Restart on 6mo diet, and bad news from the Surgeon

I had my first surgeon's appointment the other day and I found out I have to have a BMI of 50 or higher to be covered for a sleeve.  Right now i have a BMI of 47 and with the 6 month diet I'm sure it will be less in a few months.  I am covered for RNY, but I really don't like the idea of having so much rerouting of my insides.  I don't know what I'm going to do, except keep on doing the diet and see what happens.  My doctor says that he will appeal to have the sleeve after I have all the tests, but he doesn't know if they will approve it or not.  I'm at such a loss because I really want to be healthy and I am ready to have surgery as a tool to get there... but I believe the sleeve is a safer surgery and I'm not sure if I can go through with RNY :(

I posted the above comment in May when I started on my diet. I started to lose some weight so my crazy brain thought "Oh okay, I can do this on own"  Well I lost 12 lbs and have since gained about 17lbs back.  Ugh, definitely made me realize how much I need the extra tool of this surgery to lose and keep the weight off.

Well I went back to the surgeons again and asked about the sleeve, my BMI is now up to 48.  Then he told me that he has wasted a lot of time, energy, and resources trying to appeal to the insurance companies and at this point he doesn't think it's worth it to try for my sleeve becauce the RNY should work for me. I still don't feel comfortable with that surgery so now I am looking for a new surgeon, one that will at least try to get the sleeve approved for me.   

Just needed to share. Has anyone else been told by a surgeon that appeal is a waste of time?

 You must look for a new surgeon!!  You really want someone who is on your side 100% and will help you fight until you get what you want.  I would suggest writing your own letter to the insurance company and having that sent in with the appeal.  Search on this site for Appeal Letters and you will find some templates for some great ones!  But first and foremost, find that new surgeon.  
I wish you the best of luck!!  Hopefully soon you will be a sleever!

first, why did he consider it a waste of time? is it because you gained weight or something else? because the doctor should understand weight fluctuations in a bariatric patient. its the whole reason you are a bariatric patient! get a new surgeon if he is making you feel bad. 

listen, YOU have to be the one who is comfortable with what surgery you have, not your doctor. at the end of the day its YOUR body. he doesnt have to deal with malabsorption and re-routed intestines, you do.

so ill say what everyone else is thinking..if a bmi of 50 is only a few pounds away..gain the weight.  if you really feel like VSG  is what you need, another 10lbs is minimal. the 6 month supervised diet is great to learn how healthy eating is, smaller portions, yada yada but you technically dont have to lose any weight on it. just have to participate by going in and weighing etc.

Find a new surgeon. Someone on here wore ankle weights under her pants to weigh when she was only a couple of points lower than thee BMI needed.  50 is pretty high for the sleeve.  You should maybe call the insurance yourself.  For a lot of surgeons the sleeve is simply outside of their comfort zone and they put patients off so they will have surgeries they are more comfortable with.  Whatever the case you need a new surgeon. Good Luck

Trust, but verify is something I say a lot.  Call your insurance and verify the requirements. You will have a better understanding at that point and your next steps clearer.

Good luck.  let us know what the insurance company tells you.

You know, if you gain weight and your BMI ends up over 50, that is one thing.  It happens.

BUT do not wear ankle weights under your clothes!  That is insurance fraud, and it is illegal and could get you in lots of trouble!

Even if you did gain weight and meet the requirement, I would still switch surgeons because this one has already told you he's not willing to go to bat for you with the insurance company.  And who knows in the future what you'll need, whether it be approval for a longer hospital stay, or extra labs, or whatever that the insurance company may not think is necessary.

I looked elsewhere for the exact same reason - the 1st place I went basically said no you have to get the RNY - so where I am now they are at least willing to try to submit and think that my ins co will approve - I am in that 48 range as well and debate the weight gain

To be honest there were other reasons I moved too but this was one of them

Thank you all for the support and suggestions!  I have considered just gaining the weight needed, but I also think that no matter what the surgeon I choose should stand up for me and what I'm comfortable with! 

I have two other hospitals in Baltimore I'm going to try and if those don't work i'll try up near my home in York, PA.  I will keep looking until I find a surgeon i'm comfortable with. 

I will also contact my insurance company.  I have Carefirst BlueCross Blue Shield of Maryland, if anyone else has gone for this surgery with this insurance, please let me know your experience!

I'll keep you all updated :)

 As I am reading all of the posts, I must say I totally agree YOU NEED TO LOOK FOR  A NEW SURGEON!  It appears that maybe he hasn't been trained in the Gastric Sleeve procedure! From what I understand it takes additional training beyond the lapband and RNY training.  I ask my surgeon to give me a name of someone she had done the VSG surgery on so I could talk to them before I made my final decision.  She did.  
Call your insurance company and find out exactly why they aren't approving the surgery.  I had to call my insurance company for my surgery as they were not getting all the right papers they needed from my doctor's office.  I have Federal Blue Cross and Blue Shield and after I checked with them and found out what they needed, I let my doctor's office know and I was able to answer some of the questions for the insurance company and after a month of this, I was approved. My BMI was 40.5 so I am really curious if this doctor is telling you the truth about what the insurance is saying.  

As I have said before on this forum, the VSG will be the premiere surgery within the next 5 years and that is not just my thoughts, that is what the insurance people told me when I was checking on my paperwork!  Less costly for the insurance company, less side effects for the patients. 

Best Wishes and keep us informed, Keep the faith, you will get the surgery, just don't give up, 
Granny

 Waste of time? You need a new surgeon asap! At this point I wouldn't even want him to operate on me cause he's not willing to put in the work needed to get approval from insurance companies.