Lap-band Denied by BCBS Federal PPO....

Just got verbal news that my surgeon's request for preapproval for Lap-band was denied by BCBS precertification person - the basis for the denial was not that anything was missing in my paperwork or anything like that .... it was that the lap-band is "Experimental or investigational". I am sooooo mad. This is the most expensive insurance I have ever had and its supposed to be the best one. I am going to appeal, and I am determined to get it overturned,,,, (these people do not know who they are dealing with !!!) I am just really disappointed because I was hoping to get this surgery done and be healing already when we move in October..... Anyone else had success overturning lap band denial based on investigational denial ???

You need to send them a copy of the FDA approval (2001!!!) and you need to get INAMED involved on this. They will help you fight it. Although my lap band has not yet been approved, my company started with the "investigational/experimental" and dropped that defense and moved to "not medically necessary" after I fought that. They are now refusing to pay on it because of the diet requirement - I meet all other standards and they only told me about the diet requirement three weeks before my employer changed insurance. Check on yahoo's insurance bandsters group (go to yahoo, then groups) and there may be some of this info somewhere on this board. The insurance companies will try any tactic to get rid of you, but you need to fight back. Also, start some sort of diet with your doctor monitoring it as soon as possible because the diet requirement will probably be next and you want to get ahead of the game. I wish some of our lawyers would organize some sort of lawsuit against all these diet requirements. They are arbitrary, they are an unreasonable financial burden on patients, they are intended only to delay treatment, they are more restrictive than the NIH guidelines for surgery and they should be very open to challenge, I would think. What about it, Gary???