Question:
is there an alternative to the surgery i am at a bmi of 38.9 and was denied from the
insurance company iam very upset the doctor cancelled my surgery date i went through all the testing they said i wasnt heavy enough and would have to gain at least 30-40lbs does anyone have any suggestions? very desperate for help — Jennifer K. (posted on November 17, 2003)
November 17, 2003
I would assume you dont have any co-mobilities. But, if you are 38.9 I
would have them send you 'written' policy documentation of your 'coverage'.
The national institite of Health NIH states 'a BMI of 40' as medically
necessary with no co mobilities. That would mean you are a bit under that
NOT 30-40 pounds.. Do the BMI check here. If or when you get to a BMI of
40 I would resubmit again (You are allowed to resubmit to an insurance
company). If they deny you with a BMI of 40 I would appeal on the grounds
they are going against the NIH.
— star .
November 17, 2003
I know this must be very disappointing for you. I am not sure what kind of
alternatives you have in mind. There are a lot of diets and exercise plans
out there, and you could certainly keep trying to find one that suits your
needs (it seems like, of the people I know who actually succeed with diets,
most of them went with Weight Watchers or low-carbing). However, clearly
most of us are on this site because we couldn't find a diet that helped
us.
So, if you are sure that you can't lose the weight with diet and exercise,
you may want to look at self-paying for the surgery. Have you considered
going to Mexico as a self-pay patient? I know there are a number of very
experienced Lap-band surgeons in Mexico who do good work for a cheaper
price than USA surgeons do. There is a mailing list on yahoo at
http://health.groups.yahoo.com/group/mexicanbandsters/ if you want to talk
to people who have done it that way.
It is also possible to get the RNY down there, but someone else would have
to fill in the details about that, because I don't know much about that.
Good luck findign a solution that works for you.
— K M.
November 17, 2003
Jennifer,
My surgeon does surgery on patients with your BMI all the time - they do
beautifully, because typically they don't the many co-morbidities that
those of us with the higher BMIs tend to have.
You could always side-step the insurance thing and jumping through all of
the hoops and self-pay. I had my surgery in Spain, and it was the best
decision I ever made in my life.
Let me know if I can answer any questions. You can also check out
www.bodybybaltasar.com
Blessings,
dina
— Dina McBride
November 18, 2003
I had a BMI of 37.6 when I started my journey. I had Lap surgery on April
1, 2003 and I have lost 80 pounds. I have Capital Blue Cross and did not
have a problem getting approved. I was very nerveous because of reading
the website and hearing how hard it is to get approved. Try and switch
insurance companies, find a new job or take out a loan. It is well worth
the money! Good luck!
— Deborah M.
November 18, 2003
Hi there, I have HMO BLUE in N.Y. and I was approved in two days!My BMI was
37.7 and I was told to lose weight before my surgery on Dec.5th so I did
and now my BMI is 35.3.The NIH states that you have to have BMI of 40 with
no comorbities or a BMI of 35-39 with comorbities.Look at the insurance
policy closly!!
— natalie J.
November 21, 2003
I had a friend who was also too small for the Weight loss surgery, but the
WLS progam has an alternative with medication. She is on two medications a
day and she has lost around 60 pounds in about 6 months. She looks great!
— miss_sweet_lori
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