Denied...

Hi Sheila,

As a three time revision myself, I had to appeal a decision. First I had a band. It prolapsed and I wanted a revision to sleeve. They turned me down saying they would remove the band but they wouldnt give me a sleeve. I fought it out and they did. The sleeve to RNY was medically necessary but I had an exclusion for bariatrics. Since I had a hernia and chronic GERD, it was presented with this procedure code to go from sleeve to RNY.

Appeals can be won especially if there was misinformation or omission.

"Appeals can be won especially if there was misinformation or omission."

YES!!!! Thank you so much!

Don't give up hope. It took me a year and 3 denials until I was finally approved for a band to bypass revision. You had two faulty lap bands and the insurance company needs to know this. They were removed due to mechanical failure not your failure.

Good Luck and don't stop fighting.

Thank you! I won't!!

I have no advice or experience, but just wanted to let you know I'm sorry you are going through this. Just for the sake of us having the same name and initial, I'm sure you will succeed! I did a double take when I saw your name!

Hang in there, I hope it gets resolved soon.

I have seen your name a few times as well! Thanks for your kind words! I did hear from my case manager and my surgeon is going to set up a peer-to-peer with the medical director of my insurance company - so, looks like it might take a while longer to get resolved, but peeps are on my side! :-)

I was denied 4 times for my revision. The insurance company tried to run circles around me. I never gave up. I had a VBG that was slowly killing me. I came at them armed with piles of records and notes to prove my point. It took a year of daily phone calls to my insurance company before they finally approved my revision to RNY.

Get your ducks in a row and DON'T GIVE UP! I think insurance companies expect you to get tired of the fight and give up. They'll try anything to not pay for your healthcare.

I HATE INSURANCE COMPANIES!!!!!!

According to HIPAA regulations, you are not required to disclose self-pay procedures. Just FYI.

(This is a pretty decent article explaining the provision.)