Denied!!! :'(

Tina Marie · 01-04-2008, 02:08 PM

The doctors office called me today. Apparently I am not "overweight enough" I mean sheesh come on. I am 5'7 and 230 pounds!! They said I have no health conditions so no way. That sucks. I am soooo bummed! Do you think I should try some other doctor? I mean come on I wear a size 20 that is not overweight enough??? I am really really sad about this. Need help what do I do now?

Thanks In Advance
Tina

Lana24 · 01-04-2008, 02:13 PM

Hi Tina,
Are you experiencing pain? Backpain, hip or knee pain...on a personal note I have rib and hip pain that translates into arthritis...that was my saving grace. Maybe you just need to think it over for a while.
Good Luck

princesstracey · 01-04-2008, 02:16 PM

Im sorry you are bummed. I know it isn't the 'best' way to you, but after I was denied, I decided to go self-pay. I was able to go on a payment plan with very low interest. It is like purchasing a car.

I know, its a lot of monthly money. I actually had to get a second job. But, its my health. Its my life, and my future! Best investment of my money in my opinion! Look into it!

make33 · 01-04-2008, 02:20 PM

The general rule for Bariatric Surgery is a BMI (Body Mass Index) of 40, and I'm sorry to say you only have a BMI of 36.

Were you denied by the doctor or by your insurance company? If it was the doctor, call around in your area and see if you can locate one who will accept you. If it was your insurance company, you're going to have to consider being a self-pay.

To reach a BMI of 40, you'd have to weigh 256 # - Keep the faith and something will turn up for you...

Sunshine08 · 01-04-2008, 02:39 PM

Tina -
That seems ridiculous to me! I was approved at 5'8, 225 lbs! Is it your doctor that is denying you the surgery or your insurance?

tarheelluv · 01-04-2008, 05:58 PM

If you want to self pay, Dr. Kirshenbaum in Colorado is only $9950. I am doing well so far, down 15 pounds in a little over 3 weeks after surgery.

Sunshine08 · 01-04-2008, 06:55 PM

TarHeelLuv:
So funny that you say that - I am getting banded by Dr. Kirshenbaum on Wed 1/9 - I am SO SO Scared, anxious, nervous - and every other emotion!
I am glad to see you have been making good progress so far, its reassuring

tweenwaters · 01-04-2008, 07:12 PM

I was also denied.....similar story. I'm 5' 6" and 229lbs....BMI is 37. No other medical problems, other than back pain (which I've been seeing a chiropractor for 5 months). Unfortunately, my insurance didn't think it was medically necessary... My husband and I researched a lot...even considered flying to Mexico as many others have done. My hubby stumbled across a local clinic (TLC Edge) that was offering a low cash option for surgery and six months of fills...in the DFW area. We have decided it is worth every penny to make sure that I live a long and healthy life.....enjoying every minute together with our two kids.

GOOD LUCK....

ross07 · 01-04-2008, 07:30 PM

you have lost 65lbs in a mo. time. you can drop the lbs that fast

VegasGrace · 01-04-2008, 07:36 PM

Sure, sounds like they just don't want to do it.

Surely your back has hurt? Right?
Surely you snore and may have sleep apnea, Right?
And surely you have a family history of obesity w/ diabeties, heart conditions, etc?

Surely so!

If you are self pay...don't let NO stop you. You can have this procedure done for as little as $7,000.

Insurance? You will need to befriend a good doc who will go to bat for you.

Good luck!

gkeyt · 01-04-2008, 07:52 PM

There is a thread somewhere here on LBT (I think in Support) for Lower BMI bandsters...check with them, they might have some good suggestions for you. Good luck!

Lap_dancer · 01-04-2008, 08:30 PM

I was denied too. You know what? I just did self pay. It is like buying a car. I got a low interest loan, shopped around for surgery (which was REALLY fun in the end) and the whole experience turned out to be a positive one. I have a great surgeon, I'm six months post op and loving the band.

Tassie Tiger · 01-04-2008, 08:44 PM

Hello Tina Marie

Sorry you got denied. I have a BMI of 37 and here in Australia they do as low are 35. I am having my surgery on 18/2 and I am sorry you have to wait. Perhaps you should try a different doctor and talk about how you are suffering with back and knee pains. Here in Australia you don't need a reason.

Sorry again. May you have it done in the near future. All the best. Tassie Tiger

KYteacher · 01-04-2008, 09:15 PM

Most insurance companies will consider WLS with two other health issues with a BMI of 35 to 40. KEEP FIGHTING! I was denied the first time, but approved the second. I had a few bouts with high blood pressure...nothing serious, but I really pushed that issue. Write letters to your insurance company and have your doctor do the same. The bariatric office I went to really stood up and fought for me to have it done! I know it was a money thing for them, but hey...I got my Lap Band done! :)

Liz Bennet · 01-05-2008, 01:38 AM

I was also not eligible---59 years old, and at 5'8", 225lbs didn't have the BMI even if I wasn't "too old". Went to Dr. Ortiz in Tijuana, paid $8500, including hotel and transportation from San Diego airport. Was a very positive experience, can't imagine any better care. Look into it! Well worth it---am down 40lbs and although I did gain over the holidays, will have second fill this week & expect to get back on track.