Kind of Devastated - Denied DS Surgery

Married2005
on 2/5/13 10:56 pm - NJ

My whole world has just turned upside down!  My insurer has denied me for the DS because my BMI is not above 50 (I'm about 43 BMI).

I did not anticipate this - if anything I anticipated them denying me period.  Originally my choice was the sleeve but because of knee surgery I thought the DS would be a better match for me especially because I could eat normally.  Now, I don't know what to do.  They will approve the Sleeve or Gastric Bypass.   I guess I will get the sleeve.  At least that is the first step of the DS and if I don't achieve much weight loss maybe they will approve the second part of the DS

Again, I'm devastated because over the last 3 months all I have done is research on the DS and was really hyped about the great results folks were getting.  I'm thinking my results wont be the same..................HELP!!!!!!!

Valerie G.
on 2/6/13 12:03 am - Northwest Mountains, GA

This happened to someone just recently, so I hope they will chime in.  

I know that they reviewed the policy themselves and there was no stipulation about BMI requirements for DS, so they could not dictate that the BMI wasn't high enough, and they got the denial overturned.  I know that others got their surgeon involved in an appeal to help with why the DS would be a better option (ability to take NSAIDS for your knee, for example, better Diabetes resolution results.) and got success there, too.

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

Married2005
on 2/6/13 12:59 am - NJ

I won't be able to take NSAIDS with the sleeve?  Really?

Julia HasHerLifeNow
on 2/6/13 2:04 am
VSG on 10/09/12
You can. The sleeve is the same stomach as with the DS - minus the intestinal work. So if you can take NSAIDS with the DS it is the same with the sleeve. Many docs caution against them anyway because you want to protect your smaller stomach. But yes you can take them with the sleeve.

View more of my photos at ObesityHelp.com 5ft0; highest weight 222; surgery weight 208; current weight 120

     

    

Valerie G.
on 2/6/13 5:27 am, edited 2/6/13 5:27 am - Northwest Mountains, GA

You CAN take NSAIDS with the Sleeve and DS - not with RNY.

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

docputer
on 2/6/13 1:21 am - Topeka, KS
DS on 01/17/13

Just keep fighting to get it. If you give up, the insurance company has won. It took me years to get mine done. It took changing employers to get it done. MY insurance would cover it, but my employer put restrictions on gastric bypass. Anyway, keep plugging away at them until you get the answer you need.

        
PattyL
on 2/6/13 1:28 am

Fight!  Don't give up!

Married2005
on 2/6/13 1:36 am - NJ

Well, I just read the requirements for the DS and it does clearly state that my BMI must be greater than 50.  I guess that's it.  Again, are you telling me that I wont be able to take ibuprofen with the sleeve?  That will be a problem.

(deactivated member)
on 2/6/13 1:57 am, edited 2/6/13 2:00 am

You can take NSAIDS with the sleeve. It is the RNY they do not recommend NSAIDS with. I also say fight if you have co-morbidities. 

JazzyOne9254
on 2/6/13 8:19 am, edited 2/6/13 8:20 am

I'm chiming in...and yes, you can take ibupropfen, which is an NSAID,  with the sleeve...the sleeve is the top half of the DS. 

HW 405/SW 397/CW 138/GW 160  Do the research!  Check the stats!
The DS is *THE* solution to Severe Morbid Obesity!

    

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