've been approved.  *They're also claiming the surgery is investigational - which I have a ton of info to fight that claim and they're also saying he didn't do a 1yr medically supervised diet, which he did and we included it they just didn't look at it I guess.

Here's what I need...................... your name your bmi at the time of surgery your date of surgery your place of surgery (hospital name, city, state) your insurance plan THANKS for your help!!!

You should post on the DS board and ask if there are any DS'ers with BMI under 50. It was my understanding that the lowest BMI one should have to be safe is 45. So you may not find too many. You could also go the the Member List (left hand) once you're on the DS forum. Click on their profiles and you can see their pre-op BMIs. Why not just go with the Gastric Sleeve? Your insurance considers them both experimental, but at least you wouldn't have the additional burden of proving to them that a 40 BMI is safe and other insurances have approved it. There are a lot of people on the Sleeve forum who had the 2 part VGS/DS procedure due to their high BMIs, but ended up not needing the DS after sustaining great WL. There are many who have lost 150-200 lbs, and the research is showing really good sustained wt loss, especially for ppl who are "lightweights" (35-40 BMI). And no strict dietary issues or malnutrition or complications. Just a suggestion, as more inusrances are approving the Sleeve due to it being the safest procedure with fewest complications.

Good luck,

Kahlua

My insurance has a strict exclusion for the gastric sleeve - they do not cover it at all........don't ask my why........but his main reason for having the surgery is to help with his diabetes and the lower part of the DS is what does that (that's my understanding anyway).

THANKS for the info though.

Dear Tammy,

I'm sorry to hear about the diabetes and the exclusion on the Sleeve. I hope you get some posters from the DS board to help you out. BTW, it's not just the DS part that helps with diabetes. Almost everyone on the sleeve forum has had an improvement or complete reversal of their diabetes, within weeks of the surgery. I think the same is true for RNY, but I don't know about the LapBand. So it may just be loosing the weight? DUNNO. I hope you guys win your appeal and find a procedure that works for him and the ins pays for!  Good luck and BTW, you should be proud of your accomplishment too!!  Kahlua