Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Reasons to be denied surgery?



Recommended Posts

I have my consult with a surgeon next week and was just curious if anyone had experienced being denied for outrageous or really unexpected reasons?

To give you a quick background on myself, I am a 24 year old female who has struggled with my weight since I was 10 years old. I do not smoke and recently had bloodwork done confirming I have elevated cholesterol levels (not to the point of being considered a risk). I have a BMI of 47 and currently sit at 310 lbs on a 5"8 frame. I do not have diabetes or heart-related issues. In essence I meet all the criteria. I have the finances for the surgery already covered and looked after (so I know that is one thing they wont say no about)

From my own research, I can see no reason to be denied, but I have this awful fear that the surgeon will tell me no. Has anyone, who is similar in health condition and meets the criteria for surgery been denied? If so, please let me know. I dont think I could take hearing no from the surgeon when I know this is the path I must follow.

Share this post


Link to post
Share on other sites

There are reasons to be "denied" that relate to insurance, and then reasons to be denied that are medical. I'll share with you a saying my granny used to say "Don't borrow trouble". Which means, don't worry about it unless you need to.

No, most people do NOT get denied for "outrageous" reasons. If you meet your insurance criterion and do not have a disease you didn't disclose, why would you be denied? No surgeon will deny you "on a whim".

Share this post


Link to post
Share on other sites

I think the general rule of thumb for the lapband procedure is that if you have a BMI less than 40 (but higher than 35) you need to have at least one accompaning weight related health issue (as per the official lapband website: http://www.lapband.com/get_informed/about_lapband/right_for_me/). As I havent had my consultation yet and my own cholesterol has not reached the high risk category, I honestly cant give you an answer on whether cholesterol counts as such. I will keep it in mind for when I have my consultation though and will post my surgeon's answer here. It would be silly not to consider high colesterol as a comorbidity of obesity, but I am not the professional in this field :tongue_smilie:

Edited by Juwel

Share this post


Link to post
Share on other sites

Is high cholesterol a reason to be given an exception to the 40 BMI rule?

That would depend totally on what your insurance requires.

Many policies differ about what they require before they'll pay for the lap band procedure.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×