REJECTED being too fatThis is a discussion on REJECTED being too fat within the Insurance & Financing forums, part of the Main Lap-Band® Surgery Forums category; i was rejected by bc bs of oklahoma which has covered 25 other employees at where i work i have ... | Insurance & Financing For discussion of issues related to Insurance coverage and financing of lap-band® surgery. | 
04-21-2007, 09:09 AM
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#1 |
Join Date: Mar 2007 Age: 31
Posts: 59
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i was rejected by bc bs of oklahoma which has covered 25 other employees at where i work i have a bmi over 50 which is the reason for rejection and saying i could die on the surgery table.. they however approve gastric bypass which is more dangerous than LAP-BAND®. any advce would be MUCH appreciated on exactly what my next steps would be in getting approval what kind of documentation should i obtain.
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03/19 consultation with doctor: COMPLETE
04/05 consultation with dietician: COMPLETE
04/10 consultation with shrink: COMPLETE
--REJECTED for LAP-BAND® waiting on doctor submitting 2nd request-- 
Starting weight 04/05/07 : 492.1 lbs :cry  | 
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04-21-2007, 09:17 AM
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#2 | ~BCBS's Number 1 Stalker~
Join Date: Dec 2006 Age: 35
Posts: 147
State: Wisconsin |
omg the same thing just happened to me! they wanted me to switch to the gastric bypass! i have to lose around 20lbs to get my bmi back under 50, so i'm just pretty much starving myself! i know you can appeal with statistics in which it proves that LAP-BAND® is successful with patients over 50...there's people on here who have appealed with research and have won! maybe your bariatric clinic has info on this? keep in touch...as for me i'm STARVING lol!
~courtney
__________________ :rain: ~~Don't wanna be a FAT nurse~~ December 11, 2006-Seminar February 12, 2007-psych appointment #1 February 19, 2007-nutritionist visit #1 March 5, 2007-nutritionist visit #2 March 12, 2007-psych appt #2 April 20, 2007-denied over 12 lbs...currently starving myself -lol  | |
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04-21-2007, 09:18 AM
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#3 | ~BCBS's Number 1 Stalker~
Join Date: Dec 2006 Age: 35
Posts: 147
State: Wisconsin |
btw...i have BCBS anthem PPO
__________________ :rain: ~~Don't wanna be a FAT nurse~~ December 11, 2006-Seminar February 12, 2007-psych appointment #1 February 19, 2007-nutritionist visit #1 March 5, 2007-nutritionist visit #2 March 12, 2007-psych appt #2 April 20, 2007-denied over 12 lbs...currently starving myself -lol | |
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04-21-2007, 10:08 AM
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#4 | Registered User Thread Starter
Join Date: Mar 2007 Age: 31
Posts: 59
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i have no idea where to start for finding statistics first thing coming to mind is google'ing bmi over 50 LAP-BAND® results which im going to do right now
__________________
03/19 consultation with doctor: COMPLETE
04/05 consultation with dietician: COMPLETE
04/10 consultation with shrink: COMPLETE
--REJECTED for LAP-BAND® waiting on doctor submitting 2nd request--
Starting weight 04/05/07 : 492.1 lbs :cry | |
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04-21-2007, 10:38 AM
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#5 |
Join Date: Apr 2007 Age: 42
Posts: 1,160
City: MIDDLE OF NO WHERE/ Southern/Central Indiana State: Indiana |
When we met with our surgeon, he told us up front that if my BMI was over 50 he would not do the surgery. He noted complications were higher, and the need for them to be able to work aroundwithout going open.
I am not sure what the statistics are, but DONT GIVE UP.....YOU ARE GOING IN THE RIGHT DIRECTION......CHECK AROUND AND FIND OUT THE PRO'S AND CONS OF ALL OF THE SURGERYS......AND HOPE YOU GET YOUR INSURANCE TO APPROVE YOU.... 
SORRY YOU ARE HAVING ALL THE PROBLEMS WITH IT....
TRACI | |
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04-21-2007, 10:48 AM
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#6 | ~BCBS's Number 1 Stalker~
Join Date: Dec 2006 Age: 35
Posts: 147
State: Wisconsin |
Quote:
Originally Posted by BigThunder  i have no idea where to start for finding statistics first thing coming to mind is google'ing bmi over 50 LAP-BAND® results which im going to do right now | renebean is a member of this forum-she emailed me info for my fight-get in touch with her-she'll help! good luck!
__________________ :rain: ~~Don't wanna be a FAT nurse~~ December 11, 2006-Seminar February 12, 2007-psych appointment #1 February 19, 2007-nutritionist visit #1 March 5, 2007-nutritionist visit #2 March 12, 2007-psych appt #2 April 20, 2007-denied over 12 lbs...currently starving myself -lol | |
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04-21-2007, 10:53 AM
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#7 |
Join Date: Nov 2006 Age: 50
Posts: 934
City: West Central Gulf Coast State: Sunny Florida Banded by Dr. Gerald Kirshenbaum, a LapBandTalk Approved Surgeon |
I would ask to see a copy of my policy where is says that they cover bypass but not LAP-BAND®. Bypass is more invasive.
