skinnydesires

I finally got my approval:w00t: It has been a long few years of wishing I had the band but not being able to. I finally was at the right place in my life and the insurance company denied me:frown: I sent my appeals letter in and I just got a note in the mail that their decision had been reversed and I was approved! I have been grinning from ear to ear and also crying a bit:tongue: I left a message at the Bariatric Center and cant wait to hear from them on Monday to get the ball rolling again! Thanks for listening:biggrin: And I hope all that are still waiting for a decision get their answer soon. Waiting is awful! Debbie

Awww, thanks guys! I will keep you updated for sure. It is still sooo unbelievable! I am just waiting for the scheduler to call me so we can set a date. I think I will leave message if they havent called me by the end of today. Debbie

Thank you sooo much for taking the time to answer my question. Your opinion and knowledge gives me hope. I was denied a couple weeks ago and I took a break to think about appealing it. Now I have new hope and will go full force to try and fight their decision. I have reviewed UniCares policy on morbid obesity and qualifications for surgery and I definitely qualify. The doctor had written a wonderful letter of Medical Necessity which I do have in my hands and will forward again to the insurance company with my appeals letter. And thank you for the info on the grievance process. I will definitely go that route if necessary. I think UniCare is just hoping people will stop fighting after the first denial. They are dealing with the wrong girl:biggrin: Thanks~Debbie

I have a question for you:smile: Before starting this process I had called my insurance company(UniCare) several times to see if the lapband was covered. I got a couple people saying yes and a couple saying no. I finally had someone fax me any exlusions I had since my policy papers at home included nothing about bariatric surgery. This is what was faxed to me: GENERAL MEDICAL EXCLUSIONS: Treatment for obesity or services performed primarily for weightloss or control(including gastric bypass and gastric staplings): but this shall not exclude procedures that are necessary due to a specific condition caused by another illness or for morbid obesity as determined by the plan. So by the sounds of it, as long as I am morbidly obese, it should be covered. This is how my bariatric center read it also. Am I reading it wrong? I was denied a few weeks ago with the reason that it is not a covered benefit but nobody has been able to give me anything that shows where it is not covered. I just faxed an appeals letter today. Am I chasing something that just isnt going to happen???:redface:

Congratulations! Such a wonderful feeling isnt it?!!

Thank you Cingulus :smile2:

So I have been working on getting the lapband for the last few years(long story) and now I am getting close to having all my paperwork submitted for approval with my insurance company. In the meantime, I am undecided on which surgery to get. I went into all of this thinking I would get the lapband, but every doctor I have spoken with is leaning towards gastric bypass. I KNOW in the end only I can decide, but I would love to hear some thoughts. I love sugar so I am thinking that is why the doctors are leaning towards the bypass. I am, by no means, a volume eater. I am just a little over 100lbs overweight with a BMI of 42. I want to make the best decision for me. I dont want to get the band and have it not help me out. I dont want to go through bypass surgery and rearrange my insides if I dont have to. I am just sooo confused. The more research I do, the more undecided I become:confused: Debbie

Thank you to each and everyone of you who have responded. I really needed people to share their thoughts and experiences and it has helped big time! I have done research and even prayed about my decision and was 100% for the band. My only confusion came when I started having appointments with all the various doctors and they added their input. I have decided on the band. I feel good about it. I dont want to change my mind just because of the doctors personal opinons. Thanks for helping clear my head. Sometimes too much information is not a good thing You guys rock!

So we finally got switched to our new insurance which is Unicare. I was planning on getting the lapband this spring but I got the shock of my life and found out we are pregnant with our 5th baby. So of course, the lapband is on hold till at least the fall. In the meantime I thought I would see if the new insurance would even cover the surgery. There was nothing in the paperwork so I emailed them and just got this response back: GENERAL MEDICAL EXCLUSIONS: Treatment for obesity or services performed primarily for weight loss or control (including gastric bypass and gastric staplings); but this shall not exclude procedures that are necessary due to a specific condition caused by another illness or for morbid obesity as determined by the plan. Is it just me, or did that not really answer anything???!!! I guess I will just have to call them on Monday. Grrrrrrrrrrrrrrrrr:rolleyes:

Thanks guys! I am trying not to get my hopes up so we shall see what they say on Monday. It just irritates me that they couldnt answer my dang question with a straight forward answer. But that is an insurance company for ya! I will definitely get a list of my exclusions because that should have been included with all my original papers. Not sure why they left that out!

Nobody? Well darn it! Now I am just having a conversation with myself:)

So I thought I was making the right steps to get the lapband and now my husbands company will probably be changing insurance plans at the beginning of the year. Since he is with a union everything still has to go to vote, but the company has offered Unicare PPO and so we may end up with that. Does anyone have any experience with that company? I swear I have been working on this for a couple years now and I feel like I am not getting any closer. LOL! Debbie

Oh, and I forgot to mention that I am in Nevada. I know this insurance is based in Texas I think? Debbie

How specific are the CPT codes? I have Delta insurance which includes Anthem BC of CA. Previously bariatric surgery was not included in our plan. We were sent a letter at the beginning of the year stating that it is now included. We just called our insurance company to see if the lapband was covered because I wanted to start the whole process. We gave them the CPT code and they said that it is approved. We then said, "so the lapband is covered right because that is the CPT code we gave you." She then said Ohhhhhhh, no the lapband isnt covered just gastric bypass. Is this CPT code just for lapband or does it cover gastric bypass also? It just seems weird that she said yes we were covered when she looked up the code and then when we mentioned the lapband she said it wasnt covered???? And we did speak with two different people. Any thoughts?:help: Debbie

Thanks Amy. I gave them the cpt 43770 so that is why I thought it weird that they said yes and then when I mentioned the lapband they said no. Boy I love insurance companies. I did speak with our local bariatric center a while ago and they said alot of stuff is changing at the beginning of the year and alot more companies will be including the lapband. So we shall see. But getting a cpt code approval letter is a great idea. Thanks! Debbie