coverage denied

After jumping through all the hoops, I have been told by BC/BS that lap-band surgery is ALWAYS denied because its experimental. Yet, when I started the process months ago, I was told it would be approved if I met the criteria (which I have). Does anyone understand this?

Since the Lap Band is FDA approved it is not experimental.

I'm sure you're aware that most insurance companies will deny coverage for the band, claiming it is an "experimental" implement. Others are correct that it has been approved by the FDA, but I'm not sure that's any guarantee the insurance company has to recognize it. I do know that others on the boards seem to have been successful in having even the band covered by their insurance. You have to take a proactive role in the process and start working the phone lines I'd say. In the end there may also be legal avenues to recieve coverage but that's got an additional expense involved you'd have to consider. I'm guessing you have no written agreement for coverage if you met all the criteia?

INAMED has a great article that shows it isn't experimental. Also, the Journal of American Medical Association published a tremendous study that lists the band as an accepted bariatric surgery. If you need more details, I'll try to help, as I was able to successfully argue this point.

I have BCBS also. I just spoke to them last week and was assured that they will not cover the lap band, due to the "experimental" explanation. However I noted on my policy that they recently crossed through the word experimental and simply changed it to read that it was NOT covered at all. The guy I spoke to made it quite clear that they won't cover the lap band any time soon. There is a guy on this site however that wrote a wonderful letter (with lots of sound medical research attached) to his insurance company who would cover RNY but not Lap-Band, and apparently got approved. You might try posting to the main board and see if you can find the letter. I didn't keep the link, sorry. Good luck, Angela