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04-26-2007, 04:27 PM
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#8 | ~BCBS's Number 1 Stalker~
Join Date: Dec 2006 Age: 35
Posts: 147
State: Wisconsin |
Quote:
Originally Posted by Lap_dancer I would ask to see a copy of my policy where is says that they cover bypass but not LAP-BAND®. Bypass is more invasive. | ~lap- they cover both surgeries, but in order to get approved for a LAP-BAND®, you must have a bmi between 40-49. they say that there's no data supporting a bmi over 50 would be successful with a LAP-BAND®. UGH! it's ridiculous, but written in black and white in their policy. i am currently appealing their decision as i speak...wish me luck...
__________________ :rain: ~~Don't wanna be a FAT nurse~~ December 11, 2006-Seminar February 12, 2007-psych appointment #1 February 19, 2007-nutritionist visit #1 March 5, 2007-nutritionist visit #2 March 12, 2007-psych appt #2 April 20, 2007-denied over 12 lbs...currently starving myself -lol | |
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04-26-2007, 04:40 PM
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#9 |
Join Date: Nov 2006 Age: 50
Posts: 934
City: West Central Gulf Coast State: Sunny Florida Banded by Dr. Gerald Kirshenbaum, a LapBandTalk Approved Surgeon |
Quote:
Originally Posted by chubbola ~lap-
they cover both surgeries, but in order to get approved for a LAP-BAND®, you must have a bmi between 40-49. they say that there's no data supporting a bmi over 50 would be successful with a LAP-BAND®. UGH! it's ridiculous, but written in black and white in their policy. i am currently appealing their decision as i speak...wish me luck... | I'm sorry the idiots at whatever company think it's not beneficial. If you see my ticker, you can see my BMI was 62 at the time I began. It is still over 49. I'm losing weight. Fortunately my size has been documented. I think I'm going to crash an AMA convention or some insurance convention
where they say this outloud.
I would fight it but that's just me.
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04-26-2007, 04:41 PM
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#10 |
Join Date: Nov 2006 Age: 50
Posts: 934
City: West Central Gulf Coast State: Sunny Florida Banded by Dr. Gerald Kirshenbaum, a LapBandTalk Approved Surgeon |
Quote:
Originally Posted by chubbola ~lap-
they cover both surgeries, but in order to get approved for a LAP-BAND®, you must have a bmi between 40-49. they say that there's no data supporting a bmi over 50 would be successful with a LAP-BAND®. UGH! it's ridiculous, but written in black and white in their policy. i am currently appealing their decision as i speak...wish me luck... | I'm sorry the idiots at whatever company think it's not beneficial. If you see my ticker, you can see my BMI was 62 at the time I began. It is still over 49. I'm losing weight. Fortunately my size has been documented. I think I'm going to crash an AMA convention or some insurance convention
where they say this outloud.
I would fight it but that's just me.
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04-26-2007, 06:45 PM
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#11 |
Join Date: Jul 2006 Age: 47
Posts: 237
State: TX |
Just happen to pop in here and read this. I'm sorry for those of you who have been refused due to your BMI being too high. On our previous insurance, they did not cover LAP-BAND® for anyone, but would cover bypass in certain situations. Well, that was not an option for me and I probably wouldn't have been covered anyway. So, as you can see I went to Mexico. The gal who assists my doctor with patients (she was my contact and drove us there from San Antonio) was an over 50 BMI and chose Dr. Rod as she knew he had experience with these patients (as I'm sure many others do as well). So, if you don't get anywhere with your insurance (do all you can), you may want to consider Mexico or self pay in the states. There are many competent docs in Mexico and in the states. Some in the states are now lowering their prices (I would just be sure they are very experienced LAP-BAND® doctors). Mexico is still less expensive if you are open to that....($7,000-12,000).
I wish you the best in the journey of weightloss whatever you decide to do. I am very thankful that I did go ahead and get the LAP-BAND®. Each one's decision is just that...individual. (LAP-BAND® vs. bypass.....US vs. Mexico).
__________________ Mary (TX) Banded July 28, 2006 Dr. Jose Rodriguez, Acuna, Mexico
 72.25 inches gone from neck to feet!! Still going!!
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04-27-2007, 04:20 AM
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#12 |
Join Date: Jan 2007 Age: 60
Posts: 14
City: Albuquerque State: New Mexico |
My BCBS of New Mexico flat out refuses to cover banding, but would cover the (more dangerous, more complications) bypass. Go figure! I paid for myself at AIGB - Dr. Benavides in DFW 11/29/06. Best money I ever spent. The folks @ AIGB were surprised NM BCBS wasn't paying for the banding yet - they said it would probably happen "one of these days" - but I didn't want to wait.
Good luck!
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Dreaming in the desert...
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04-27-2007, 09:51 AM
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#13 |
Join Date: Apr 2007 Age: 56
Posts: 664
State: TEXAS |
Bless your heart...I know that must be so disappointing and frustrating...I hope that there will be a way for you to have the LAP-BAND® done..I wish that everyone that needs it, could have it done...These insurance companies really confuse me...I don't get it....mine denied my claim, so I am a self pay....good luck....I wish you all the best...
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