Question:
IMR-Insurance please help!?!?!

Orange Coast Memorial in Fountain Valley, CA told me about this site. I'm trying to get approved for the lap band right now. My insurance (blue cross hmo) already refused me 2 months ago for the surgery because my BMI is only 38.8 . They only cover the lap band if you have a BMI of 40 or higher or 35 & up plus a life threatening illness such as sleep apnea or diabetes. I went through the appeal process a month ago only to be refused again! Now I'm in the process of filing for an independent medical review. It feels like they want me to get sick or gain weight before they will approve me. Geeze 38.8 is so close to 40 as it is and this isn't even the most I have ever weighed. I was just wondering has anyone else been through this process, and what was the outcome? Thanks! -Lauren    — foryoublue (posted on June 17, 2009)

June 18, 2009
I can't respond to your particular situation but I do know many insurance companies make their subscribers jump through hoops before they approve. My ins had me go on a 6 month doctor supervised diet before they would approve. They did eventually approve me for RNY 2 years ago. I've heard since then that Med Mut (my ins co) has since agreed to pay only $10,000 for the surgery and the patient has to pay the rest. Many companies just don't want to pay for this surgery any more and are making it difficult. Just keep trying. Good luck.
   — Muggs

June 18, 2009
I really hate to say this but, sometimes you have to play the insurance companies games! Why dont you just gain the weight? It really not that much you would have to gain for your BMI to be at 40. I know so many people that have done things to have there BMI higher to qualify for the surgery! I never had that problem my BMI was 47 morning of surgery! Good luck.....
   — roz_1