Denied and need to Appeal, will someone help!

HI Ashley,

First of all take a deep breath and realize that this is not the end of the road.  As long as you have a benefit for this surgery then you always have a chance.  Sometimes this is how you find out exactly what they need to approve your request.  They must now tip their hand and tell you exactly what criteria you did not meet.  They also have to clearly outline your appeal process.  You must make this denial letter your guide.  Follow the appeal process to the letter and don't miss any deadlines.  IF the letter does not clearly outline the reason for the denial then contact them and request that information.  Once you get that try to meet the missing criteria and then appeal.  So if they denied for not enough weight loss documentation find out exactly what you need to add and then appeal.  Often you have several levels of appeal available to you.  And you can always appeal to your employer to over turn the insurance denial (if it is self funded).

As for the lap band appeal help.  Your surgeon's office needs to submit the request for them to take your case.  Once they review your information they will decide if they are going to appeal on your behalf.  They have taken on one of our patients cases and won it for us on appeal and one did not meet their criteria to take on for no cost.  They will always be helpful in information on the best way to appeal.   Our office just overturned a denial with Cigna today with a Peer to Peer review.  (that is M.D talking with the reviewer M.D.)  That particular case took a lot of hours of preperation and record seeking for this call.  So help your surgeon's office by being proactive and getting involved in the fight.  You are your own best advocate. Good Luck, Mary

Ok, so i'm confused. Because I want the lap band I can have the people at obesitylaw.com fight my denial and the people that produce the lapband will pay the fee? Assuming of course that they agree to fight my denial?

Vicki R. on the lap band forum helps people with appeals.  Bing9910 said that she appled for the people who make lap bands to help her.  I am using Obesity Law.  I hope this helps.  Good Luck!

try gary obesitylawyers. com  because he is suing OH for breach of contract they cut him off from this forum, so you wont see his FREE advice here anymore thanks to them