Insurance Question????

Ok, here's the question. My insurance company requires a six month PCP approved diet, egd, medical documentation blah, blah, blah all before they will approve my surgery. Now, my PCP has discussed the surgery with me because I have a long running history of stomach polups. I do have the kind if not removed, will turn to cancer. He has recommended that I go with the Lap Band. When I talked to my insurance company about this, they told me that I had to prove it was medically necessary to have the lap band procedure instead of the bypass. What's up with that? I would think that would be better for them and me. Anyone got any answers? This insurance stuff is driving me nuts.

Well most insurances require that any WLS be medically necessary. I'm thinking the insurance probably wants to know specifically why you couldn't do the bypass instead of lap. A lot of insurance companies are still considering LabBand Experimental. Even though it has been out for a while now. Just my humble opinion on this one.

Hey there Dixie Flower, Your humble opinion was very much appreciated. I talked to Dr. Watson's office today and they told me that he was going to start doing the lapband in November, so I won't have to change doctors. I think that is great. I am pretty sure I won't have a problem meeting there medical necessity requirements since my dr. has flat out told me if the polups are left untreated, then they will turn to cancer. So I guess I will be going with the band. Good to talk to you. Take care.