Denied for Lap Band to DS Revision (x-post)
I'm sorry you were denied. But please do Appeal!!!! Insurance often doesn't want to spend money, and they think if they deny people, people will think it's really a NO and won't appeal, but you should appeal.
I appealed and won.
Documenate your experiences, and a study that gastric banding has low markings, (Shoot, i have the papers but not with me), some posts that I printed off OH and submitted along with the letter, bombard them with all kinds of lapband failure study, etc... Explain your complications. I have a copy but it's on the computer at work and I'm off tll the 17th.
Let me see if i can find the link about band have low marks.
go get them!
I appealed and won.
Documenate your experiences, and a study that gastric banding has low markings, (Shoot, i have the papers but not with me), some posts that I printed off OH and submitted along with the letter, bombard them with all kinds of lapband failure study, etc... Explain your complications. I have a copy but it's on the computer at work and I'm off tll the 17th.
Let me see if i can find the link about band have low marks.
go get them!
246 in Dec 2008 before banded 1/28/09 at 215 lbs, band crapped 9/09 at 170 lbs and struggled with it and regained to 203 revised to bypass on 8/1/11 and am very happy.
Here's the link that's what I submitted when I appealed.
http://www.medpagetoday.com/MeetingCoverage/ASMBS/20919
Also when I posted a question on one of the boards here on OH on how people felt about having band removed and revising and they repleid they feel much better, etc.. I printed them and submitted.
I told them about constant regurguation, 5-10 days of good eating a month ... and people looking down on me whenever I puked at work asking me if i was pregnant, worrying if peopple thinks I'm bulimic or something
http://www.medpagetoday.com/MeetingCoverage/ASMBS/20919
Also when I posted a question on one of the boards here on OH on how people felt about having band removed and revising and they repleid they feel much better, etc.. I printed them and submitted.
I told them about constant regurguation, 5-10 days of good eating a month ... and people looking down on me whenever I puked at work asking me if i was pregnant, worrying if peopple thinks I'm bulimic or something
246 in Dec 2008 before banded 1/28/09 at 215 lbs, band crapped 9/09 at 170 lbs and struggled with it and regained to 203 revised to bypass on 8/1/11 and am very happy.
Forgot to include:
Also show that DS might be cheaper than lapband, maintenance-wise. Costs of fills, doctor visits, etc. How many fills and unfills, etc. Compare costs.
Also show that any of your co mordibities did not resolve. My diabetes, sleep apnea, etc did not resolve ... also had high cholestrol.
Also show that DS might be cheaper than lapband, maintenance-wise. Costs of fills, doctor visits, etc. How many fills and unfills, etc. Compare costs.
Also show that any of your co mordibities did not resolve. My diabetes, sleep apnea, etc did not resolve ... also had high cholestrol.
246 in Dec 2008 before banded 1/28/09 at 215 lbs, band crapped 9/09 at 170 lbs and struggled with it and regained to 203 revised to bypass on 8/1/11 and am very happy.
Not sure of your exact situation, but I have BCBSIL and their policy says DS is only medically necessary if BMI is greater than 50. Even for revisions, it seems to read that you have to meet all criteria for the surgery and then also meet revision criteria, which with the band basically states it has to a complication from the band. Any which way, insurance companies have us cornered sometimes... Sorry to hear of your denial. Hopefully you can appeal and get them to change the decision. Good luck to you!
I will be anxiously awaiting my insurance decision regarding revision to VSG sometime soon hopefully too.
I will be anxiously awaiting my insurance decision regarding revision to VSG sometime soon hopefully too.
Amy
Revision: Realize band to VSG....loving my sleeve!!
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