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Insurance Denial For Revision -Then, Approval!

misschris

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This is to all those people out there who need revision. KEEP PUSHING YOUR INSURANCE COMPANY! I had a band and had it slip. I had to have emergency surgery to get it removed. After a year, a re-gained 30 of the 80 pounds I lost. My surgeon recommended me for revision surgery to a sleeve, but my insurance denied me. The insurance was trying to treat me as if I was brand new to bariatric surgery. They said that I did not weigh enough! Clearly, I was on my way to total re-gain. It was a gradual, upward trend. I appealed and was denied again. I was about to give up and saw that there was a 2nd level appeal process that went through an outside panel, independent of the insurance company. I sent a detailed, tabbed binder with my medical records prior to the band and after the band with a 2 page cover letter describing my journey and the anguish that comes with failed weight loss surgery. Much to my surprise, they granted approval. This process took about 6 months, but was totally worth it!



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Wow! amazing what they put people through! You would think that they will be willing to help people lose weight, when all the data is there showing how that improves patient's health. Which means, less money spend on medications, Doctor visits, and all other cost that is tied to being overweight... maybe that's the whole point. We are more valuable sick.

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