So Depressed! BCBS Denied Lapband Surgery! Please Help!

I just received the phone call from my doctor's office that my surgery was denied. It seems that bariatric surgery is NOT covered under my plan even though I had called BCBS and they told me it was with preapproval. Under further investigation, my husband's employer excluded it from the plan.  Please help... do I have any options. Have you ever heard of an appeal being approved under these cir****tances. Thank you.

I know it is no consulation but there have been a lot of problems with BC/BS recently. I had routine 6 mons post op visit with my PS. They were telling me they've had patients pre-approved for procedures, procedures done and THEN BC/BS says "oops". The person's individual policy does not cover this procedure or that, leaving the patient responsible for the cost of whatever was done.  Many doctors that do WLS and PS have loan programs that you can check into. The best of luck. Wilma

HI -  I know that nothing I say will help with the frustration you are going thru, but I just wanted to let you know that Dr. Davis did my surgery ( I had gastric bypass) in jan. He is an a great surgeon and his office will go out of their way to help you in anyway they can. I had bcbs as well, and I have heard that since my surgery they are really getting stricter about the surgery. I'm sorry you have to go thru this. I would talk to the office - do they have any options that you could explore ?  Good luck  -

I am so sorry for your disappointment, I know you must feel devastated right now.  I would try the appeal process, there is a process there, give it a try... at least you know you are fighting for what you want.  Maybe your husband can switch providers and you can try to get it approved with the new carrier?  I wish you luck.  Don't give up.

Michelle

I am sorry to hear you were denied.  I have bcbs and both my husband and i were approved for the surgery.  They did not give us any hassles at all.  I would definitely appeal this.  Is there any way your husband can upgrade in the medical plan?  Just remember chin up..... things will all work out for you in the end!  hugggs Christine

YOU KNOW ,  I WOULD TRY ANOTHER DOCTORS OFFICE.   IT SEEMS TO ME THAT SOME DOCTORS OFFICES KNOW WHAT TO GIVE THEM AND GET APPROVED .    I DO NOT HAVE YOUR INS.   BUT I DID NOTICE PEOPLE AROUND ME AT MY SUPPORT GROUP KEPT. CALLING THEIR INS CO.   I NEVER CALLED THEM, I LET THE DR. OFFICE HANDLE IT.   I HAVE AMERIHEALTH, AND WAS APPROVED IN 24 HOURS.    ALSO,  I HAVE HEARD THAT MANY INS. CO. WANT YOU TO HAVE  GB RATHER THAN LAP-BAND, BEING THAT LAP-BAND IS NEW,  BUT IT COST LESS. I'M A LAPBAND PERSON.   SO I WISH YOU LUCK.   I SEE ANOTHER POSTER POSTED THE USE OF ANOTHER DOCTOR THAT DOES TAKE YOUR INS. I WOULD TRY IT,  YOU HAVE NOTHING TO LOOSE.  JUST GO FOR THE CONSULT AND LET THEM DEAL WITH THE INS. CO.  THEY KNOW WHAT TO SAY, AND WHAT NOT TO SAY. GOOD LUCK BRIDGET   K.

THATS SO AWFULL SWEETY,  BUT IF YOUR HUSBANDS EMPLOYER HAS EXCLUDED THAT PROCEDURE FROM THE GROUP POLICY THEN THERE IS NOTHING THERE TO APPEAL TO. GROUPS (EMPLOYERS) USUALLY EXCLUDE THESE SURGERIES FOR A REDUCED PREMIUM FOR THE INSURANCE.    TRY TO TALK TO HIS BENEFITS ADMINISTRATOR  AT HIS JOB FOR A POSSIBLE EXCEPTION.  ITS WORTH A TRY!!    IT ALL UP TO YOUR HUSBANDS JOB!!! GOOD LUCK BYVONNE

IF I were you, my next step would be to call BCBS directly and find out if, in fact, the surgery is excluded.  If it IS, there's not much you can do (unless you want to go to your husband's employer and ask them to REMOVE the exclusion - and/or see why they excluded it if it was allowed before). Don't be afraid to call the insurance company!  you PAY them for coverage! If it is not excluded, then I would ask them to provide you with a clear WRITTEN statement as to why you were denied, and for a copy of their appeal instructions. HTH... Wendy