My insurance comp. said NO to the band..........

[fatgirlnomore 0]

BUT yes to bypass surgery. What do I do? Should I go ahead and get the bypass? Im scared of the bypass to be honest. My insurance company said the band was unfounded.....whatever the heck that means!! They did say I was approved for bypass, but that means I need to find a new surgeon (mine does band only) and get new referrals.

Grrrrrr why cant anything be easy????

Any opinions or advice are needed and welcome.

[Alexandra 55]

My insurance company said/did the exact same thing. I fought, appealed, and finally won on external review. This was three years ago, now, so I'd think it would be even easier to get this absurd position overturned.

What does "unfounded" mean? Your carrier is saying that a procedure approved by the FDA almost 5 years ago is still untested? Bah.

Personally I wasn't going to let my insurance carrier make my medical decisions for me. Based on my health I felt it was better to try the safer, less invasive procedure first to see how far that would take me toward better health. It's a very sound medical position and ultimately convincing to a third party whose decision was binding in my case.

What are your options? You should appeal, absolutely, and Inamed can provide you with information that will support your position. Elsewhere in this section are threads with appeal letters you can read that can give you ideas for yours. Good luck!!

[princess_n_thep 2]

If your approved for Bypass I would try the appeal process and see where it takes you. If they still say no to the band choice, then I would do the bypass. But that is me. You have to make the right choice for you.

[SherryW 4]

I agree with Alex. Start searching around in here, get those appeal letters, have your doc's office direct you to information they have regarding the successes of the surgery and the benefits of that over RNY Healthwise and risk wise etc. Especially if they approve RNY that means their not totally against WLS like some insurances out there. Don't give up...this is for you..you've taken the first step in wanting to have the Lap-band surgery to take better care of yourself for yourself so keep doing the research and work to get it. YOU'RE WORTH IT!

[fatgirlnomore 0]

I just got off the phone with my Health Benefits Advisor. She is looking into it, and I also got off the phone with my surgeon and he said he has tons of info on banding and info right directly from Inamed that he will send off to my insurance compnay.

I am keeping the faith that my insurance company will see they are wrong in trying to decide whats best for me, rather than letting my doctor decide!! Everyone keep your fingers crossed for me please?

I am going to visit family for the holiday and I am not going to let me stressing out over this ruin it.

Happy Holidays!!

[SherryW 4]

Way to go! I'm glad you didn't give up. I've got my fingers crossed for you and I'm sending an angel your way. Have a wonderful Holiday!

[MerryHearted 20]

Good luck! I hope they approve you!

As for the bypass, do research it carefully. It's scary to consider, but there are obviously a ton of people who have been successful with it. Maybe find a bypass-related Yahoo group or chat board where you can read about both the successes and the issues that folks run into. A bypass clinic might also let you sit in on a support group meeting as well, so you can meet people who have had it and listen in on what they discuss in group.

[Pansy 1]

I too recently had my request for lap-band approval denied, and the insurance company was amenable to approving the bypass instead. Thanks

[Pansy 1]

I too recently had my request for lap-band approval denied, and the insurance company was amenable to approving the bypass instead. Thanks to everyone who posted--you've helped me greatly!

Pansy:clap2:

[Pansy 1]

Ew, sorry for that messed up post!

[Sugarbear 2]

why would they approve the by-pass instead of the lapband?? I have read of this several times. Maybe you can explain their reasons to me. I am sure they must be valid but I just don't know what they are. Thanks

[Cindy Krebs 0]

If you wish, look into "mini by-pass surgery"-do a search on the internet. The surgery takes around 30 minutes, per their site, and they even show a video of the entire process! It is an option.