Denial Letter

I have Anthem Blue Cross Blue Shield and I just received my denial letter today. My doctor will send in an appeal. The problem is I have to remove my tonsils and was hoping to have both surgeries at the same time. The problem is I am getting sick again with my tonsil. I do not think I can wait for the appeal period, but will go ahead and have my tonsils removed. Then have the lap-band surgery later. If anyone has any suggestions, PLEASE LET ME KNOW. The decision is driving me NUTS.

Hi Just let you know that I have Federal Anthem Blue Cross Blue Shield and they won't cover for lap band but do cover for lap or open RNY Kathy K

Deb - I'm sorry to hear that your tonsils are acting up. That truly stinks. I can't give you any help as I don't have BC/BS. But my thoughts and prayers are with you. Love, Tammy

HI Deb I understand your frustration with BC/BS. I have BC/BS of Northeast Pa and they're giving me a hard time too. But do what you need to do to get yourself good and healthy with the tonsilectomy. It'll help you with your recovery from the WLS surgery when it happens. And it will happen!! Keep your chin up! I'll keep you in my thoughts and prayers. Heather

Hi Deb, I may be wrong but I seriously doubt any insurance would pay for you to have both surgeries at the same time. I worked at BCBS years ago and it was very clear that they would not pay for two surgeries on the same day even if it was the through the same insicion plus the two you are speaking of are sooooo unrelated. That might be why the denial. Also BCBS doesn't always cover the Lap Band. Check with your benefits people at work and get your tonsils taken care of Linda

Deb: Is the same surgeon doing both operations? Towanda

I have Anthem Blue Cross/ BS State Preferred and I went on my own to the BCBS web site and looked at what was and was not covered...they consider Lap Band an "Investigational" procedure and will not cover it. They cover the RNY. Sorry if this is bad news....I had considered lap band myself...now hoping for laporoscopic RNY.... Good luck with the tonsils...maybe it is a slight blessing in that now you won't be hurting in 2 places at the same time! God Bless! Sher'

I hate to beat dead horse, but I guess I will again.... MOST insurance companies do NOT cover lap bands. The success rate is lower than the RNY which they do cover. Get your tonsild done asap, and consider revising your surgery for RNY. It does have an effect on the outcome of your appeal. Peter