Denial Band to Bypass

I am at my wits ends. My pre determination of benefits were denied. My doctor did a peer to peer review this morning and it was denied. I filed an appeal as soon as I got the denial call. The reason I was denied was because my current EGD shows no sign of erosion, slippage, or reflux. I wrote a pretty lengthy letter and faxed to the insurance company. The letter detailed all the issues I have had with my band over the last two years. I have had horrible reflux and port pain. I faxed over 132 pages. Yes I know that's a lot. Has anyone had to appeal?

Sorry to hear this. I did not have this experience. For my husband's surgery, our doctor had to do a peer to peer review. She had to get the procedure approved because he didn't meet requirements because his BMI was too low. She had it approved because of the reflux and bleeding ulcer he had developed because of the band. Maybe your doctor could try again and use a different approach. Good luck!

I had to have emergency lap band removal in February because of major slippage that was cutting off my small intestines. The dr told me the conversion approval shouldn't be a problem because the band failure was not my fault and I was very successful with it. I just got my denial today and I am so pissed! I have gained 20 pounds in the past 2 months after being stable for 11 years! Now we have to go to peer to peer challenge. Wish me luck.

Good luck. I would love to be updated on your story.