Insurance won't pay!!!

My doctor's office called yesterday to give me the news..... my insurance won't pay for the sleeve.  They say that it is still too new of a procedure.  That makes me mad because they will pay for the lap band, (that I had before and they had to pay to remove)  What a waste of money!!! Im just frustrated, but I know that good things come to those who wait!!!

Curious to what insurance you have?

 I think that I would call and talk to someone about this.   Most other insurance companies are now approving the sleeve.     I do believe I would think about appealing this.    Will your insurance co. approve RNY?   Just curious about that.   Not fair if they will approve lap band only !!!   Good luck to you and prayers coming your way that they will reconsider.

Hugs and blessings ~~~ Vivian

I would appeal!  Write a letter stating that other major insurance carriers do not consider this procedure as experiemental and it is not a new procedure.  Send documentation showing that other insurance carriers have been approving for over a year.

If possible,  you may also want to apply for an outside appeal (certain carriers allow--i believe if your policy is not self-insured). 

Most insurance companies cover the procedure.  Who is your insurance carrier?  I also know that each insurance company has their own criteria to qualify.  I would appeal it until it is finally accepted.  Have your doctors work with you on that and prove that it is medically necessary.

When is open enrollment? Do you have an option to change at that time?

read my blog page under four and a half months out. it tells how i appealed this same issue and won two years ago. my appeal letter is posted. the research needs to be updated but this procedure has become totally mainstream and is not investigational. check with your state insurance department on appeal procedures . they usually have a division that will help consumers. also read your policy on how they define investiagional or experimental and what appeal procedures they have. Send all appeal materials by mail with tracking receipts. Many people have copied parts of my letter and won. good luck.     Diane

They cover the RNY too, just won't cover the sleeve.  I am on TRICARE.  I was approved to have the RNY but could not go through with it.
 

 Where are you stationed?  If you can get stationed at a major military facility most of the military bariatric surgeons do the procedure.  I"m having it done at Bethesda.  That way you get around tricare AND don't have to pay.