Now I am denied!!!

Hello everyone! I had posted on here previously stating that my lap band surgery was set for May 18th at 7:30 am. Now my insurance provider has told my surgeon's office that they will not be covering the cost of the surgery because it is an exclusion in my policy. Back in February the surgeon's office had been told that it would be covered (that is at least what they told me!) I am appealling the exclusion to policy right now and am hoping it all turns out that I can go ahead and have my lap band surgery. The insurance representative is saying that the gastric bypass would be covered, but not the lap band because they are considering it experimental. Please keep me in your prayers. I am so upset right now.

Hi, sorry to hear about your insurance problems. Have you considered having a gastric bypass? From all of the research I've done, the bypass has a higher long-term success rate than the other procedures anyway. And, if you have to go through it, you might as well go through a surgery that will keep you well for the long haul. Just a thought. Good luck on whatever you do. Tere

Did they send you the approval in writing? I was worried about this too, because ANY weight loss surgeory or programs are excluded, but I did get an approval letter in writing. I was told that once you have it in writing they cannot renige. If it was verbal, that may be another story. Good luck! Pam

No, it was not in writing. The surgeon's admin staff called me in Feb 04 and told me that the insurance representative said that I met all the criteria and the surgeon's office started setting me up with all the pre-op appointments and I had everything done (including the hospital pre-ops) and then the surgeon's staff called and said that the insurance said there was an exclusion in my policy that they did not cover lap-bands (they would cover the gastric bypass (which I do not want)). Yes, it is true I should not have trusted the verbal approval, only the written approval. I am trying to appeal the exclusion right now.

Wow, you didn't have trouble to have an approval for the gastric bypass? You should do that if you really want to have WLS. I am doing Open RNY, and I am excited. I think it will be the best long term surgery for me. Think about it. Good luck!! Tricia

I can only imagine your frustration. I was told upfront by my insurance that the Lap Band surgery would be denied. I opted instead for gastric bypass and had approval in 3 days. I was told that there have been a number of problems in the U.S. with the Lap Bands, so my insurance would not consider paying for it. You might want to reconsider the kind of treatment you are seeking. Good luck and lots of prayers for you!

What it seems like they are covering is the open and not the Lap. They are not telling you "NO" They are just saying "NO" to the Lap. If you want it bad enough and they approved the open. I am sorry to say I would swollow my pride and take the open. This is more of a cosmetic issue with yourself then a direct "NO". I would take what was offered and run. If they say they would cover OPEN then you know I wouldn't be upset at least they are covering some form. I would be right under the knife and saying ok I am ready.........Bring it on..........................Is the issue of a scar worth all of the tears?