BCBS Options insurance - DS approval for those @ 40BMI?

Has anyone here ever been approved by BCBS of NC when their BMI was under 50?  I'm right at 40 and have no co-morbidities (unless you can count family history of strokes and diabetes).  I've been through their online policies, and it seems like they cover all WLS so long as you've got a BMI of >40.. except for DS.  To be approved for the DS, you need to be >50.  Why in the world would they make a distinction like that?  I've spent every free moment for the last week researching DS and feeling more and more hopeful, and now that I've found that, I'm in tears.

Hi littlekites,

You will find that practically everyone on the NC forum has a lap band or the RNY.  i am with you, I want the DS.

One other NC'er, Angela, and I are above 50 BMI and trying to get the DS with BCBSNC.  I'm not sure it's realistic to think they will approve you  for a DS at a BMI of 40, but keep reading the DS board to get info about the appeals, the process, and the possibility of self pay surgery.  Sometimes when your insurance turns you down you can appeal to your company's HR dept.  

I think you're right, I think the DS provides a much better lifestyle than the RNY.  I repeat, don't give up yet.  Where there's a will, there's a way...

Nancy S.

I emailed a bariatrics center in Charlotte that does the DS today to ask about self-pay options, but it's not going to be something I'll be able to do for years; I don't make nearly enough money to make payments on something like that.  If it takes me that long to save the money, heck, maybe by then the insurance will have smartened up and made the requirements more reasonable.  Then I'll have $$$ to buy myself a nice treat.  (wishful thinking I guess!)

Hi Little Kites,

Try posting this to the insurance, DS and main forums where you are likely to cast wider net and possibly get more input.

Wishing you all the best,

Barb

I will, thank you!

I have BCBS of NC also and am looking to get the sleeve. Right now, policy strictly says it does not cover the sleeve but rumor has it, they reviewed their policy this summer and so the online version is not  completely correct. Supposedly they are doing away with the lapband BMI requirements and going to start approving the sleeve beginning in January 09.( If that is the case, with your low BMI, the VSG (first half of the DS) might be all that you need. I would call and talk to a rep and get whatever information you receive in writing. Maybe even an email to them. I have a BMI >50 so they do cover that (biliopancreatic diversion with duodenal switch) on a case by case basis. Even if policies don't change, you could have a good argument for appeals that you don't need the malabsorption portion with your low BMI. There are BCBS folks that have won their appeals with DS and VSG. And if it is a federal policy, they are covering VSG as of January 08. Good Luck to you. Let me know if you find out anything good!

I have a copy of that revised policy for January '09 -or the revisions to it, at least -  I had to get it from a coworker having lap-band, I couldn't get it from the insurance co. itself, they said it wasn't available.  Co-worker told me she was told the same thing, and after she had a fit, it turned up on the website under an "updates" section.  If I can find it online and figure out how to message you, I'll send you the link.  I don't see anything about the VSG on here, but I don't know half of what they're talking about, so I might be missing it.  When I talked to a rep, I definitely got the feeling they had no idea what they were talking about; one girl I called told me I'm only allowed to see my surgeon 4 times, which seems very, very bizarre to me. 

I emailed a bariatric center in Charlotte with some questions about self-pay, so I'm going to see how doable that is as well.  That, and find out how willing they are to help people regarding insurance woes; they have very good reviews, so maybe I can get some assistance from them as well.  I wish they were closer to me, though, trying to do this long distance is a pain in the butt.

Thanks, I got the link. Didn't see anything on VSG or DS though in the revisions. Will still keep my fingers crossed!

You're welcome.  Keep checking the update section.  It seems like they're adding things regularly.  Maybe if we're reaaally lucky, they'll add/change something in our favor in another update.

Unfortunately, I had to delete this post due to privacy concerns.