Walter

Before appealing on your own or having your surgeon appeal remember that if you are getting an Allergan LAP-BAND® our office works in conjunction with you and your surgeon's office to handle LAP-BAND appeals at no cost to you. You get the benefit of our 13 years of experience handling bariatric surgery cases (not to mention any personal tidbits I can offer having had an open gastric bypass in 1994 followed by a LAP-BAND® in 2003!) You should contact your surgeon about getting an Appeals Program application before doing anything else since we can only take these cases on at the time of the first denial.....in case you're wondering, our success rate in 2008 with this program exceeded 92%. Hopefully we can help you or others in your position overturn that denial. Good luck.

My name is Walter Lindstrom and our site information is Obesity Law and Advocacy Center. I am a "banded gastric bypass patient" meaning I had gastric bypass in 1994 and a LAP-BAND placed over it in 2003. I know what you're going through. If you are having a LAP-BAND (as opposed to a REALIZE Band) you may qualify for Allergan's LAP-BAND appeals/advocacy program. There is NO COST TO YOU for this program. Here's how it works, and it's really pretty easy: 1. Please contact your LAP-BAND surgeon's office and ask them to get an Appeals Application for you. They get it through a provider hotline number. You are not able to get the Application on your own; the surgeon's office must be the ones to start the process. IF YOUR SURGEON'S OFFICE DOESN'T SEEM TO KNOW ABOUT THIS APPEALS PROGRAM (SOME PRACTICES ARE LESS AWARE OF THIS GREAT SERVICE THAN OTHERS), PLEASE HAVE THEM CALL OR EMAIL KELLEY BROWN LINDSTROM AT (619) 656-5251 (KELLEY@OBESITYLAW.COM) HERE AT OUR OFFICE FOR MORE INFORMATION. 2. Once they get the Application, follow the instructions on that packet. They can help you fill it out (it really is quite easy) and then either you or the surgeon's office FAXES us the application and the supporting materials we need. That all needs to be done within 2 weeks of the application being received by the surgeon's office so we are sure that there's ample time to appeal on your behalf. 3. The faxed information comes to us electronically (no paper is used/no trees destroyed!). We review the information and notify you and the surgeon's office that you have been accepted into the program or if we cannot take the case, we'll let you know why. From the looks of what you gave us in the online form you just sent I see no reason we cannot accept it. If, for whatever reason you may not be accepted into the appeals program or this type of denial does not qualify for that program, we can then discuss whether you should hire us directly. I'm confident we may be able to help.

Someone told me about this thread...don't forget that if you were denied LAP-BAND Surgery we handle those appeals under an agreement with Allergan under a special program at no cost to you or your surgeon's office. Hopefully we'll get the chance to get you approved - in 2007 our rate for the program was over 87%. Good luck however you decide to move forward!

Sorry to hear about the UHC problems...happens a lot more than you would ever believe. Don't forget to ask your surgeon about the Allergan LAP-BAND Appeals Advocacy Program....it is free to you and them and takes the burden off you and makes sure that your appeal is the best it can be. Good luck to you however you decide to pursue things!

If you have coverage for weight loss surgery but were denied by your payer because they didn't agree it was medically necessary, or your BMI was too high, or you weren't morbidly obese for 5 years, or they didn't like your supervised diet documentation or they will pay for a bypass but not a LAP-BAND, did you know Allergan sponsors a program where you can have your appeals handled professionally at no cost to you? Your surgeon can get you an application for that program and we will be able to help you get through this. Our success rate in 2006-07 with this program approaches 90%. Don't get discouraged and don't pay cash until you have to. FIGHT! Walter Lindstrom Obesity Law and Advocacy Center Gastric bypass - 1994 LAP-BAND - 2003 Weight less now than since junior high school thanks to my LAP-BAND!

