Denied by Insurance for the 3rd Time (x-post)

Unfortunately, I had to delete this post due to privacy concerns.

Hugs to you. I can't imagine how disappointed you must be. At least my crappy insurance states the only WLS it will cover is the band.

I'm swinging my poor kitty by hos hind legs hoping your perseverance pays off.

How much would you need to gain to get to a BMI > or = 50.0000000001? 

1st, did you check that the internal docuent they cited does actually say what they claim it says?

Were you able to submit documentation that showing that other medical authorities do not conider it investigational, like medicare, Anthem BCBS of Cali, CA DMHC, ASBS, etc? 

How do the insurance reps at your surgeon's office say people with your carrier get insurance approval?

No idea aboutt he lawyer stuff, sorry.

Good luck and hang in there.  the miute you give up, they win.

I am not sure about the difference in prices between the US and Canada but here, a lawyer wanted a $5000 retainer to start.

Have you talked with Diana Cox ? I had BCBS of MN living in AL and made it thru on peer to peer review. Not sure now NC differs from MN policy. You need to get word for word on why NC approves or disapproves WLS. Did they pay for the lap band ? Do t hey have a  once in a lifetime payment for WLS ? Check those things out and good luck. I hope you find something.

Keep going Shelli! File that next level appeal! Go all the way up if you have to!

Shelli

I would suggest contacting Diana Cox immediately. I believe she will be of great help to you in regards to this matter, especially considering your legal questions.

I might also add that I had my surgery performed by Dr Ara Keshishian in Glendale, California. At my last check up,a sweet young lady was in for a visit with Dr. K as well. I could tell that she had just had surgery, because she had the bruising on the back of her arms from the Heparin shots. However, she was so tiny that I deduced that she must have been a revision surgery. We started talking, and I found out that she was a revision from a lap band. Unfortunately, the first doctor who tried to remove her lap band didn't know what he was doing, and she almost died. She was lucky enough to find Dr. K, who is a skilled revision surgeon, and he saved her life.

So, I hope that when you are choosing a doctor you will find one who is highly skilled. It just scares me to think of the doctors out there who are trying to take those bands out and making a mess during the attempt. I'm wishing you all the luck in the world. I hope you can join us on the dark side soon!!!

Unfortunately, I had to delete this post due to privacy concerns.

Dang it Shelli!!    Keep fighting, try and chat with Diana......she rocks at this stuff.....also have you considered that surgeon and hospital Diana was talking about awhile back that was looking for DS patients?  Maybe it was for virgin DSers, cant remember but I think it was really good pricing!

Hang in there!
I hired an insurance specialist who handled my appeal for me for a ridiculously low fee. Her name is Karlene Dittrich, and her email is [email protected]. I have no idea if she's still around but send her an email and see if she can help you. She's based in GA but I don't think that will matter. She's a real pit bull when it comes to getting coverage for bariatric procedures and she is educated about the DS.