No AGB Yes RNY ??????????

My insurance has denied me for the Adjustable Gastric Band, which is a surgery that I prefer. My doctor's office is certain that I would be approved for the RNY. Even though the AGB is an outpatient surgery and would cost THOUSANDS of dollars less than RNY. I am so disgusted with an insurance company making the decision of what I am doing to my body! I am wanting to have the surgery as soon as possible (of course), so I will try for the RNY. If they deny the RNY, will I be able to appeal the AGB? Or will it be too late then?? I have Healthlink Insurance and I have found someone on these boards that was approved for the AGB with Healthlink as well. But it was over a year ago. Thanks for your time and answers!

RNY is still considered the "Gold Standard" of WLS. Insurers are reluctant to pay for anything else, unless you have mitigating physical cir****tances to exclude you as a candidate for RNY. Some insurers were paying for the Lap Band over a year ago, and then "mysteriously" it became "experimental" and they took it off of their approved procedures list. Good luck on your appeal, Roberta

I had a question similar to yours. I had a consultation with a surgeon for RNY and my insurance denied due to not being morbidly obese for 2+ years (my BMI was above 39 for the past 5+ years but that didn't matter). They also said my sleep apnea wasn't significant enough to qualify as a comorbid. Since that denial I have been working on my appeal. I had a checkup with my PCP and subsequently have added to my list of comorbids, which I feel relatively confident would affect their decision. Anyhow, I recently found out that a) my insurance policy does indeed cover LapBand; and b) there are several local surgeons that do LapBand (still checking out one of them...). I haven't had a consult with any of the LapBand surgeons and didn't know if that affected where I was at in the process with my original denial of coverage. Or if I consulted with the new surgeon, it being a different procedure altogether would be like starting all over again. I don't care either way, but really just want to make sure that I do things correctly. I would really rather go the LapBand route if at all possible. RNY would be my second choice and not ruled out altogether. Just my personal preference. Sorry I didn't answer your questions...I just have had pretty much the same thing going on myself. Hopefully someone can shed some light on this for both of us. Sandi (AL)

Sandi, Since your denial was based on not meeting the definition of medical necessity, and not the procedure itself, it doesn't matter if you decide to change procedures. Fight the good fight! Roberta