BCBS DENIED LAP BAND-DAMN THEM!

OF COURSE AS I KNEW THIS WOULD HAPPEN. I HAVE NOT RECEIVED THE LETTER, BUT CALLED TODAY AND THEY SAID BECAUSE IT WAS "INVESTIGATIONAL"???????????????? WELL, WHAT THE HELL DOES THIS MEAN? SORRY, I AM A BIT MAD IF YOU CAN'T TELL? I WAS APPROVED FOR THE GASTRIC BYPASS ACCIDENTALLY, BUT I WANTED TO FIRST SEE IF I COULD GET THE BAND FIRST,SO THEY RESUBMITTED. I JUST DON'T GET INSURANCE COMPANY'S??? .....HELLO, IT WOULD BE CHEAPER FOR THEM, LESS FOLLOW-UP ON HEALTH ISSUES, LESS HOSPITAL STAY PAYMENTS LESS EVERYTHING..........!!!!!!!!!!!!!!! ME LIKE MANY OTHER'S HERE ARE SO UPSET WE ARE GETTING DENIED. IT'S NOT OUR FAULT WHICH INSURANCE WE CARRY....WHY SHOULD OTHER'S GET THE SURGERY AND WE DON'T? I ABSOLUTELY CANNOT SELF PAY OR GO TO MEXICO...NOT AN OPTION FOR ME...... I DON'T KNOW WHAT TO DO???? JUST GO WITH THE GB OR APPEAL? EVERYONE I HAVE TALKED TO HAVE APPEALED WITH THIS INSURANCE AND HAVE BEEN DENIED AGAIN, SOME ARE APPEALING FOR A 3RD TIME.....I COULD HAVE THE OTHER SURGERY AND BE DONE WITH THIS YO-YO ING! MY REASONING IS NOT WHAT EVERYONE TALKS ABOUT IN WHICH SURGERY TO HAVE.......MY REASONING FOR HAVING THE BAND OVER THE RNY IS BECAUSE I DON'T NEED TO LOOSE MORE THEN 100 POUNDS....BUT 100 LESS WOULD BE NICE. I KNOW WITH THE RNY YOU HAVE NO CONTROL OVER HOW MUCH YOU WILL LOOSE.........I TALKED WITH MY SURGERY CO-ORDINATOR AND SHE SAID SHE THINKS THEY CALL IT "INVESTIGATIONAL" BECAUSE THEY DON'T HAVE ENOUGH DATA ON THE OUTCOME....I'LL GIVE THEM SOME DATA !!!!!!!!!!!!!!!!! OK, I AM DONE *****ING...........I JUST DON'T KNOW WHAT TO DO ?????????? THANKS FOR LISTENING! NADINE

hi nadine, I'm sorry you wern't approved for the proceedure you want.. I went with the RNY because that is what the "surgeon I wanted" did.. I had 121 lbs to loose... (256/135) I am 13 months post op yesterday and I am literaly stuck at 104 lbs loss and have been for 4 months.. there are many, many people on the MB who had "around" 100lbs to loose. the thing I have found very common while reading the MB is that no matter where you started out wieght wise that last 20lbs is a ***** to loose.. I know you have done research and probably a hell of alot more than I did so I am not gonna say one is better than the other I honestly don't know becuase I didn't research any other types...but from what I have seen posted they all have there pro's and con's.. good luck in doing what ever you choose.. Theresa

Nadine - I can't say one is better than the other either, but I will say that I have heard that BCBS is really coming down on wls everywhere and are starting to not cover it where they had before. I don't say this to try to scare you into pushing for the rny when you have your heart set on the band, but I do think it's an important consideration in the equation. I have Regence BCBS for state employees and it is completely excluded. Again, not trying to tell you what you should do, but were it me, I'd take what I could get... Dina

Nadine, I too am very sorry to hear you didn't get approval. I attended the Beaverton support group last week and Dr. Rabkin was a guest speaker. He encouraged anyone who's been denied to appeal.....several times if necessary. He said you CAN get what you want! As far as being "investigational", he said all procedures and medicines are investigational for quite some time. The fact that other insurance providers are covering it shows it DOES have acceptable history and it's just an excuse for them. I also had a woman say her attorney filed a "wrongful death" type of suit against the insurance company, claiming that they would be responsible for her early demise by not addressing her weight and weight-related health problems. I guess you need to decide how dead-set you are on the Banding surgery. Everyone has to make their own decision as to what surgery they want and whether it's worth fighting and waiting for....if it is for you...then go for it! If there is a second choice that can be approved without all the hassles and getting the procedure done sooner, perhaps you may consider it. I wish you luck in whatever you decide! Michele

Nadine: Sorry you're having difficulty with your insurnace company. I hope you can get it approved after appeal. Pam

I'm sorry you were denied Nadine, but I would definitely appeal if I were you. No one but you knows what surgery is best for You and your individual situation. I chose VBG (no flames, PLEASE!) because it was the best option for Me. Neither the Doctor nor the Insurance company has to live in your body- so don't settle for what you don't want because They approve of it. Just make sure you have done all the necessary research to make a qualified decision. Good Luck! Tammy