Now What? Approval Denied...

I kind of figured that the answer from my insurance company was taking too long - and that this wasn't a good sign. Well, yesterday I got the letter... In a nutshell it says, "according to the terms of this patients contract, this treatment would be considered INVESTIGATIONAL and not covered." So, is this the end of the road? I cannot believe that they would dermine the process "investigational" when there is so much proof out there that this surgery is very successful. I guess I need to contact my surgeon to see what the next step is. After all I have gone through already, I'm just not ready to give up... Still, as you might imagine, today I feel like someone has just destroyed all my hope of ever having a normal & healthy future. FYI, my insurance is Blue Cross/Blue Shield of Alabama. Nan

Nan, I don't know if this is the case with all BCBS plans but I did read on the main board today that someone else w/BCBS had to go threw the HR department of the employer -- so maybe check that route. Also Dr. Chua's office should know what to do. I know that this insurance you have to have every option to prove it is medically needed before approval. Again, Dr. Chua's office should be able to help you out w/the needed appeal process. Gala

Thanks; I'm hoping Dr. Chua's office can help me out. Kind of hesitant to go to my HR department. Despite the fact that it is illegal, I'm pretty sure that they wouldn't keep my medical information confidential. And I'm not sure I want to deal with that.

Nan, Which procedure was your surgeon requesting approval for? Many times they will consider the lap adjustable band experimental as well as the dueodenal switch. Another option is to contact your human resource department at work and ask them to go to bat for you. Either way your surgeon's office should send a letter of appeal on your behalf if you request it. I wish you all the best. Stephanie Dr. Rupp Open RNY 4/27/04 262 down to 180

I'm asking for the lap band - or gastric banding. Hopefully Dr. Chua will be able to send a letter of appeal for me. Like I said in my last post, I'm somewhat hesitant to contact my HR department.

Would you be open to the option of switching to a different surgery type? That may be an option for your wls. My ins co (Aetna) said that the lap band was 'experimental' also -- that was my first choice. I am now in the 'pending review' stage awaiting approval for the lap rny ... I understand your frustration! Ms Dfawn

Nan, I do know that the banding procedures are considered investigational for some policies with BCBSWi. I, too, suggest looking into another option such as the gastric bypass. Just a thought. Good Luck to you! Shawna