Notice of Adverse Determination

Hi everyone, I hope this e-mail finds all of you "Losers" doing well and the ones in waiting..know each day is one day closer to a "new beginning". I have received my letter from my insurance regarding my denial. Thought I would share this with you. A GHI Clinical Peer Reviewed the information provided and has not authorized the services for the following reasons: "The Lapband procedure requested is not authorized. There is insufficient evidence in the published scientific peer-reviewed literature to support the use of this bariatric procedure in the treatment of clinically severe/morbid obesity. It has not been proven to achieve equivalent or improved patient outcomes relative to other available alternatives". Can you believe this??? Now we all know that there is proof...so I am going to appeal this letter, funny how they also do not mention the 6 month supervised diet that they say is needed. So, for the next few days I will be gathering any and whatever information I can about the band and statistics. I am not giving up all hope, although so devastated about it, but where there's a will there HAS to be a way, someway...I want to be a bandster, like all of you. I truly believe, it is all the support, love, encouragement and friendships that I have found along this path, that have helped strengthen me in this time where i would just feel like giving up. Love you all, Laryssa

Arg. Stupid insurance companies. I'd recommend contacting someone like Walter Lindstrom (www.obesitylaw.com) to help put together your appeal. He's had tremendous success with these types of denials... Nancy 394/299/180

Thank you so much, Nancy, I just contacted Walter Lindstrom, so I am hoping that starts it for me. You have done a wonderful job! Thank you for the information. Laryssa

Laryssa---I just emailed Dana this info Yesterday I read on the bandsters board that if you do not have a exculsion in your policy for wls legally they have to approve any procedure you choose. This girl called Walter Lindstrom and he appealed for her and he won. I don't know if her insurance was ghi Good Luck Donna

Oh Laryssa I am so sorry. What kind of Insurance do you have. I have to do the 3-6 month diet also. I agree you should contact Walter Lindstrom and let him help you. Good Luck and keep us posted.

HI Kathy, Thank you so much for "feeling" my pain. I just read your profile and see you also were denied. So sorry and it's just so sad, especially when they do it for "lack of scientific reasons", maybe then the insurance carriers should do the research we all did. I will keep you in my thoughts too, that you too, will soon be approved. Thanks again, Laryssa

Thank you Laryssa.

Thank you again, and you are so welcome

I forgot to tell keep us in touch with how its going.If there is anything you need or if you need a little support just email me

Dear Cindy~ Thank you so much for the kind words, support and encouragement. I am hoping since it really is a matter of the insurance not "knowing enough", that once they do and I appeal, I am praying I win. I read your profile and yes, you are very lucky ...but all round... Thank you Love Laryssa