Denied insurance coverage

[Guest Elizabeth]

I am so sad, today I received a telephone call from my surgeon. I was told that my insurance (Blue Cross and Blue Shield of Minnesota) has denied my Lapband procedure because it is too investigational. However, they would cover the open RNY. Not sure I want to go through getting everything disconnected.

[Alexandra 55]

Hi Elizabeth,

I so know exactly how you feel. But the important thing to remember is that you can't let them make your medical decisions for you!! There's no reason to jump ship after one denial, when so many other people have had denials overturned. Here's what happened to me:

My carrier had a blanket exclusion for the band since it was experimental. I was approved for WLS, but not for the band. I appealed, was denied again, and appealed again and was denied again, thus exhausting the appeals process within my carrier.

But my state, like many others, offers third-party review of insurance-carrier decisions. Find out if your state offers such a thing--call your state's department of insurance or visit the state's website to find out. It was a simple process to appeal to the state board, and within three weeks my denial was overturned. My carrier was ordered to pay for my surgery and at least three adjustments.

If you don't want to go through all that trouble, you could just wait it out. It's only a matter of time before the old "investigational/experimental" excuse ceases to hold Water. It's happening more and more often that those denials are overturned.

Don't give up! It may take a while, but you're in very good shape if you've already been approved for WLS. For many carriers that's the hard part. Now you just have to get someone rational to overturn your appeal, and I'm here to tell you that is FAR from impossible.

Good luck, and keep us posted!!

[GeezerSue 7]

Call Don Mills at Inamed. If he can't help, Walt Lindstrom can. They've been through this before. It is NOT investigational, or experimental or unproven. They just don't want to pay.

I understand Walt writes a pretty effective letter:

http://www.obesitylaw.com/

[GeezerSue 7]

Call Don Mills at Inamed. If he can't help, Walt Lindstrom can. They've been through this before. It is NOT investigational, or experimental or unproven. They just don't want to pay.