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Denied for sleeve trying for lap band, has anyone had any success in similar situation?

by Maggie
(Washington, DC, USA)

I found out last week that I was denied for the gastric surgery, not just the gastric sleeve. I went to Sibley Hospital in DC and paid $600 for their program. They told me they would do everything and submit for the sleeve operation, but I have found out that I had to constantly call (I hounded them for at least a month) to get them to submit to BCBS.

I am 100 lbs overweight, have a BMI of 38.5, have high cholesterol - especially the Trigs, and problems with my ankles. I do not have co-morbidities yet. I am disappointed and frustrated.

Has anybody else been denied by Fed BCBS DC (Washington DC area) and been able to get approved for the lap band instead?

Also has anyone else experienced the delay with Sibley Hospital?

Is there a better facility in the Maryland, DC, Virginia area to have the surgery done with? I am also considering paying out of pocket.

Any recommendations would be great.

Thanks,
Maggie

P.S. I was done with all my program work in September and they did not even try to book the operation until till mid October. I had to call each week to get this done. I then called up Fed BCBS in Washington DC to find out if they had even submitted the request for the sleeve. I also found out that they did not submit the required psych evaluation when BCBS denied me. I asked Sibley to resubmit for the lap-band, but I am guessing that when I call them on Monday that they have not done anything.

Comments for
Denied for sleeve trying for lap band, has anyone had any success in similar situation?

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Some thoughts...
by: Jeff

Hi Maggie,

Insurance companies can be tough to work with, especially if your situation falls in their "gray area." Since your BMI is less than 40 and you have no existing co-morbidities, unfortunately I don't think that you will be approved.

Regarding your options...

First, there is legislation in the works that may reduce the required BMI levels down the road. This body mass index page remains updated with the latest requirements and info.

In the mean time, there are several self-pay/cost-reducing options at your disposal, including:

1. Payment Plan Through Your Bariatric Surgeon
2. Friends & Family
3. Secured Medical Loans
4. Retirement Plan Loans
5. Permanent Life Insurance Loans
6. Brokers, Direct Lenders and Credit Cards (Unsecured Medical Loans)
7. Medical travel (traveling abroad for surgery)

See this weight loss surgery financing page for all of the details.

Whichever route you take, be sure to choose the procedure that is right for your lifestyle and body rather than just focusing on the procedure that is right for your pocketbook. The following page is a good place to start for the pros, cons, risks and average outcomes of each procedure: Compare the various types of bariatric surgery here.

I hope that helps, and please come back to this page and click "click here to add your own comments" to keep us posted.

Take care,

Jeff

P.S. In regards to other surgeons in the DC area, take a look at the Bariatric Surgery Directory.

Thanks for your comments
by: Maggie

Thank you for your comments. I am going to gain a little weight, since the only thing really preventing me from getting the surgery is the low BMI. I am also going to resubmit for probably the bypass or the band. Seems to be a problem to qualify for the sleeve (50 + BMI) -Maggie

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