Revision--DENIED!! What do I do now??

Ok, so its not like I'm surprised.  I knew there was a high likelihood that I would initially be denied for revision.  The plan was to at least get the band removed (the Dr. was going to do the revision in 2 separate procedures to allow the stomach to heal) and try again with under a different policy next year (that way they wouldn't have to know I ever had bariatric surgery).  My current insurance company will not even approve a removal because I don't have any complications from the band and they don't feel I've tried hard enough to lose the weight.  (I used to feel that way too...but its been 3 yrs, and I still have diabetes and PCOS to contend with and its hard as hell to lose weight with these 2 particular conditions!!!).  I think I have a right to have the band removed if I no longer want it inside of me! Although I despise being denied, I'm not devastated or anything, but I do intend to give the insurance company a hard time until they at least agree to pay for the band removal.  How do I do that?

My surgeon's office, particularly the insurance coordinator is doing very little to help.  I asked for a peer-to-peer between the Dr. and the insurance company and all she did was try to assure me that that won't work because the insurance company believes I have been non-compliant.  I despise nay-sayers!  If I can't get them on board, I am going to another surgeon!  I think insurance companies use the non-compliant excuse to make people feel guilty about failing to lose weight with the band.  That's not going to work for me.  I have a two-fold plan.  One, I am going to appeal until I can't appeal any more, so I am going to see what advice I can get from the insurance forum.  Two, I am going to work the hell out of this band for 6 more months (or until they approve me, whichever happens first) and document everything (diet, exercise, fills, complications, and weight) myself (on a blog, so it will be time-stamped and they can't say I just made it up).  If this appeal does not work out for me, I am going to resubmit everything again in August/September.  At that point the non-compliant argument will be a moot point.  I also intend to keep seeing the psych and using the nutritionist as need be.  Hopefully I can at least get the insurance company to reconsider the removal.  If I can get that approved, then I will keep the removal in my back-pocket ****il the end of the year) so if showing compliance doesn't work, I can go back to my original plan of getting the band removed this year, and reapplying for bariatric surgery next year under a different policy.

I, too, hate it when people tell me no.  Ugh! 

I think you have a plan.  I am not sure how to get your insurance company to do anything it is not contractually obligated to do.  So, as you outlined above, document everything to show them that they are contractually obligated.  And if that doesn't work, you could try to save the money and self-pay.  I know Mexico has some very good surgeons that do revisions and have very reasonable prices.

But I think you are on track by doing your plan first - you go!!!  Good luck!

I have Lindstrom's office working on my appeal at the moment. It might be worth pinging them for info to see if they could help. Definitely less expensive than self pay in Mexico.

I'm curious, what insurance company denied you.

Blue cross blue shield of nc

That's actually part of my plan. Comply and show them its not all its cracked up to be, and go to all fill appointments and nutrition appointments all while appealing. I followed the eating and exercise for a long time with not very good results. The dr never gives me a fill and I don't feel like I have any restriction. I hate this. I have felt like a failure for so long because I can't get this weight off, even with the band, and I am convinced my hormone imbalances due to pros and diabetes makes it extremely difficult to lose the weight. I need malabsorption to help.