HELP APPEALING THE INSURANCE TO HAVE MY DS

maxie1
on 12/28/12 8:26 am - PA
RNY on 06/10/13

Hi, can anyone out there help me appeal my insurance.  i had the gastric sleeve in june of 2011 insurance will not cover me to have a ds... they will only cover me to have the gastric bypass.. can anyone tell me on how to appeal this thanks

                  susan

susan                                                                                                
Hislady
on 12/28/12 9:41 am - Vancouver, WA

Try posting this on the DS  forum too there are some very sharp, insurance savvy people over there. The only basis I know of is if you have to take NSAIDS  for anything you can sometimes appeal on that basis. Seems a DS would be more logical than bypass anyway since you have the first part of it already with the sleeve. Good luck to you hope the DSers can help you out!!

 

maxie1
on 12/28/12 9:43 am - PA
RNY on 06/10/13

thank you

susan                                                                                                
pineview01
on 12/28/12 12:27 pm - Davison, MI

Hep, what HL said.  They have some letters and such to look at too.  Check our DSfacts.com too

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

maxie1
on 12/28/12 12:50 pm - PA
RNY on 06/10/13

thank you

susan                                                                                                
maxie1
on 12/28/12 12:50 pm - PA
RNY on 06/10/13

what did you do to fight your insurance for your ds?

susan                                                                                                
Hislady
on 12/29/12 8:25 am - Vancouver, WA

Neither of us has had the DS we just read alot!!! kiss

pineview01
on 12/29/12 9:31 am, edited 12/29/12 9:32 am - Davison, MI

kiss What HL said!

I did revise from a band to sleeve with a once in a lifetime WLS policy.  With that it was a mater of proving that I had medical issue and they would have OK'ed a new band if it was broken or repair a RNY if it had something go wrong.

If you are trying to get a procedure they don't cover it would be different.  I have seen appeal letters on DSfact.com.

Remember, someone has to be first.  Last year ours didn't cover the sleeve until a man appealed it. 

HL and I are research nuts (or is it just nuts)

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

Snow Daisy
on 12/30/12 9:04 am - nnn, OK
Just curious but wouldn't the insurance company be tempted to change their policy based on the fact that as half of the work is already done when revising a sleeve to DS it would be cheaper?

X
pineview01
on 12/30/12 12:23 pm - Davison, MI

You would think wouldn't you?

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

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