Insurance Complications

I submitted for pre-approval on 4/15, I called to find out my status today and learned that more information has been requested. I had a Lap-Band in 12/2004 and today weigh more than when I had the surgery. I am attempting to convert to a RNY. Insurance has requested proof of my weigh prior to banding, AND compliance to the program.  I saw the MD every 3 weeks for the first 15 months and was only able to lose 33 pounds. A few of the fills were undone because of excessive vomiting, I was even hospitalized for it at one point for IV Fluids and Zofran (anti-vomiting medication). Afterward I saw a nutritionist for 8-9 months and her notes detail that I did in fact follow the plan. How can I avoid being denied with all of this documentation? I know that insurance assumes you have had one procedure why should we give you another one...but at my 2 prior jobs the Insurance (aetna and united healthcare) approved the conversion no additional documents requested. Now I have FiServ (FirstHealth) and I am very very worried......

I really don't see how with all of the documentation they can deny you, did you already give them this information, and their asking for more, or is this the stuff your going to give them? if you are just going to give it to them, i think you will have it in the bag. If you already gave it tothem, they are just dragging thier feet, it wasn't an outright disapproval, that is good, don't panic, I am sure the ins. people know what alot of the surgeons know, and that is that the lap band just really isn't all that effective for alot of people, my surgeon used to do them , but stopped because he said you do not lose enough weight, and a high a percentage of people gain it back to make it worth the money . Now that's an honest dr. I think they continue to do this because it is a short relatively simple procedure without alot of risk, they can do several a day $$$$$$$$$ cha ching! good luck , i'm sure it will work out fine please let us know, call the ins. and bug them alot!!

susyalba thanks for the reply.  The doctors office said they had already sent all of this information in the original packet.  I did have a pre-op note that wasnt in the original packet.  I hope thats all they need. The Lap-band IMHO is waste of money. I know 6 people who have ithe band and only 1 has lost more than 40 pounds.  If you are more than 100 lbs overweight I dont think they should even offer the band as an option. I will hang in there and try not to go nuts with all this waiting. 

I'll say a lil prayer for you tonight. My sister had the lap band 6 mo's ago, and has so far lost 60 lb.s I will not tell her all I know about it (i researched 4 yr.s before i chose rny) maybe she'll be one of the lucky ones that it works for. she started out at almost 300. BTW did you say that you have differen't ins. than you did when you had the lapband? if so why are they sweating it?

Sounds like you've really struggled with the lapband.  A co-worker had lapband done in March 2006.  She lost a lot of weight at the beginning but stalled and looks like she has re-gained a lot of weight.  She lost 80 lbs. and had 50 more to lose at one time.  One of her problems is she eats a lot of junk food and doesn't follow the instructions from her surgeon.   I've read that lapband patients are more apt to re-gain their weight.  My surgeon said I am more apt to lose all my excess weight with RNY than lapband.   Hope you get approved soon.  Good luck!! Jo

thanks for your well wishes, after 9 days and 12 pages of faxed information, I was APPROVED!!! surgery 6/3.....thanks.

Hurray for you!!  I hope to join you sometime in June.   Insurance is great and a real necessity but it can be such a headache to deal with. Jo