Lapband to Bypass - Insurnace Woahs

Hi Everyone!

(I did post this on the insurance message board but wanted to try here too)  I need as much advise as i can get!!

I am hoping for some help.  In 2005 i got the lap-band which i self paid for.  Back then the doctor i had really didnt have any type of program like most places have now.  Well in February i started a great program in hopes to get a revision for Gastric Bypass.  I passed the program with flying colors and everyone thinks i am a great candiate for the bypass.  Well insurance has denied me because i was not complianet with the lap-band.  What it comes down to is that on one note that my doctor took it stated that i admitted to not following the nutrition guidelines even though i came back month after month nothing else was reported that i had changed and started following the guidelines.  Considered i was self-pay i dont see how its relievant to what i did back then but again its insurance and they dont want to spend the money.  This was 7 years ago a lot of things have changed including me.  I was wondering if anyone has gone through this or has any tips for me.  A couple people have suggested getting a lawyer but i  just dont know.

I would certainly appeal and explain that you were still in the learning how and what to eat stage and that you've adjusted your eating patterns by now and that one bad report shouldn't condemn you to a life suffering from the band. We are now learning that the band is very dangerous for some people and in fact causes weight gain if too tight or not working correctly by forcing us to eat whatever garbage will go down. Maybe include a report from the recent group to show your change in behavior. If you do go the lawyer route check out ObesityLaw.com they sometimes help out. Also my surgeon had a special person who did nothing but deal with insurance issues so see if yours does. I wish you luck, it may take time but don't give up!

Hmmm. That makes me sad.
I am getting ready to submit to insurance myself for band to bypass.
What was your insurance company?
My doctor's office says that there are three levels of appeals.

Have you appealed yet?

definetly ask for a appeal and ask for a peer to peer phone call to your dr where your dr can discuss why he thinks you would be a good candidate.

you only have so many days to appeal after you get denial so start working on appeal and your reasons.

most insurance have a form so call the insurance and get the form or find out out to access online



Tamara