BCBS of NC-Anybody win an appeal for lapband?

Hello Room, I have just finished a 5 page appeal letter to BCBS of NC. Has anyone EVER appealed, and won? I doubt it, since they have a written exclusion for lap band. Ive written them not only a statement proving its a medical necessity, but also I pointed out where it was endorsed by the FDA in 2001. I included alllllll the "buzz" you hear on this website, but Im not optimistic. The truth is, you hear of alllllll these people appealing insurance companies, and winning. But is that the norm, or just the EXCEPTION? Maybe Im just anxious, but Ive learned this site is full of opinions, and ideals. I just hope its real. I appreciate all the help and guidance you guys have provided me over the long haul. I hope to join the bandster nation soon. Steve

My understanding and I do not know for a fact is that BCBSNC doesn't approve the lapband. I also understand that in August, I believe, that policy will be changed. I hope you get the answer you need. Good luck G.

Hello Steve, I was turned down after several appeals, so I am a self pay. It is worth every cent to save your life. I know you want the lap, I did read your profile, but really the RNY was so easy , don't be scared. I know easy for me to say since I have already been there and done it. And I also spent several sleepless nights , but in the end it worked perfect. BUT, Good Luck, and Take care and I hope you get approved for the lap

I dont believe you can appeal this since BCBS does not cover the lapband at all - its not that your particular plan doesnt cover it - they just dont cover all together (as far as I can remember). I have BCBS of NC as well and my surgeon told me I could only go for RNY and not lap with them. I was denied 3 times for RNY and finally was approved thru external appeal.

Steve: I won an appeal for the RNY but I too understand that BCBSNC does not cover the lap band. Like someone else stated though - they may be changing this in August. I am almost 6 weeks post op and doing great. My BMI was only 37 so I did have to prove co-morbility for 4 out of the 5 past years (high blood pressure). Good Luck. Donna

Good Luck Steve!!! Fight for that band - it is so worth it!!!

Steve- I definately wouldn't give up. I have BCBS of NC. I looked into the lap band but decided to go for the laporscopic Roux-En-Y. I highly recommend it. Keep up the fight- you will be glad you did!

Hey Steve! I too wanted the lap band to begin with, however insurance would not cover it, so I went with the RNY....you may want to go to the lap band forum and see if anyone can help you with your questions there. http://obesityhelp.com/forums/LapBand/posts.html Best of luck! Nancy