question any help appreciated

I already put this on the main board but maybe this is where it belonged all along , so here goes.

  I have a private insurance thru my employer and I got a call back Thursday and the Nurse from the ins co said they denied me because they don't pay for experimental surgery. see I was try ing to do a procedure called the m&m not very well known and not much written on it at all. She said I met criteria but again they would not pay for an experimental surgery, I asked if I changed it would they pay , she said they didn't say if they would. So here is my question the wls is in the policy now , so if I change to the rny what do you think my odds are? she told me I could appeal but that takes time and I have 10 days to do it, or I can call my surgeon and switch to another well known non experimental procedure , she was very nice but what would you do and again what are my chances of being approved my BMI alone is 65?

thanks  you in advanced.

                                                                  Patty

With that BMI, you need the DS honey, not RNY. Why don't you visit us on the DS board (link in my signature) and ask all the questions you need? About 80% of insurers cover this proceedure now, so if you have any WLS coverage at all, you an excellent chance.

Change your surgery type and resubmit. Are you sure RNY is the way you want to go with a BMI of 65? Have you considered the Duodenal Switch?

I highly doubt an appeal would work on a surgery no one has heard of (and, quite frankly, doesn't make any sense to me, but I am not a doctor). You won't have any studies or anything to substantiate your claim that it is a good procedure.

None of the insurance companies are paying for any of the surgeries that are still considered experimental.  VSG, etc...

Do you have a manual for your company or can you access it online?  It should list the types of surgery they approve and I would think you'd be approved.

Good luck!