State by State Lap-Band Surgery appeal rights link

[foolsrushin772 0]

say, would someone tell me how to move my ladybug?:cursing:

[peg pugh 0]

Having the same problem.I'll let you know what I find out and please do the same for me.Good luck!

[Destined 0]

I'm new here and just starting to do my research. Lap band sounds like it would be great for me. I'm in Florida and have CHP (Capital Health Plan) insurance. Has anybody had any luck with them?

Edited April 30, 2008 by Destined

[NancyL 0]

Has anyone heard of an insurance company giving a verbal approval code and then a denial after surgery was preformed?

[luvmy2dogs 2]

Hi, I'm from VA, and have been going through the approval process with my Insurance Co. BCBS of Georgia since February. What a nightmare. Gary, If you're still out there, I would love some help if you could give it to me. First denial came because they said I wasn't a covered member. Obviously an admin mistake that took about 5-6 weeks. Second denial said I needed a nutritional eval, which I got and Weight Loss Center resubmitted. Next denial came today (several weeks later), saying I needed all sorts of things, that have already been done and provided to them. Ex. Psych eval, letter of necessity, etc.... These have all been given. They are definitely giving me the runaround. All my insurance required from the beginning, was a letter of necessity from the surgeon. So they say... It's been a crazy frustrating ride. Pls. help anyone if you can.....Is there anything anyone can recommend to help me fight them?

[jillissac 0]

Grandview Hospital in Dayton Ohio is a Center of Excellence. I just attended the seminar Thusrday and they mentioned this.

[RfishN 0]

I work at a hospital and have Gilsbar. I am told that Bariatric surgery is "excluded". Is there anyway around it. I meet all other criteria. My insurance will pay for all the results caused by being overweight but not help me fix the root problem. Do I have any chance of coverage? It's funny, but I have learned that a lot of school teachers are covered because their employers want to keep them healthy and working a long time. Why is that focus not also in the hospital setting, where I work?

Please let me know if I should pursue coverage or just pay out of pocket. I need the surgery for my health.:confused2:

[jillissac 0]

I f your insurance has an exclusion...I don't think there is anyway you can get them to pay for it. Your bariatric doctors office may have a suggestion, but paying out of pocket is probably going to be your only choice.

[Melisa1 0]

Hi guys...i dont know if im in the right place to ask this question but...I have UHC ppo. They cover 90% for bariatric surgery. Ive done all my testing. sleep study, ekg, blood, urin, chest xray and endoscopy. Then "today" my surgeons office tells me that i have to have a five year history of having a bmi over 40 or two co morbidities. First of all...why didnt they tell me this at the beginning? and second is this stated in my policy? they flat out told me all of a sudden that it wont be approved by my insurance? This is such a slap in the face. Ive been over weight all my life, my bmi is 40 and i weigh 230 lbs. 5'3". Yes my weight has dropped 5-10 lbs up and down forever but COME ON. thats rediculous! Does anyone have any recommendations or ideas, answers, hope??:rolleyes2:

[MacMadame 81]

My experience is that UHC rarely (if at all) requires a weight history. You should never give an insurance company information they don't require as it is just giving them ammunition to deny you.

[Melisa1 0]

So dont send them my 5 year history? The surgeons office required me to fax them my five year history. Then they said i wouldnt qualify because my bmi hasnt been over 40 for five years straight?? SO thien i called my insurance myself and actually ive called and asked 6 times. not one person found anything in my policy that stated that i had to have a 5 year history of a bmi over 40!!!! what the heck? Im so confused at why the office would tell me that before they even submit to my insurance.?

[martucci 0]

Hi, can you tell me , did medicare pay for all fills also? Thanks so much.

I am hoping to be approved soon.

Karen

[NEWLIFE4BEV 0]

Obesity Law and Advocacy Center - has anyone heard of them?

I am appealing through them (information given to me by my doctor's office) No cost to me or practice. Any information would be appreciated if anyone knows about them. Thanks.

[lisablack 0]

Can you please help me, I need to know if you know the name of an attonery that helps fight the insurance when they say no, and its medicaly nessecery thanks lisa

[mroseharvey 0]

My insurance company denied me saying not medically necessary. I am going ahead and having surgery on a cash basis. Does anyone know if I can appeal the insurance decesion and possibly get reimbursed my cash payment.