Challenging Insurance for Coverage/Approval on Uncovered Procedure?
Hello Everyone!
I had a general question and wanted to see if anyone had challenged their insurance who covered other gastric surgical procedures, but not a one you specifically want/need? I want the sleeve and it's the best fit for me but it's not covered by insurance.
I have good reasoning, and I think my doctor will agree that none of the covered services are a good fit for me. My insurance covers the traditional gastric bypass, the band, and the old vertical banded gastroplasty (which I don't think is even done anymore to be perfectly honest). I want to challenge them and have my doctor back me to see if they will give and cover the sleeve with a letter of recommendation from him and why he thinks nothing else is good for me.
Anyone else have similar experiences?
Not personally, but yes, many, many people have appealed and gotten the procedure they want. I suggest your go to www.bariatricfacts.org and get in touch with a woman named Diana Cox. She's a lawyer and a biochemist, and she helps people with insurance appeals pro bono.
