MVP denial--guidance on appeals needed

Hi, First of all, let me introduce myself. I am a 40 year old woman who has wanted the lap band for the last 10 years. I finally have insurance and started the long process about 16 months ago. I did everything required of the program I had signed up with and then their only band surgeon quit. Since I do not want the RnY bypass, and that was the ONLY bariatric surgery that program now offered, I had to switch programs. Along the way my company switched from BCBS to MVP. MVP had been approving the band without extraordinary fuss according to my new surgeon. I spent months jumping through program hoops and they finally submitted my paperwork, thorough and complete. MVP just sent out a denial for the following reason: there are no medical contraindications for the RnY bypass, so they are not approving the band. Now I only have about 100 pounds to lose, but they are 100 pounds I've been struggling with for nearly 20 years. I don't want the RnY--I don;t have that much weight to lose that I need the malapsorption component, nor do I want that. The bypass is much more invasive, has more complications, a longer recovery time, and is neither customizable to my body's needs, nor reversible in the event of serious complications or catastrophic illness. I also prefer the slower rate of weight loss associated with the band, as it allows my body to adapt better.  It seems to me that if there were medical contraindications to the RnY, they would also be contraindications for the band, and so you would still get denied. At any rate, I want to appeal and will do so repeatedly if need be. Where I could use some guidance is in what grounds to cite aside from personal preference, and how best to go about the appeals process. Because their denial is based on such a vague reasoning, its not as if I could meet some specific issues that they had.  Has anyone else dealt with this from MVP? Evidently, its the new loophole they are exploiting to avoid covering the lap band, and I would love to hear from others who either have dealt with this or are currently dealing with this. Thanks in advance for any replies or advice, Katlinel

I think there are specific conditions that make RNY not an option in which case a lap-band would be used. I'm sure if you call your surgeon he should know what those conditions would be.  I just wanted to share what i know about lap-bands. One of the many surgeons that i have met only does revisons for lap band and i didn't understand why he refused to use the lap-band on his patients.  He showed me a video of a revison he performed and in that video i saw the lap band had cut through the persons intestin and when it was removed i could see that the white plastic had grown a green crust on it. The surgeon said that happens very often and that is the reason he will not use the lap-band on his patients. After all it is a foregin object in your body and it is always possible that it can be rejected. I don't mean to scare you or try to change your mind but that video i saw just impressed me so much. Anyway, im sure you are well informed about the risks of both surgerys and I hope you can find a way to appeal their denial. I am also going through an appeal and i know it can be frustrating. Good Luck!

Can you please tell me what your letter your PCP wrote ahd said?? I'm curious...and Does MVP go by just what the Dr wrote or by both the Bariatric Center says and what your surgeon states?? :)