Denied...what should I do?

[kerri76 0]

I got the call from the insurance company today that I was denied. I meet the criteria for the insurance to pay for the Lap-Band in all areas except one. I need hypertension, heart disease or diabetes and I have neither. I am fat (BMI over 50), have high cholesterol and depression. I am only 34 and will eventually get high blood pressure or diabetes if I don;t lose the weight. I told a fellow bander that I was denied and she said that I should go see her surgeon and see if they can get the insurance to approve. Do you think it is worth it? Do you think that maybe I can find a doc that will give me a diagnosis of high BP even if it really isn't? I know that's bad! This sucks, I am soooo disappointed. I was looking forward to starting my weight loss journey and actually being successful. Any suggestions would be greatly appreciated!

[sweetsagi 28]

Im so sorry to hear that. What insurance do you have? Most insurance dont require that you have 2 co-morbidities if your BMI is over 40.

[charms 1]

I would go through the appeals process with your insurance company and get appointed a case manager to help you through the process.

I don't believe that a doctor is going to commit fraud to get you banded, but another surgeon might be albe to work with your insurance company to prove that the band is necessary in your case.

Who is your insurance company? Definately make sure you go the route of the appeals process, it could be that your surgeon didn't cross all the t's and dot all the i's in your referral paperwork.