Question:
has anyone had to change surgery type because of insurance denial?

recently seen by a physician for the vgb surgery, got all my paperwork together, tests, etc. everything was submitted to my insurance for approval, came back denied because my insurance does not cover vgb but does cover gastric bypass..now i am scheduled to see a new doctor on feb 28, will i hath to go through all the paperwork all over again? help someone please!    — kuteypie (posted on February 27, 2006)

February 27, 2006
Alot of people have their insurance 'choice' choosen by their insurance company. In some cases, they appeal and win That ups to you. The reason alot of compaines are turning away from the vgb is its not very effective. IF thats the type of surgery you want; you would be better off getting the lapband.
   — star .

February 27, 2006
I also had orginally wanted lapband but when I turned into the insurance co for approval they denied it, said they only covered gastric bypass. My wonderful ladies at the insurance co, told me to have the papers resubmitted saying I wanted gastric unstead of lap. I didn't have to see any other doctor.
   — momtoall

February 28, 2006
I was denied for the lap-band also, I got the procedure code from the surgeon and called the insurance company. They didn't even know what the code was! i asked them if Gastric Lap-Band surgery is an exclusion of benefits. They told me if was not and I sent every piece of paper ever given to me by my doctors. i am now waiting to find out whether they are going to approve me or not. Good luck!!
   — debbyg

February 28, 2006
If your surgeon perfoms the covered procedure, AND you want said procedure....your surgeon only need to resubmit with the new procedure. IF you must find another provider, he can obtain the test results from the first provider and submit his own.
   — RebeccaP

March 1, 2006
I was denied in the summer of 2004 due to a written exclusion clause. I went on the hunt for a new insurance. I chose my insurance SPECIFICALLY because it would cover the surgery. I chose non-group BCBS of MI and was prepared to wait the six month pre-existing condition waiting period. I was approved four months after coverage began and had my surgery in October of 2005. My insurance paid 100% so it was worth paying out the nose for a few months for the coverage!
   — L S.