Gastric Sleeve Surgery Appeal Denied - Soooo Disappointed

[want2bthin 93]

Just heard from United Healthcare that my appeal has been denied for a revision to VSG. They already approved the Lapband removal but not the revision. I don't have the paperwork yet but the coordinator said their response was several pages long but amounted to that they felt I didn't have success with the Lapband so would not have success with another restrictive procedure. I feel there is no comparison to having VSG vs. Lapband and I explained that in my appeal letter (which was 42 pages in total since it included years more of medical records).

I'm told my next step is to submit for a Level 2 appeal which will be reviewed by my employer (a major corporation).

I'll post this on the Insurance forum too but am just hoping for some encouragement and advice from others who may have been through the same thing.

Thanks.

Susie

[want2bthin 93]

Just heard from United Healthcare that my appeal has been denied for a revision to VSG. They already approved the Lapband removal but not the revision. I don't have the paperwork yet but the coordinator said their response was several pages long but amounted to that they felt I didn't have success with the Lapband so would not have success with another restrictive procedure. I feel there is no comparison to having VSG vs. Lapband and I explained that in my appeal letter (which was 42 pages in total since it included years more of medical records).

I'm told my next step is to submit for a Level 2 appeal which will be reviewed by my employer (a major corporation).

I've posted this on the band revision forum too but am just hoping for some encouragement and advice from others who may have been through the same thing.

Thanks.

Susie

[wishes 125]

I am so sorry. Don't give up though!

[Becca 108]

I went through the same thing. DON'T GIVE UP! Keep fighting. My doctor submitted the final appeal, so I am not sure what the doctor's office said to get it approved. I did have lots of band complications that may have played into them finally approving. Are you seeing a revision specialist? Specialist have the data to back how successful the sleeve is after a revision. That is total BS about not being successful with the sleeve after the band. The band never worked for me. Now with the sleeve, I have been 100% successful. The insurance company thinks they can bully you by denying. You need to ask to speak with someone and let them know you plan to keep fighting this. I get so mad with these insurance companies! It is not our fault that we were "sold" this story of how great the band is. Just don't give up. I called the insurance company a couple of times a week for about three months until they approved me. I let them know I was not going away. Hugs!!!! I pray that your Level 2 appeal goes through. The sleeve is worth fighting for.

[FXDF2008 14]

I'm just starting my revision journey due to erosion so haven't been down your path yet. Just wanted to wish you the best of luck in your next appeal. Keep fighting!

[want2bthin 93]

Thanks for the encouragement. I intend to keep on fighting. I saw my Primary Dr. again this morning and he is going to write a letter for me to send

with the second appeal. I'll also get in touch with my surgeon's office next week and press them to drive the appeal this time instead of me.

Happy Thanksgiving everyone!

[want2bthin 93]

Thanks for the encouragement. I intend to keep on fighting. I saw my Primary Dr. again this morning and he is going to write a letter for me to send

with the second appeal. I'll also get in touch with my surgeon's office next week and press them to drive the appeal this time instead of me.

Happy Thanksgiving everyone!