Good bye group

[420gal 1]

I just found out that my insurance company won't cover the sleeve unless my BMI is over 50 (my BMI is 44). Since self pay is not an option for me (history of bad credit so no one would loan me money), my only choices for surgery are the band or RNY. Gastric bypass is not for me so my only real option is the band. I'm just sick over this news and I've been crying off and on all day. I really don't want the band but at this point I see it as "better than nothing." I'm scared of complications and a possible revision in the future, but what can I do? My hands are tied at this point.

I just wanted to take a quick opportunity to thank everyone who replied to the few posts I made in my short time on this forum. Thanks for being open-minded and supportive.

Best of luck to all of you!

[Brian66 85]

Don't give up. Things may change with your insurance company. My sense is that more and more companies are going to start covering the sleeve. For the time being, just concentrate on doing the best you can to keep your weight under control. If it is meant to be, it will happen.

Best to you,

Brian

[MINI-Me 196]

How far have you taken this with your insurance company? Have you done an appeal? If GB not an option due to medical issues? If so, you may have lots of room for an appeal.

If they cover GB, do they cover 2-stage DS? If so, maybe you can go that route & just choose not to have part 2 of the surgery at a later day. (Or, you have that option if you don't make it to goal???)

If you haven't appealed, your case is not finished. I'm sure several people who have won appeals can jump in and provide advice.

[Neoteric Verve 65]

Don't give up!!! There has undeniable an option for you out there. If you really want this it will happen. If I were anywhere near you we'd have to brainstorm and figure out something. One thing you can try (if you haven't) is this:

1) Have your doctor take your height with your shoes OFF. Shorter height + same weight = higher BMI.

My doctor did this to me and my BMI went from 54 to 60 (and that freaked me out).

2) Guerrilla tactics. Ankle weights (c'mon I've seen worse), heavy clothing at weigh-ins.

3) Have yourself weighed during your monthly. As you perhaps retain more Water you'd essentially weigh more. Remember, height taken barefoot.

[Sleevie WonderLand 41]

I'm so sorry to hear this! Isnt there an appeals process? Do you have any co-morbidities? Isnt there something your surgeon/hospital can send to the insurance co to show that you need this surgery to save your life? I cant imagine what you're going through. Some of these insurance companies are really unfair to it's customers. I'm with Brian; dont give up. Maybe you can switch insurance companies? I'm not sure if you're insured through your employer, but open enrollment season is usually in November; if your employer is offering different plans research all of them to see who covers WLS and what the stipulations are and then make the switch if possible.

[boots1 0]

Sorry for your disappointment. I was originally wanting a band until I went to a lapband seminar. I had never even heard of the sleeve before then. There are alot of people who have had great success with the lapband. There are successes and failures with every form of WLS or diets or work out plans. You will just have to make your mind up to make the lap band a success for you. It will be a tool.

Sometimes we have to deal with the hand we are given. You are fortunate that your insurance will pay for a lapband, Mine wouldn't pay for anything because I have nothing wrong with me except being over weight. So don't stress just be thankful that you are able to receive some help, not exactly in the form you were wanting, but help just the same.

Good luck to you and God Bless!

[KellyL 173]

I'm sorry about this, I know it's frustrating! I have never heard of the bmi over 50 for approval of the sleeve. That's strange. If you could show in your medical records why rny or band wouldn't work (like the need for NSAID's) then you may be able to get it approved or appeal it. Good luck!!

[JackieOMonroe 123]

There is so much good advice in this thread already, so I have nothing to add to that. If it does come down to lap band surgery, try not to be too disheartened. Many people have had a great deal of success with the band, most notably in my life would be my mother-in-law and sister-in-law. Things will work out for you, even if the path you take to get there is changing.

[fatticus ratticus 0]

Don't give up!!! There has undeniable an option for you out there. If you really want this it will happen. If I were anywhere near you we'd have to brainstorm and figure out something. One thing you can try (if you haven't) is this:

1) Have your doctor take your height with your shoes OFF. Shorter height + same weight = higher BMI.

My doctor did this to me and my BMI went from 54 to 60 (and that freaked me out).

2) Guerrilla tactics. Ankle weights (c'mon I've seen worse), heavy clothing at weigh-ins.

3) Have yourself weighed during your monthly. As you perhaps retain more Water you'd essentially weigh more. Remember, height taken barefoot.

LOLOL!!! I LIKE those tactics!! ~~ gol ~~

[Wheetsin 714]

420 gal - have you talked to your surgeon and/or hospital of choice about a payment plan? Hospitals often set up payment plans without running credit checks (at least they do here, though they might not for such a large amount.... though I've heard of stranger things).

Would it be possible for you to place the amount on a credit card you already have, and make payments? People often find that the money they aren't spedning on foods (and eventually meds, as cholesterol/BP/etc. improves) can easily offset the monthly payment and then some. (Please note I don't mean to advocate going in to debt, but I do advocate doing what it takes to get the surgery you feel you need to improve your quality of life).

Occasionally people will chime up on messageboards and "donate" a surgery. I've only seen this happen about 2x in all the time I've spent on WLS boards, and there has always been some question as to the validity, but just maybe if you keep your eyes open...

Do you have any unnecessary assets you can liquidate? Any family or close friends you can borrow money from? Have you applied for Care Credit or whatever it's called? (I'm not sure how reliant it is on credit history). Have you tried taking any quick lmeasures to improve your credit? There are things that can be done short term to give your credit a boost.

People have done some pretty desperate things to make surgery happen for them. I"ve heard some stories that are mind blowing. You sometimes have to get really creative, but usually it's true that where there's a will, there's a way.

[Just-A-Gem 86]

Dr. Almanza is doing in-house financing for me with credit that includes a recent bankruptcy when medical lenders declined me.

[420gal 1]

I'm sorry my previous post sounded so dramatic and depressing. I was really feeling sorry for myself immediately after getting the news that my insurance wouldn't cover the sleeve. Now that I've had some time to think about, I've decided that it's not so bad. I'm going to play the hand I've been dealt, so to speak. I will, however, be speaking to my doctor about a possible appeal first.

Thank you for the advice, words of encouragement and support.

[Heatherr 149]

If they cover GB, do they cover 2-stage DS? If so, maybe you can go that route & just choose not to have part 2 of the surgery at a later day.

^^^^ooooo, good idea

[Tiffykins 673]

Whatever you decide, PLEASE make sure your insurance company does NOT have a 1 weight loss surgery procedure per LIFETIME, or policy period exclusion. With the recent study out in 2010 showing 1 in 3 band patients need another surgery and it's typically a revision, you'll be stuck with a band.

I have appeal letters, and there are SOOOOOOOOOOO many people on obesityhelp.com that had the same rule with their insurance, they appealed it and WON for the sleeve.

I had the band because VSG was not available when I had to choose. So, believe me, I do understand in choosing the band, BUT VSG was NOT even offered in my area, along with government ran insurance through the military, I had to tackle 2 hurdles to get VSG.

I say do NOT give up, do not settle for the complications that come with the band lifestyle.

[Downsize Diva 1]

Tiffykins is 100% correct. My insurance (Aetna) didn't offer the sleeve in Oct 2009 so at the time my only other option was the band. My port flipped and my band slipped and I now have a hiatal Hernia. Now Aetna allows the sleeve. So I've been approved for the revision but would have been a whole lot happier and healthier if I was given the option to do it right the 1st time with the sleeve. Hang in there and good luck to you.