Absolutely Disgusted!!!!!!

I have been trying to get approved for lap band surgery since Jan 2014. First, insurance required I complete 6 mo. of physician supervised nutrition counseling, a psychiatric eval and at least have a BMI of 39 or greater. I am 5'4" 244lb. I have hypertension,GERD,Hyperlipidemia,Hypercholesterolemia,degenerative disc disease and Hypertension. They are now denying me saying I am not sick enough. WTH??? How did you guys finally get approved. My PCP refused to write a letter saying any of my comorbidities were life threatening. Any ideas?  I need this surgery to improve my quality of life... I am willing to try whatever it takes to get approved!!!

They have done you a huge favour - the lapband is not the best weight loss surgery - it has the worst weight loss statistics and the highest rate of complications!!!

Do a lot of research and find a surgeon that will do a VSG and resubmit to insurance!

Does your insurance require your comorbidities be life threatening?

I didn't think so, I have several close acquaintances that have used the same surgeon and have the same insurance that had no trouble at all. To be honest, one of my friends has nothing but hypertension. I know a bit about insurance and truly to seems to depend on the person that is approving your case.

I work in insurance as well, while they do have medical policies they have to go by, some things like comorbidities are a grey area and can be left up to the opinion of the reviewing doctor. So yes it is possible that one doctor will think it is medically necessary and another may disagree. That is when you appeal the decision. The appeal cannot be reviewed by the same doctor.

Yes Bella, I am a Medical Coding/Billing Specialist and we both know it just depends on who gets your case and whether or not they are in a great mood!!

First run far far away from the lap band it is a very inefffective way to lose weight and has a 50% failure rate which is very high! There are a few successful losers but they have worked very hard to get and stay where they are. Plus the lap band is only good for 10 years and then you have to find another form of weight loss. Most of us only went 2-6 years before having serious problms with the band before having to have it removed. I causes serious damage to the esophagus just by being placed near it. Some of us have had permanent damage from them, even the Mayo Clinic will no longer place them.

Second you need to contact your insurance company and get a written list of what their requirements are and if they even cover weight loss surgery many do not. Also what they consider co morbidities,m then you know what you are dealing with for sure.

Are you working with a bariatric surgeon, if not, you should. The lap band will not yield the best results. The gastric bypass or bag are your best options. But a bariatric surgeon could better advise you. 

Find out what the requirements are directly from your insurance company. Take control of your own health care. if younare satisfied with your pcp, change.

Yes, as a matter of fact, my surgeon is certified in lap band procedures. Looking to have a sleep study then go from there.

I'd go to a Bariatric Seminar and research all the WLS options (personally I think RNY might be a better choice for you given your GERD diagnosis) then ask the Bariatric Coordinator or Surgeon which PCP's he gets referrals from. I might consider a switch to one of those Dr's (make sure they are in your network) they may or may not feel the same way but at least you know they are pro-weight loss surgery as a treatment option... perhaps some of your conditions may not be currently life threatening in the acute sense but certainly they are effecting the quality of your life and over the long term they are taking a toll. 

Best wishes to you!