Insurance denied..Investigative!?

[Guest billiebranham]

Today I received the dreaded denial letter and the reson for denial was, "Is investigative per our medical policy". I hadn't heard this one before. I plan on appealing but was wondering if anyone had any ideas where to start. I appreciate any responses! Thank you!

Billie

[Graceful One 4]

Billie,

I would speak with the insurance coordinator in your office as Inamed is appealing denials on behalf of patients based on the exact same reason.

[Ginger2120 0]

Billie,

I was denied for the exact same reason, but I filed an appeal and insurance eventually covered it. Definetly talk to the insurance coordinator because surgeon's will often write letters and send information from Inamed that supports the fact that the Lap-Band is no longer experimental.

Good luck to you,

Janel

[Guest billiebranham]

Thank you so much for replying! Now I know there is a possibility of this decision being reversed. My doctor just moved to another city the other side of the state and when his office called me they said he is having a hard time getting his practice organized so everything is running behind. Hopefully they will take the time to help me beat this. Thank you again!

Billie

[TraciLJ 0]

Billie:

I just called my docs office to check to see if the psyc eval got there yet. (it hasn't)

Anyway, the coordinator wanted me to know that they recently received a denial from BCBS of MN for the reason that they now consider the LAP-BAND experiemental. The office has enlisted the assistance of INAMED in the appeal.

You may want to check with your doctor's office to see if they're doing the same. And, if they're not, ask that they do.