Absolutely Disgusted!!!!!!

I have attended several bariatric seminars but honestly haven't thought of checking with them about the PCP's. Another thing to add to my list!  Thank you!!

I would either go and try to get the VSG or RNY considering your conditions and resubmit to insurance. I had the VSG (highest weight was 212) and I'm 5'1 and I got approved the first try. I probably wouldn't have gotten approved with the lap-band in my opinion. Have you been working with a bariatric office?

go and appeal it.  The first time I had to go all the to the state level.   Document every thing.

Chris, i am ready to do that!!  I also called an obesity advocating lawyer...hopefully it works out in my favor!

What state do you live in? There are 6 states that are mandate states. Meaning the state requires insurance to cover if certain criteria is met. I cant remember the six states but just google it. That is how I found it and luckily Ilive in a mandate state and was given a preauthorization no questions asked!

Thank you! I will do that. I live in Indiana and yes, my insurance covers weightloss surgery.

I agree with calling your insurance company and getting a copy of their policy. Mine emailed me the link, so I could see exactly what it was. I've never heard of it having to be 'life threatening' in that verbiage. My doctor had said the only problems they really consider are: Diabetes, Sleep Apnea, and Hypertension. Plus your BMI is over 40, which usually doesn't require any co-morbidities. You don't really say if you are working with a surgeon's office, they are the ones that usually deal with the insurance companies, not your PCP. Oh and yes, consider something besides the band. Good Luck!

Doctors typically have to indicate that your conditions are severe and will become better with weightloss. Most insurance companies list their medical policies online. I would find the policy they are going by and if you meet it, then I would appeal the denial. Make sure your doctor did not forget to send something. If you have not already, I would call and ask specifically what caused the denial.

I honestly am looking at this from a different angle.  It is completely possible that this surgeon no longer wants to do lap band surgery because he/she knows the failure and complication rates and most surgeons now are refusing to do it. But..this surgeon maybe doesn't want to SAY it because he/she has done them in the past and now that the info is getting out about the reality of the band, would have to address the issue with them.

Did the insurance company tell you themselves that you were denied or did it come from your surgeons office?

I am a skeptical personality anyway so this is why my brain goes there but still, I do not see this as being far fetched.