UGH DENIED !!!

autumnM.80
on 6/7/12 10:35 am - Johnson City , NY

So I went to a consultation at my surgeons office today, They talked me out of the Lap Band and into the Roux-en-y Gastric Bypass ! After 2 hrs they then told me with a BMI of 38.9 and no co- morbidities EVERYTHING was a no go ! I am SO UPSET!!! I was under the impression that there was more than 3 co- morbidities ???

poet_kelly
on 6/7/12 10:37 am - OH

RNY on 11/04/08

Different insurance companies consider different comorbidities in determining eligibility for WLS. What does your insurance companies guidelines say?

Kelly

Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.

autumnM.80
on 6/7/12 10:41 am - Johnson City , NY

Only Hypertension , Diabetes and Sleep apnea. They are sending me for a sleep study as a last resort however i highly doubt I have Sleep Apnea. I just dont understand how i am 100 pounds overweight and the insurance denies me

poet_kelly
on 6/7/12 10:54 am - OH

RNY on 11/04/08

Most insurance companies only pay for WLS if patients have a BMI of 40 or above, unless they have comorbidities. I think it is generally believed that, if your BMI is lower, the risks of surgery outweigh the benefits.

Kelly

Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.

JUSTJUNQUIES
on 6/7/12 11:27 am - Citrus Heights, CA

RNY on 04/04/12

depression
urinary incontinebce
my daughters doc said she was over an inch shorter and she wore heavy clothes, they want to make money , I am sure they can make it happen daughter's ate themselves silly till surgery and BMI was 40..barely
are requirementd different for the sleeve?
I personally would not reccommend the band, but that is just me , and your doc of course.
Was it the doc that said no or insurance?

Donna Q. --5'8" -60 years old
Band 2005
hw320 sw276 lw with band 195 gw 160-180?
Bypass 4/4/2012
pre sw 258 lw RNY 162 cw 203

DebsGiz
on 6/7/12 8:46 pm - FL

I would not discount the sleep apnea. This was my "in" to qualify me for surgery. I did not think I had it either, so was surprised when the results showed I did.

Since losing the weight, I no longer have sleep apnea.

Keeping my fingers crossed for you!!!

Oxford Comma Hag
on 6/7/12 10:45 am

RNY on 09/12/11

I recommend going on your insurance company's website and viewing the surgery criteria for yourself. Call and talk with them if you have questions.

My surgeon is excellent. His insurance coordinator is not. She gave me bum information, and I didn't trust it. Good thing, because she was dead wrong.

autumnM.80
on 6/7/12 10:51 am - Johnson City , NY

@ Rosyfuture,
I wish that was the case but this came from the doctor. Do you think its different state to state? I really dont understand my PCP is trying his hardest with all the right documentaton.

JUSTJUNQUIES
on 6/7/12 11:30 am - Citrus Heights, CA

RNY on 04/04/12

go to another doc

Donna Q. --5'8" -60 years old
Band 2005
hw320 sw276 lw with band 195 gw 160-180?
Bypass 4/4/2012
pre sw 258 lw RNY 162 cw 203

Cicerogirl, The PhD
Version
on 6/7/12 12:58 pm - OH

RNY on 08/27/07

It is specific to your company's (or your husband's comany's) individual insurance plan. Going to another doctor will not make any difference nor would going to another state. Go straight to the insurance company or to their website and get a copy of the requirements for determining medical necessity for WLS. Then you will know for yourself (and not have to trust what anyone else says about) what your insurance requires.

Lora

14 years out; 190 pounds lost, 165 pound loss maintained

You don't drown by falling in the water. You drown by staying there.

UGH DENIED !!!

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UGH DENIED !!!