I hope insurance doesnt "make" me get an RNY

Im submitting to insurance next week for DS approval. Ive talked to them and they cover RNY easily, but the DS has to be medically nessary. Whatever that means!!! I hope they dont deny me and im forced into an RNY. I dont have time to appeal decisions, im loosing my insurance next year.

 Don't do it!  If it comes to that, I'd say get a sleeve instead.

How long would an appeal really take?  Greenbaum's office should be able to help if you need it.

If they deny me, ill go for 1 appeal but after that im out of time (insurance wise).

I don't know your insurance policy, but when it comes to a bariatric surgery being medically necessary, generally your BMI has to be 40 or above, or 35-40 if you have comorbidities.  It SHOULD be that simple.  Generally when it comes to insurance policies, the carrier doesn't really care what procedure you get as long as you fit certain criteria.  Again, this is generally speaking and not universally applicable.

If they deny you, arm yourself with facts and information to appeal the decision showing why the DS is medically necessary in your case.  Your insurance company can't make you get an RNY.  Only you can make yourself get an RNY and I think you know better.

Good luck!

I DO NOT want an RNY!!!!!!! Maybe they will sleeve me but even with that, i have too much weight too loose!!!!

At least with a sleeve you'll be halfway to a DS.  Don't get too far ahead of yourself about worrying over this.  Do you have a copy of, or a link to, your policy?  Who is your insurance company?

Horizon NJ health, its state coverage, kinda like medicaid, but not exactly.

I understand you want the DS and I hope you are able to get it but please do not rule out the sleeve.
I easily lost 135 lbs with the sleeve in 10 mos and have easily maintained that loss for about 15 mos without having to do low calorie or low fat.
My BMI was over 51 when I started (I am really short).

Sleeve is a better alternative to RNY but may not be enough for a lot of people.  For example, I was a lightweight when I had surgery (my BMI was 40 day of surgery) and even with a tiny 2oz sleeve and DS reconfiguration I'm still 25 lbs from goal at 1.5 years out.

If your problem is largely metabolic, you need to think long and hard about a restriction only surgery.

If your problem is eating too much and eating the wrong things and you're a pro at dieting, then the VSG may be enough.

If the issue is metabolic and she cannot get a DS there really are few options open to her and in that case the sleeve may still be a better option overall than RNY,
For me I was NOT a pro at dieting, if I were I would not have had to have WLS and with the sleeve I have been very successful without dieting. I agree that if you metabolism is "broke" a restrictive only surgery may not be your best option but in some cases it may be the only option if self pay for DS is not a viable altenative.