Hi folks: hope you're doing well for this holiday weekend. I wanted to remind all you potential LAP-BAND folks having (or expecting) trouble from your payer that there is a FREE APPEALS PROGRAM available to you if you have been denied your LAP-BAND and as you get closer to the end of the year, when insurance changes for many of us, you could possibly be making a big mistake by not being more aggressive in fighting your insurance company now - especially those of you who are in the process of trying to do their six or 12 month "supervised diet." Remember that if your insurance changes to an exclusion or coverage is somehow limited while you are in the middle of this "supervised diet," you've possibly hurt your chances to get an approval. You certainly should continue on that diet program, but we urge you/your surgeon to get your submission into the payer ASAP (that means NOW <grin>) so if you are denied, your appeal can be filed and you can be sure coverage exists....too many folks email us in December or January when it could be too late complaining they didn't know their insurance was going to change....please don't wait...you have nothing to lose by moving forward now and everything to gain! Good luck!

In addition to hypertension. obstructive sleep apnea, type 2 diabetes etc. there are a number of other co-morbid conditions which payers find relevant and which you should report to your doctor. GERD (gastroespohageal reflux disease), Urinary stress incontinence, hyperlipidemia/hypercholesterolemia, degenerative joint disease, low back pain, shortness of breath with exertion (exertional dyspnea), asthma, gallbladder disease, lower extremity edema (swelling), venous stasis (The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin)...talk to your PCP about all of these. Good luck and don't forget there are possible free appeals available to you if your LAP-BAND is denied. You DO NOT have to jump through all the insurance company hoops before getting approved!

For the past couple of years our office has been contracted by the manufacturer to handle certain types of LAP-BAND denials. Pretty much any kind of denial other than a direct contract exclusion is eligible. An application is obtained by your surgeon, filled out by you and submitted to us. There is no fee to you. We've gotten hundreds of LAP-BANDs approved through this and encourage you to consider that option before shelling out your hard earned money on a cash pay or financing alternative. Just a thought. Good luck!

Good luck! But if you're denied, be sure to have the doc submit you for an Application into the Allergan appeals program....it costs you ZERO and we can help you get approved if GHI (as they sometimes are) is a "jerk."

Starting, continuing and finishing the program cannot hurt you; waiting for that to occur before submitting the request for surgery is what can hurt... if the program/practice gives you a hard time about "hoop jumping" you can refer them to me . . . we've taught bariatric practices those skills for years and can help them to help you. Good luck!

No doubt some practices are better at the insurance game than others....but here are some bad things they can and do happen by waiting when you DO NOT HAVE TO WAIT: (a) your insurance changes its requirements to become more stringent; ( your insurance changes and ELIMINATES COVERAGE for weight loss surgery; © your hospital abandons its program; (d) you are successful at weight loss and they deny you because you were successful; (e) you were unsuccessful at weight loss and they deny you because you "were not committed"; (f) you suffer physical injury due to your weight and co-morbid conditions that prevents you from having surgery.... we've dealt with all these problems and they are no fun for patients.....that is why you should start/continue the weight loss program but get the practice to submit to the payer right away and NOT WAIT until the 6 months is over . . . too many bad things can happen. Just some things to consider....best of luck to you!

Why isn't your surgeon making use of the FREE LAP-BAND Appeals program? We can assist you with appealing to BCBS AL and/or BCBS NC - having had success with both! You should talk to them about that program. Walter Lindstrom LAP-BAND APPEALS ADVOCATES (A PROGRAM OF Obesity Law and Advocacy Center)

Good luck! Some thoughts about the "I" word (Insurance) Either continue or START a medically-supervised weight loss program as that helps both medically and for coverage. If you are denied all patients should PLEASE REMEMBER that there is a FREE (to you) appeals program available through your LAP-BAND surgeon's office....we'll be happy to help you if we can. Walter Lindstrom LAP-BAND Appeals Advocates (A Program of Obesity Law and Advocacy Center) LAP-BANDED RNY Gastric Bypass patient (May 2003)

If your insurance covers weight loss surgery but you have been denied, there is an appeals program that is of NO COST to you as a patient that you definitely should take advantage of. Contact your surgeon's office about it. If they do not know about this program (although they should!) they can contact our office to learn about this vital resource for patients seeking out the LAP-BAND. Good luck! Walter Lindstrom www.obesitylaw.com LAP-BAND Appeals Advocates, a program of the Obesity Law & Advocacy Center