Appeal?!?

[kerri76 1]

I had seurgery for the Lapband May 2010. I lost 80 lbs and have gained it back plus more. I called my ins and they said that bypass is covered (it wasn't at the time of my band). I have completed all my requirements needed in order to be considered for the surgery but today I found out that the ins only pays for one WLS per lifetime. Will I have a chance if I appeal? The denial has NOT been received yet and I am hoping that it will still be approved based on all the documentation. Any ideas? Thoughts?

[ElleG 394]

I don't think they will. Wait to see you could be right and there is an exception. Good Luck!

[kerri76 1]

You don't think they will approve it?

[SoccerMomma73 1,867]

Typically, unless there are extenuating circumstances, if they say 1 surgery they mean 1 surgery and rarely make exceptions. That said, my insurance had the same clause, I'm a band to RNY revision. My band slipped after I'd had it for 2 1/2 years, I had successfully kept off a significant amount of weight. My insurance paid for the revision because I had a failed band....if I had gone to my doc and said 'I hate this damn thing, take it out and do RNY' (which I actually had contemplated doing cuz I did hate that damn thing!!!) they would not have paid. As miserable as the slip and emergency surgery were, they were actually a blessing in disguise . So it DOES happen!!!! good luck! Fingers crossed!

HW 312, pre-op (lap-band) 294, pre-op (RNY) 255, surgery date 2/11/13, goal weight 154, current weight 219