BCBS Fed Employees Program Denied Band Removal as "Not Medically Necessary"

[abraxasbear 16]

Feeling very discouraged today. I called to follow up on the preauthorization for my band removal, and after placing me on hold, the rep came back to tell me they'd decided today to DENY, on the basis that it's "not medically necessary." This, after the surgeon has said it needs to come out as soon as possible.

Apparently a badly dilated pouch, with nausea and vomiting, isn't what they consider "necessary" to deal with. :(

Has anyone had success appealing for band removal, with no revision surgery? Especially with BCBS Federal Employee Program?

[Ivy Verde 68]

I'd fight back really hard on this. Maybe see another physician for a second opinion? The squeaky wheel and all that... if you're relentless, they might remit. I'd call and write to the point of annoyance, personally.

As someone who had massive band complications, I would advise you to get the band OUT, however you have to go about it. It can get worse the longer the band is in your body. I wish you the best. I certainly hope you are able to get the band removed to avoid further injury.