Question:
Approval for Open RNY/Denied for Lap?

I got approval for surgery in the mail, but the next day I got a denial for the lap. Does this mean I'm approved for open? Is the issue the cost? Doesn't it cost more to stay in the hospital the length of time it requires for open, vs the savings of going home earlier after lap?    — Debby M. (posted on June 30, 2002)

June 30, 2002
My insurance company also initially approved me for open and denied me for lap. Their viewpoint was that in the morbidly obese patient, lap presents more risk than open. True or otherwise, that was what I was told. Now, my surgeon does the procedure both ways. After speaking to him about the pros and cons of both, I CHOSE open rather than lap and here's why. Being 150 lbs. overweight, I wanted the procedure that my surgeon was most comfortable with. He required the same amount of time in the hospital regardless of which procedure you had done. The length of time under anesthesia was actually a little longer with the lap surgery. They also inflate your abdomen with gas during the lap procedure and I was warned that I would have some additional tightness and pain from the gas. Now, I'm sure that folks who had lap will come on here and disagree with everything I've said so......let me repeat.......this was the logic behind MY choice based on the information available to ME at the time of my surgery. My insurance company later changed my approval to include lap surgery but I still went with the open procedure. You may want to call your insurance company and ask why you have been approved for one but denied for the other. It may be something as simple as cost or as complex as what your doctor is certified to perform. Good luck, either way!
   — Pam S.

June 30, 2002
I would appeal and get your doc to write a letter that LAP will save insurance money because of fewer in hospital days and 30% of opens get hernias requiring yet ANOTHER surgery, that will cost them $$$. Good luck. LAP incisional hernia risk is near zero...
   — bob-haller

July 2, 2002
debby my dr sent mine inas lap i got denied. i called ins myself and resent that day and received approval same day for open only i didnt ask questions iwas just happy to get approved. but every company is different. good luck with ur journey amanda surgery date 7/22/02
   — amanda W.