BCBS PPO SD won't cover Lapband

I just got off the phone with BCBS - waiting for my 1st denial letter to arrive and was told again that lapband is considered investigational! The girl I spoke with said she knows its been approved by FDHA for years but many hospitals are going to stop covering wl surgery at all due to the high cost of malpractice - she mentioned Mercy Medical I'm going to appeal.. but right now I'm feeling so defeated!

Don't be devastated that's what they want. Appeal and remind them that the band is FDA Approved and ASBS certified. It has been tested and is approved for use. End of story. Good luck. Let them have it. Gary Viscio obesitylawyers.com

Thanks Gary, the letter arrived this afternoon and was just a generic denial, no reason just checked a box that says lap-band and thats that. My husband called and let them have it. I now have the appeals form and am going to call my surgeon tomorrow to help with an appeal letter from him and one from me. Thanks again!

I am going through the same thing. I didnt go through the process of pre authorization as I called and was told absolutely not. I was told by the insurance rep at BCBS that there is a panel of doctors that look into new procedures and make the decisions as to what to cover. She suggested I write to the senior medical director. She gave me an address. Will be glad to share it with you . I dont know if there is one medical director per state or one for all of BCBS. Maybe if enough of us write , they will look into it again and approve it

Hi Teresa, yes I'll take that info please! I spoke with my Dr's office today and they were already preparing an appeal for me when I called (grin) - I dropped off my 25 page appeal (with documenation) to them, they'll add their appeal and documentation then send it on to INAMED who makes the Lap-Band and they have an appeal department that will go to bat for me! That feels really good =) Thanks! Melissa

Melissa, Did INAMED win your appeal for Lap Band???Just wondering that is what I want and need some help. Thanks, Shirley

Unfortunately - Dr asked to put off the appeal as at the end of October the SD Board of surgeons was meeting with BCBS to try and get the band approved. so I stopped the appeal and waited... only to find out now they did NOT approve it.. again. DR says wait, they are meeting again in February (sigh) is there a point to this?

I can't remember which states, but three of the BCBS's took Lap Band back off of their experimental list within the last three months. Other companies have been overturning their denials on appeal for Lap Band. Fight this one with everything you have. Insurance companies cannot override the decision of the US govt and the leading bariatric surgeons association in stating a procedure is experimental when it clearly is not. Fight the good fight! Roberta

Thanks SO much Roberta!! I'm feeling better about this after a talk with my DR office yesterday - they are going to appeal with me, and INAMED's appeal department is going to submit the whole kit and kaboodle for us - it will be such a happy day when this goes through! Thanks for the support!!

Any clue on how to find out which BCBS companies took it off their experimental list?