Appeal denied by Anthem OH

My level 1 appeal for a lap band was denied. I guess I shouldn't be surprised at that, but I'm really depressed. I've even thought about trying for an RNY or going selfpay. Gary told me to hang in there for another go at it. So I guess I'll just pull myself together and try to keep busy at other things. I hope everyone else is doing better than me. I could really use a good night out with the girls. cathy

I'm sorry to hear that. Waiting is so hard after you've made up your mind. Good luck with the second appeal. Caryl

Cathy; This occured to me yesterday;I went for my first Support meeting at Dartmouth Hitch**** they were talking about the Lap Band......and the MD was calling it a "different BYPass Procdure" I came home and looked at my insurance brochure and (I'm BC/BS FEP) it does not specifically say the Lap Band is not covered; it says Gastric Bypass Procdure(S) are a covered surgery. If the medical community is calling the Lap Band a BYPass procedure, then I would think that the insurance industry will have to start paying for them. I'm in the same boat as you are, I don't want the RNY and my insurance say's they won't cover it. Gary however says that they will, just have to pressure them into it. In reality the insurance industry doesn't want to pay for any of these procedures! They are just betting that subscribers will back away when they first get told NO. And I'm not backing away on this one. The RNY may be the "Gold Standard" but I just can't bare having my Gut Sliced in two. gail

I know what you mean, but it seems that the insurance companies have a whole different way of thinking then a normal semi-intelligent person would think. They seem to have their own set of rules also. I remember a time that a lawyer friend of mine said that in any retail transaction there were usually 20 laws broken. I would think that it would be a misrepresentation that my policy book says WLS is covered but then hidden somewhere at the insurance company, they come up with a policy that says RNY, VBG & DS's are covered but not lapband. I agree with Gary that they are afraid of the lap-band because it is not as scary. People even at lower BMI's may be attracted to it. If the word got out to the general public, there would be thousands of people running to get lapbands. That's what scares the insurance companies. cathy

Oh..I forgot.. My doc's says that the lapband in the gold standard in every other part of the world.