Looking Up

In case anyone is reading this thread, I just wanted to provide an update on what happened with my insurance company. I submitted a grievance form noting all the reasons why the adjustment/fill is necessary. And then my doctor's office submitted in writing a request for pre-certification. They initially denied the pre-certification on the phone. I say don't accept a phone denial, get it in writing. After about 3 weeks we got notice that they were going to approve the adjustment/fill. Hallelujah!!! :coolgleamA: I think the problem with my insurance was that they just started to cover the lap-band as of January 2008 and they either were not familiar with the fact that there are adjustments/fills that go with it. Either that or they just didn't have it in their system yet or hadn't trained/educated their reps on it.

Has anyone had this problem and been successful in getting the insurance company to overturn their decision? I had my lap-band surgery pre-approved and had the procedure done on March 3rd of this year. I will be ready for my first fill on April 22 and have an appointment all set. When my doctor's office called the insurance company (Unicare), their pre-certification people said adjustments/fills are not covered!!! Say what????? I don't get it.... you can approve the surgery, but then leave me hanging there? I sort of feel like what if I were a patient having breast reconstruction following a mastectomy.... have you seen some of those surgeries? Sometimes they put in delated implants and have to fill them up once they are in place? So if I were one of those women, would they say we'll cover the surgery to put them in, but not to have them filled and be willing to leave me hanging with empty bags in my breasts? Back to my original question... anybody have this problem with their insurance company and if so, were you able to get it overturned and how did you do that?

Got my first fill today. I'm kinda hungry - havn't had anything to eat yet. Thinking of going to the local Juice It Up and have a smoothie made, but not sure if this constitutes a true liquid (maybe I just have to stick to juice and broth). Can someone help?:glare:

Thanks for your responses. I wouldn't be balking so much if my doctor is charging me $100, $200 or even $300 for a fill, but they are going to charge me a whopping $800!!!