Question:
I'm 54 and my insurance criteria is 16/50. Can they legally do this?

   — Sandra W. (posted on April 28, 2001)

April 28, 2001
I don't know if they can do that or not, but I turned 54 in January and the RNY proximal was my birthday present to me! I am doing GREAT, have lost 53 lbs. I thought the age for not doing the operations was 60. It may help you live longer if you DO have the operation. I'd fight it! Good luck!
   — Betty Todd

April 28, 2001
My surgeon does it between ages of 15 and 70. Check with obesitylaw.com and see what they say.
   — Cindy H.

April 28, 2001
I think you need to find a new doctor. I am 62, just had my pulmonary and cardio consults, and am now waiting for insurance approval and a surgery date. This year i heard of a 66 year old woman and i myself spoke to a wonderful woman in grand rapids, michigan, that had RNY done two years ago without a complication and is having the time of her life. Start searching until you find a doctor who knows what he's doing. He may be playing it safe by having age restrictions, due to inexperience or afraid age related complications that he may not be able to handle.
   — judy M.

April 28, 2001
It appears the last response was talking about the surgeon's criteria, but If I'm reading your question right, you are asking about INSURANCE criteria. Each policy can have it's own criteria, and usually the insurance companies can refuse to cover certain things. Did they already refuse to cover it? Did they send you a rejection letter? If not, it doesn't necessarily mean they won't cover you, you may just have to work a little harder. Make sure you have all of your documentation together and be prepared to appeal. If you can prove all your co-morbs and still show you are healthy enough to survive the surgery, you may actually get approved. Keep trying, you never know. Plenty of people here were approved after an appeal. Good luck.
   — Maria H.

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