Article for why BMI is not a requirement in revision?

Hi all,

I'm in a 14th month fight with Federal BCBS over revising my lap band to a VSG. They finally agreed to take out the lap band and that was done in October, but now they're still denying the revision part. At first it was because it wasn't medically necessary, then it was because my BMI wasn't over 35 (which is now is), now it's because my BMI isn't 40. Every bariatric surgeon I spoke with is appalled that you'd have to gain weight to get a revision. My surgeon even wrote a letter stating that a BMI requirement is not the standard of care in a revision.

What would be super helpful is to find some sort of article or policy about the standard of care for revisions that mentions the BMI. Anyone know of anything like that? I'm googling to death but haven't found anything yet. I'm trying to get this resolved with the OPM in DC this week.

Thanks!
Britt

I can't believe they still won't give. BMI of 35 is obese. I think my BMI is 35 and I was approved (UHC) within 3 days to RNY. Do you have any comorbidities? That might help. I didn't and still don't. I know you must be so frustrated. I've heard of others who have written letters & won their appeals but it sounds like you've tried that. Good Luck!

If your doctor submits proof of damage from the lap-band, such as band erosion, esophageal erosion, etc, it's not a weight issue, it's a health issue. I was able to bypass BCBS's 6 month diet requirement because of esophageal erosion from a ring on my stoma.