UPDATE to FINAL DENIAL OF FINAL APPEAL

Hi everyone: Many weeks ago I posted that my employer issued me my final denial of my final appeal.  This final denial was the end of the road for me as far as appeals were concerned.  I had no other recourse. I did find another avenue though and changed my address from MA to CT so that I could be insured under Cigna's who covers Lap Band. (with my company, anyone in MA has Highmark BC/BS)  Not a proud moment but desperate measures call for desperate actions. On December 19, I got a call from my employers appeals division and they wanted to talk to me about my appeal.  They said that they wanted to "revisit" the issue and asked me all sorts of questions.  They told explained to me that  appeal was very well compiled and that the issue I had with my denial with an issue no one had ever brought to their attention before.  I find that hard to believe but...whatever.  My contention was that they were not offering uniform coverage (for the same premium) too all of their employees.   To my astonishment, they completely agreed.  So, the long and short of it all is that they are sending all of my information back to Highmark BC/BS and telling them to review it just like any other bariatric surgery that is covered under the plan.  As far as Alcoa employee goe, Highmark is not allowed to use the inestigational/experimental as a basis for denial any longer.   As far as I understand, it will be a very manual process that could take weeks but I've aready called several times just to let them know I'm still out here.  Now, I just sit and wait and nag them.   It's opened up a whole other can of worms though.  It took me a few days to get over the final denial and then I did the change of address and started down the path with Cigna.  Now, I'm sort of back to where this all started and the waiting game is starting all over.  It stresses me out to think that after all this I could still be denied and I'll have to bark up another tree. I'm concerned about the criteria.  I think I meet all of it.  This is the one thing that worries me is this criteria:

• The patient has received non-surgical treatment (e.g., dietitian/nutritionist consultation, low calorie diet, exercise program, and behavior modification) and attempts at weight loss have failed.

I have to be honest that I have never tried behavior modification.  I'm assuming they mean hypnosis or psychotherapy.  I've gone to a phychologist before but never for my eating disorder. I guess we'll just have to see what happens.  I hope they just cut me some slack.  I do have to say that I'm really happy with this new turn of events though.  Apparently, due to my appeal, 142 other Lap Band appeals will be turned back over to Highmark for review.  That's AWESOME. Take care everyone and wish me luck!!! Gina B.

Way to go!  That is great and shows what one voice can do!  As far as behavior modification the way I understand it is much easier that you are thinking.  Simply put it is like it sounds simply working to change your behavior.  When I talked to my doctor about it we went over some of the following:

• Eat slower
• Take smaller bites
• Stop eating when you are satisfied not when you are full
• If you are a stress eater take your stress out in other ways

So I bet you have been involved in it and just did not know it.  Again congratulations on a big win at a big battle!