Denied by Insurance for the 3rd Time (x-post)

Band to DS
on 9/12/11 10:45 am, edited 2/3/12 11:05 pm
Unfortunately, I had to delete this post due to privacy concerns.

Got a lap band in 2008. Tried hard, but didn't lose much weight & developed swallowing problems. Fought my insurance company for almost a year & finally had a band to DS revision on 5/11/12. Have now lost 125 pounds. Yay!

TamaraL
on 9/12/11 8:24 pm
I know that this is frustrating!!!   YOu know that they are supposed to start covering the sleeve in the next 6 months.  Just a thought since the sleeve is the first part of the DS




 

MsBatt
on 9/13/11 2:27 pm
Do you know/have you talked with LeaAnn Johnson? She wound up going to Mexico and self-paying, then came home and sued BC/BS of TN. (Gave them a real ass-whuppin' too! ) Her BMI was about 43, I think.
Lynda D.
on 9/13/11 4:24 pm
 I don't know if this will help you or not, but back when I was researching my RNY, I remember people who had to get lawyers involved to get approval. But what I remember is that they had their lawyers draft a very strongly worded letter–which costs way less than a retainer fee, I believe–and sent it to the insurance appeal people. That usually did the trick. 

Just keep at it, and keep going up the ladder of authority. Get a lawyer involved, if that doesn't work, get the state health department involved. If that doesn't work, get the governor involved. I don't know, I'm grasping at ideas here. 

A thousand dollar fee is much cheaper than going to Mexico for surgery. Just sayin'...

Lynda

First Surgery Date: November 5, 2005
Surgery Type: RNY--Proximal
Height: 5' 3"
Beginning Weight: 250 lbs.
Lowest Weight: 125 lbs.
Current Weight: 230 lbs. Seeking Revision to DS

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