Denied: Insurance says Outpatient, but surgeon wants Impatient

I got a denial letter from FED BCBS, stating that I am denied because they will not cover my surgery if I stay in the hospital.  This is for Lap Band, they only cover if you go in as an out patient.  But my surgeon has all of his patients stay a night in the hospital.  I can't believe that one night hospital stay makes a difference.  WTF.......My surgeon is not willing to fight the insurance company, so I have to do a self appeal or find a doctor that does outpatient Lap Bands.  The letter stated that they will not do anything just for the convenience of the Doctor, patient or facility.  They feel that the Lap Band should be on an out patient basis.  My doctor refuses to let me just go in and come out...I suppose he is only motivated by money.  It really sucks....because he is a so called "good" doctor.  It's only one night...what is the big deal.  I understand where the insurance is coming from...sure I can stay if there are problems...but if not they do not see it to be necessary.  I really don't know what to do now.  I am a government worker, this appeal can go all the way up to D.C if I want it, but by that time I can lose some weight on my own.  I just don't know...my BMI is 48.  I really want the surgery, but I have to start all over with someone else who does lap band out patient. jeez...... Please help!  I don't know where to go from here..........

Your fastest, and probably easiest route would be to find another surgeon.  The lapband, from my understanding, is pretty non-evasive and can be done as an outpatient proceedure.  It sounds like your insurance compant is trying to save some $$$.  You could probably fight it, and win, eventually.  I guess it just depends on how quickly you'd like it done.  Have you researched other surgeons?  Many do the lapband..some in less than 30 minutes! 

I have not seen Lapband approved for inpatient and I work for an ins company, anything medically necessary is not approved.  However, if there were complications that is a whole new ball game.

I am not even picking this issue up until after the holidays...I just don't want the stress now.  I am trying to decide if I want to appeal or go with another surgeon.  I just don't like how they kicked me to the curb so quick..why should I try to to work something out with them. BP