Not sure what to do

I was denied earlier this year by my insurance company to have the lap-band procedure. They denied me saying it was a cosmetic surgery. Well I appealed twice and even sent a letter from my doctor stating my families history with heart problems and diabetes and they still sent me a denial letter. Fine, we went ahead with the surgery as a self pay patient. For some reason the surgeons office submitted to the insurance company and they paid it! So then I called the hospital and anesthesiologist and had them submit. I figured if the insurance company made a mistake this would prompt them to catch it. So far they have now also paid the hospital. Well of course I would rather have my money back. I'm not sure if I should call the insurance company directly or just hope that they never catch their mistake. Once they've paid, can they ask for their money back? Any insight would be greatly appreciated. Thanks everyone. Denise

wow so do tell did you get your money back i dont think i would of called insruance i would of called hospital and told them i wanted my money back LOL this is my first time at this board..shelly

Hi Denise. YES, they can always ask for their money back. I am the coordinator for an office here in the South and that happens all the time. It's very unpredictable, unfortunately. You're in luck, though. The only company available right now that makes a Lap Band is called Inamed. What most people don't know is that Inamed has provided a division of their company that does nothing but work to acquire approvals for the Lap Band procedure. You should absolutely ask each of the members of the bariatric team to submit to insurance and if they are denied, then turn the information over to Inamed. If this happens and you need their information, please......absolutely.....fell free to contact me by e-mail and I will be more than happy to supply this information to you. Sorry, I am probably killing the obesity attorneys and patient advocates by offering this information, but I am on a rampage tonight. I am fighting for 7 bands right now and the insurance companies are my enemy tonight. I was here looking for information on those approved for the band to submit tomorrow at a meeting with BCBS and I ran across your post. You can do this. Your insurance is there to pay for your care. Lap Band is an FDA approved procedure for treatment of morbid obesity. NOT COSMETIC TREATMENT. Make them pay. Let me know if I can help you nail them to the wall. Lots of luck and best wishes for a great success. Marcie www.obesitysurgeryLA.com

You need to contact the hospital and the surgeon to let them know that you want your money back. I know that it was a lot of maoney that you must have paid out of pocket. They are required to give you your money back if they submit it to the insurance company and the ins. co. pays them for the exact procedure that you paid them for. You must demand a refund of your money. If it was a mistake on the ins. co. part, that is a problem that they and the hospital and/or surgeons office will have to deal with. As far as you are concerned they paid for the procedure and you are entitled to your money that you paid out of pocket. Let me know how things work out. I go in tomorrow morning for my surgery!!! Thanks Krissi

I agree 100% with Marcie. INAMED's Customer Care number is 1.800.766.0171. As a Patient Advocate, I am not offended, and doubt any attorney would be either. Personally, if someone can appeal themselves, or get free help from INAMED, they should do it. Fight the good fight!