Approval for DS BMI under 50 with BCBSNC

Has anyone been approved for the DS by BCBSNC(state health plan), with a BMI under 50. I currently have the Lap Band and I am in the process of getting a revision. Dr. Sudan suggested that I get the DS. I am concerned about the vitamin deficiency as I am really bad about taking pills. I originally wanted the Sleeve but BCBS still considers that investigational. I feel that I am going to have to get a surgery I do not want, RNY, or no surgery at all and remain overweight. I don’t know what to do at this point and I don’t know where to turn.

Hi Sheila,

I would check on the DS and insurance forums about experiences with the BCBSNC state plan accepting DS revisions on patients with BMIs under 50. However, I hope that you really listen to inner voice and evaluate your ability to be compliant with the vitamin regimen. The DS is a very good solution for some people and I personally know several DS patients that have done very well with the surgery, but they are committed to the supplementation requirements necessary to support a healthy post DS life. I would suggest getting the supplementation regimen and trying to execute it as you await approval for your surgery. You may find that the rewards related to your health and quality of life will propel you towards making the changes necessary to support the supplementation requirements, however if you find that you cannot do it, you need to talk with your Dr and be honest about your ability to be compliant and ask for their recommendation on what will work best for you. I certainly do not want to sway you towards or against DS, RNY or any other surgery. This is a decision that you need to make for yourself. I do have a large support group that you are welcome to attend if you would like. You can talk to a broad cross section of people who have had a variety of surgeries including the RNY, DS, Revisions from Bands, etc... We also have a special interest group of DS members. Most are new, but some had their surgeries 18 months or more. I don't know if it would help to talk to people in person. If you think so, please feel free to join us at our next meeting. 

Wishing you all the best as you work to decide the best route for you.

Regards,

Thanks Barbara, that is great idea! I don't think it's that I won't take the vitamins as I'm sure I would but it just seems confusing about how and when to take certain vitamins with other vitamins. I know once I get used to it, it will be no problem. I just want to make sure one vitamin it not counteracting another one. That's my biggest fear.

Sheila,

While it's a juggling act, it's definitely one that can be managed and honestly, if you want to come to our next DS group in Raleigh and talk to others to find out how they are handling it, you would be most welcome. It might help to actually see and hear how it all works, what the challenges are and how they are dealt with. You might want to 'talk' to maripsantos. She often is on the DS board. She also had Dr. Sudan at Duke and heads up our DS group. She's fairly new to this, but very knowledgeable and very nice. Another person that you may want to talk with, but who no longer comes to OH is AngelaP. She comes to the DS meetings and my monthly General Meeting. She had her DS surgery almost 2 years ago and is a great 'mentor.' She will caution you to ensure that you really can 'sign up' for the supplementation, but is a real advocate of the surgery and proof that it can be done and done well. If you are interested in attending any of my support groups, you can register at www.meetup.com/nc-wls and you'll get information about upcoming events. 

Wishing you all the best as you find just the right path for your own journey.

Regards,

I have blue cross blue shields.  If you go onto their website you can see what surgeries they will cover.  In the search box just put morbid obesity and the surgery stuff comes up.   I know that they will cover lap band, gastric bypass.   

I just had a revision from lap band to RNY


Tamara

THis is what mine says

D. Biliopancreatic bypass with or without duodenal switch may be considered on an individual consideration basis for patients with a BMI>50.

Thanks Tamara, that is what my policy says too. I was just asking because my BMI is 43. So I was just checking because they also have the Sleeve as a possible covered surgery listed but they won't approve the Sleeve. I think the diiferent groups cover different things.

I have BCBS of PA, however, all of my paperwork at Duke states BCBS of NC. Everything gets routed through BCBSNC so I'm not sure how all that works.

Anyway, I have a BMI of 42 and got the DS Nov 2nd. I had no issues whatsoever with getting approved.

Good luck!

Thanks Sabrina!

I too have the same question.  After MUCh research, i've decided that I would like to get the DS but my BMI is 42.  I've never had to utilize my BCBSNC for anything other than preventative survices and I have not a clue about their approval process.   I've submitted my paperwork and will hope and pray that I get the surgery that I feel is best for me.  Please keep us posted.  Hope all goes well!