Need Help with appeal

I need some help.

I had lap band in 2005. The past several years I have had a slip/and developed reflux. Ok, so back in August of 13 I had an EDG done to see what was causing the severe reflux, and at that time I was told of how tight the band was and possible hernia.
So I had my band removed and revised to sleeve. I was self pay for the revision, but they billed my insurance for the EDG and for the hernia repair. Insurance paid and I go on my merry way. Fast forward and now I am receiving bills from the hospital/pathology and such as my insurance has recouped the $ and now I am being billed. I called them and they said after reviewing, they discovered that it was WLS related and so no benefits. I need to appeal this, but don't know where to start. Any help you guys could give me would be very much appreciated.

Thanks

Montie

I have no experience in appeals so you can take this for what it's worth, but first try and get a copy of your medical policy dating back to your surgery.  Then if you click on the magnifying glass at the top right of OH, search for appeals.  I'm sure others have gone through this too. Good luck! 

I'm not sure if this is specifically in their area of specialty, but Walter Lindstrom's office was tremendously helpful during my appeal to even get surgery. I am thinking that if they can't help you directly, they could get you going in a direction. It might be worth contacting them.

Laurie

The hernia repair could be from anything and should be covered.   I would be guessing the band did cause it though as it often does.