appeal insurance for the ds

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

If you find a good surgeon, their office should be able to help with the appeal...they deal with this all the time!

Why, specifically, were you denied?  I'm in the same boat - Sleeve to DS.  I was denied for three reasons:

1. I didn't provide a 3-month doctor-supervised diet and exercise program.
2. The code submitted indicated that DS was experimental.
3. My BMI needs to be 50 or more.

1. I've gotten the 3-month diet taken care of and have documentation.
2. My insurance company explained which codes need to be submitted instead of the experimental ones.
3. This will be the only piece that can potentially still cause denial. But I'm within 5 of having a BMI of 50 so we're going to use that approach and see what happens.

If all else fails, I will go with revision to RNY.

My final doctor appointment is this week so we'll see what happens.

Send details and we might be able to help more. Good luck!

Hi,

   I am from pa so the code they are using is a covered code but I am having the surgery in NJ so the bc/bs in jersey is saying the code is not a valid code..that my insurance will not pay for the ds... only gastric sleeve which i have , the lap band and the gastric bypass.. i am confused why one state says its a good code and the other says it not..

Now i have to put the surgery on hold all together because of blood clots in my leg.. so it will be a little bit before my revision of some kind is done..

                           susan