Question about success
Hi Melissa,
This past Monday I was revised from Lap Band (2006) to RNY. I am so very pleased. I am now on Day 6 of Post Op program and this is the longest I've gone without throwing up in years!
The insurance process took six weeks from initial appoitment to surgery date. My surgeon specializes in revisions and was a real advocate for the surgery.
Let me know if you have any questions.
This past Monday I was revised from Lap Band (2006) to RNY. I am so very pleased. I am now on Day 6 of Post Op program and this is the longest I've gone without throwing up in years!
The insurance process took six weeks from initial appoitment to surgery date. My surgeon specializes in revisions and was a real advocate for the surgery.
Let me know if you have any questions.
Good Morning. Thanks for your help.
I do have a small situation though. For insurance, I need to have a BMI of 60 or greater to be approved for the DS. Currently, my BMI is 56. I am missing this benchmark by about 20 pounds. To me, it would be worth it to gain a little bit of weight.....and then go for the DS. I really think that is the procedure that I would prefer to use.
How would insurance look at that? I have to have 6 months of PCP visits and for my first visit, I had the BMI of 56. Would the insurance company go by that BMI or the BMI that I had at the end of my visits, or an average? Am I crazy for thinking like this?
Long story short, If I have this surgery, I want to benefit from it as much as possible. I don't want to settle for something because I HAVE to.
Help.
I do have a small situation though. For insurance, I need to have a BMI of 60 or greater to be approved for the DS. Currently, my BMI is 56. I am missing this benchmark by about 20 pounds. To me, it would be worth it to gain a little bit of weight.....and then go for the DS. I really think that is the procedure that I would prefer to use.
How would insurance look at that? I have to have 6 months of PCP visits and for my first visit, I had the BMI of 56. Would the insurance company go by that BMI or the BMI that I had at the end of my visits, or an average? Am I crazy for thinking like this?
Long story short, If I have this surgery, I want to benefit from it as much as possible. I don't want to settle for something because I HAVE to.
Help.
If your BMI is 56, your DEFINITELY need to hold out for the DS! And no, I don't think you're crazy for thinking about gaining 20 pounds in order to get it. Let's face it---if you don't get SOMETHING, you're going to gain that 20 pounds sooner or later anyway.
I suggest you call your insurance company and find out about the BMI thing. Also, I think you can appeal their position on restricting the DS to patients with a BMI greater than 60---it's a totally ludicrous idea. Studies show that the DS has the very best long-term, maintained weight-loss stats for patients of ANY size, but especially so for those with a BMI greater than 50. Greater than 50---no need to wait until someone's BMI gets to 60.
I suggest you call your insurance company and find out about the BMI thing. Also, I think you can appeal their position on restricting the DS to patients with a BMI greater than 60---it's a totally ludicrous idea. Studies show that the DS has the very best long-term, maintained weight-loss stats for patients of ANY size, but especially so for those with a BMI greater than 50. Greater than 50---no need to wait until someone's BMI gets to 60.
Amy Farrah Fowler
on 11/1/11 7:41 am
on 11/1/11 7:41 am
With a BMI of 56, you NEED the DS. I like the sleeve too, but not with your BMI.
Appeal this, as the requirements for RNY, DS or sleeve are supposed to be all the same (=>40, or =>35 with comorbidities). This should be an easy appeal to win.
I agree with not settling, and feel strongly that we want surgery only once, if possible. The DS is your BEST shot, and if they butcher your stomach into a RNY pouch, and then you need yet another revision to DS, (and MANY do) it is much higher risk to fix that stomach.
Pick the right surgery now, to avoid a third, and high risk surgery.
Appeal this, as the requirements for RNY, DS or sleeve are supposed to be all the same (=>40, or =>35 with comorbidities). This should be an easy appeal to win.
I agree with not settling, and feel strongly that we want surgery only once, if possible. The DS is your BEST shot, and if they butcher your stomach into a RNY pouch, and then you need yet another revision to DS, (and MANY do) it is much higher risk to fix that stomach.
Pick the right surgery now, to avoid a third, and high risk surgery.
So, I know I can't do anything as far as insurance approval until January when my new insurance begins. However, do I send the initial information for approval to the insurance company AND THEN appeal it? If I appeal their information, how long does that generally take?
I want to do it right this time!
I want to do it right this time!
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