I'M SO CONFUSED

SO YESTERDAY I FOUND OUT MY INSURANCE DENIED MY REVISION SURGERY ALL TOGETHER BAND REMOVAL AND VSG I CALLED MY INSURANCE COMPANY TO SEE WHATS THE NEXT STEP SO I CAN START THE APPEAL PROCESS AND THEY DIDN'T KNOW WHAT I WAS TALKING ABOUT WHEN I SAID I WAS DENIED AND NEEDED SOME INFORMMATION ABOUT 2ND LEVEL APPEAL I SPKE TO 2 DIFFERENT PEOPLE I REALLY NEED HELP I'M CONFUSED AND DON'T KNOW WHERE OR WHAT TO DO NEXT

The denial letter should have told you how to go about appealing and your insurance co. should have a website that also explains the process, I hope one of these will be able to help you.

i guess thats where i wwent wrong bc i didn't receive the letter just the phone call from my dr office who told me about the denial.

Call your insurance and ask the status!  If they said it is denied as when you will receive the notification.  I was given the news by phone from the doc office also.  When I called to find out why is when I did a verbal appeal and started the ball rolling.

The reason for me was they had gone to a once in a life time policy.

i received the letter it stated its not medically necssary becasue nweight gain or weight plateau resulting from failure to follow the regimen of a diet and excerise recommended after the bariatric surgery would be excluded from coverage for a repeat, reversal or revision of a previous obesity surgery because the second procedure is not being performed to treat a complication or technical failure of the initial procedure

essentially the denial says that since you don't have medical necessity (erosion, slippage etc) to have the band removed then they will not pay for another procedure-do you know if that is indeed the case?  it is very difficult to get a procedure revised when there are no issues-but make sure you don't have any issues...with the band it is a matter of time till you do...good luck...with your journey

i do have issues thats why i was shocked they denied band removal..

Do you have reflux since the band was placed that you didn't before?  Do you have any pains, vomiting, pbing sliming.  You need to report everything and make sure they note it in writing.  If you are too tight get unfilled.  If you can eat to much get a fill.  When I was too tight the did a scope after a upper GI said everything was OK and it showed problems.  If you keep documenting everything you should be able to show complications of the initial procedure.

I got a copy of all my notes and found the tech wasn't recording all the issues I complained of.  I started making sure the RN or PA put all I had told them was wrong in writing.

yes reflux, constipation, pain around the port area, all these issues was after i had the band placed and everytime i get a fill i have to get it it unfilled i haven't had liquid in my band in almost 2 yrs. when i got a fill i can;t digust food well so out comes the liquid..i'm getting all my information together so i can appeal the denial hopefully it works out for me

Than you need to appeal as you do met the current requirements of the letter for surgery.  You need to go over your medical records with your surgeon to make sure they have this all documented and than put together an appeal.

My insurance talked to me on the phone after I asked to talk to a customer service supervisor and she talked to the appeal person who talked to me and the insurance person at my surgery center that verified all medical issues.