Insurance will not pay for my DS because my BMI is too low

Imissthe80s
on 8/5/11 12:26 am - Louisville, KY

DS on 02/27/12

This morning, the surgeon's office informed me that my insurance requires a BMI of 50 before they will cover the DS, mine is only 42. I'm not really certain how or if I should proceed here, any thoughts on this? I'm kinda taken aback and a little distraught over this. I knew it could happen, but now that it has, I'm kinda out of sorts about it.

MajorMom
on 8/5/11 1:58 am - VA

DS on 08/09/07

I'm so sorry. Do you have an option to switch insurance providers every year or are you stuck? You may also want to ask on the DS board if anyone has successfully fought your insurance company's policies and won. Last, take a look at Dr Ungson and Dr Marchesini in Mex and Brazil.

I hate insurance companies!

--gina

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
******GOAL*******
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
DS on Aug 9, 2007 with Dr. Hazem Elariny

Imissthe80s
on 8/5/11 2:09 am - Louisville, KY

DS on 02/27/12

Gina, I'm on the case. Yes, I posted this over at the DS forum. My insurance will cover all three of the other procedures since I qualify with my BMI. They just have a requirement of a BMI of 50 for the DS. When I get my official Denial from them, I will appeal and make my case for the DS.

MajorMom
on 8/5/11 2:37 am - VA

DS on 08/09/07

Good job! The 50BMI is a gimmick to avoid having to pay for a more involved surgery. Good luck!

--gina

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
******GOAL*******
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
DS on Aug 9, 2007 with Dr. Hazem Elariny

tanya8071
on 8/5/11 2:20 am

what does your BMI have to be for the other types of surgeries ???

Imissthe80s
on 8/5/11 2:43 am - Louisville, KY

DS on 02/27/12

40 or 35 with co-morbidities.

lerkhart
on 8/5/11 3:01 am

RNY on 08/03/09

Do you know if anyone has appealed and won? That's what I would do if that is the surgery that I wanted. Fight and see what happens.. Can you have a lower BMI with comorbidities?
Good luck.
Linda

14.5 lost pre-surgery 5'1 1/2"

Imissthe80s
on 8/5/11 3:28 am - Louisville, KY

DS on 02/27/12

Linda- Since I have a BMI of 42, the insurance would cover the Lapband, the RNY, or the Sleeve. They just have a higher BMI for the DS only. I will contact HR first about this and see if they are willing to work with me on this.

Ladytazz
on 8/5/11 7:33 am

Do you have a need to take NSAIDs regularly? Like arthritis or something? I think that is one of the things that may help you win an appeal.

WLS 10/28/2002 Revision 7/23/2010

High Weight (2002) 240 Revision Weight (2010) 220 Current Weight 115.

Imissthe80s
on 8/5/11 7:48 am - Louisville, KY

DS on 02/27/12

I take them but not regularly.

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Insurance will not pay for my DS because my BMI is too low