Anyone been denied because your BMI was too high???

Our insurance (Anthem BC/BS) denied my husband because his BMI is 60. The policy states they only approve LAP-BAND® for patients with a BMI of 50 or less! Ludicrous!

I was wondering if this has happened to anyone else? If so, did you appeal? What was the result? The LAP-BAND® company is taking up his appeal and we're wondering what the chances are of the appeal being approved.

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<p>My sister had a BMI of 51 and was told by her surgeon that she had to lose enough weight to get down to a BMI of 50 to be covered by insur. Good luck!</p> She lost the weight and got the surgery so we didn't have to appeal.

Thread Starter

If his BMI was 51-53 or so, the surgeon would have told him the same thing, but he'd have to lose 100lbs to get to a BMI of 50...that would take a LONG time as he's a slow loser as it is.

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I was denied because my BMI is 61. I am currently appealing that decision. (Empire BC/BS).

This is just a thought...perhaps they deny because the band has a slower INITIAL weight loss amount than other weight loss surgeries? They all equal out after 2 years (I think it's 2, but they do eventually equal out.) Again, just a thought, but who knows what these companies' ratioanale about anything!

Good luck in your appeal process,
Karen

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Karen
banded 12/10/04
Drs. Ortiz/Martinez
revised to RNY 6/18/07
Dr.Shawn Garber