FRustrated! Insurance says this is an UNproven surgery!!?? Help!

I am so frustrated...my insurance company says that they will cover wls YEAH...however, they will cover "open or lap vertical banded gastroplasty,RNY, gastric bypass, duodenal switch" however the "mini gastric bypass or loop bypass and the Lap band surgery are considered investigational as it has not been proven to improve health outcomes" "The FDA has given premarket approval for the lapband but there insufficiant evidence in medical literature to draw conclusions about the safety and effectiveness" Does any one have any information, articles, etc that I can use to prove my case? Also does investigational mean they will definately not cover? Kelly

I would suggest contacting someone like Walter Lindstrom (www.obesitylaw.com) who specializes in this sort of appeal. He's had very good outcomes with the whole "investigational" nonsense... Nancy 394/299/180

I was denied for the same reason...investigational/experimental. I fought my insurer and won. Check out my profile for more information and resources. I list a website I started...go to the appeal information section to get information on the studies I used and be sure to check out the references in the letter as some of the information I gathered was from websites. Good luck! --TJ

Hey, Maybe you should gather up the info that is being posted under Sweetie Beanie's posts for Laryssa (sp). She's apparently having trouble with her provider as well. I was self pay so I don't have any other advice for you. Good luck! Sarah

kelly, I am so sorry to hear you are going through exactly what I am right now too. Please check out the posts that are mostly from Sweetie Beanie, Dana and I, there is so much useful information there. I am gathering as much information as I can to appeal this, if you'd like once i have some "good enough" proof, I can share these with you. http://www.obesityhelp.com/morbidobesity/surgtype-forums/LapBand/postdetail/95235.html?vc=0 Please keep in touch, I am sure we can help eachother out. Laryssa

This is a fight worth having! That is total bull. This surgery is no longer experimental. I'd say contact Inamed (the maker of the band) as well as the many people on here who've fought their insurance companies on this issue & won. There is plenty of literature out there that you can use to your advantage. I would advise against going to any attorney unless that is your LAST resort, this is a fight you can win as a patient & consumer, although it may take a little while. Good luck & keep us posted! Candi