tasherie

Well it is a covered procedure, and even in their update it is proposed as a stand alone procedure but they still carry the stipulation that you have to have a BMI of 50 or higher whether its the single procedure or a two part staged procedure (VSG..then DS), which is kind of outdated since the last update on the matter was in 2008! SMH I will make sure to keep everyone updated, cuz I am sure someone else will have to go through the same thing.

:banghead: Spent ALL day writing my appeal letter. They denied me because my BMI is not 50+. Carefirst...sooo behind the times. I kind of knew I would be denied at first anyways so I was really prepared with my guns already cocked :aureola: ..so hopefullyy with all the information I just threw in their face I will be getting my approval soon. LOL :Banane56:

Hi I am still in the process also. (Just finished my six month appointments today..yay!)..your appointments dont have to be exactly 30 days apart as long as you have a weigh in once per month at least 2 weeks apart (what my insurance company told me..I have carefirst bcbs of maryland) so if you time it right you could finish in the beginning of July..and depending on approval time and how fast your insurance company works could have surgery that same month.

Thank you so much! :biggrin:

:bigear: I know that I am going to have to appeal so I would LOVE LOVE LOVE to hear how you approached your appeal and finally got approved :blush5:

Hey I am kinda in the same position you are. My bmi is 41, my insurance covers the procedure but requires a bmi of 50 for the sleeve. I think they will deny me at first but with all the research I have done and have on hand I am prepared for the appeal. ASMBS updated their position paper on the subject and I have l a lot of studies that were done on patients of a similar bmi to mine. I am armed and I am not going down without a fight, I hope you won't either.

I am 5'6" and weigh 252 currently, my BMI is 41. At this point I am 2 1/2 weeks from completing my final appointment for the insurance hoops of fire. At first I was going to get the bypass, but with research the RNY scared me more and the VSG scared me less, it actually brought me to my 'calm' or 'peaceful decision' lol I have yet to be approved, but I plan to fight. My insurance policy covers the sleeve but the wording states that its for patients with a BMI of 50 or over as part of a two step process blah blah blah :banghead: . Hopefully with the updated position paper from ASMBS (10/28/11) I can gain approval. I just told my surgeons office about the switch..and asked if they needed me to do anything different and they said no. I was never told to lose any weight...so idk.. :blush5: btw..why are there so many banana's doing it in the smilies?? lol

Thank you so much! Heres to praying that the process isn't long and drawn out, but I am prepared to fight. Mostly, because I do not want to have a surgery that I am not completely comfortable with just because some insurance company thinks I should.

I really want the sleeve. I was originally researching the RNY, but with all the research and information decided to go with the sleeve for a lot of reasons. Now to my question, I have heard that Carefirst only does the sleeve for a 50 or over BMI? I am coming to the end of all of my insurance hurdles and I am really getting nervous that I will be denied because of a low bmi (for sleeve). Does anybody have any experience with Carefirst?