Lapband removal denied

[bb00024 21]

Has anyone experienced that your RNY surgery is approved, but insurance denies to cover the removal of the Lapband. I can't have the RNY with the Lapband still inside me, so it doesn't make sense to me. However they approved the RNY. I have appealed and they still denied the LapBand removal.

[SoccerMomma73 1,867]

Are you having and negative issues with the band? Heartburn, pain, anything????? Mine was approved because I had a slip. I come up with every issue you can think of and talk it over with your surgeon. (Also, if he's doing removal at the same time as RNY you could pay cash for that portion....not a clue how much it would be though )

Good luck!!!!!!!

HW 312, pre-op (RNY) 255, current weight 217.2

[HeroOfThisStory 24]

My insurance company has "revision" guidelines for WLS as a completely separate benefit so that may be something to look in to.

[SoccerMomma73 1,867]

The irony of being approved for RNY but unable to get your band removed is killing me.....I'd be developing severe abdominal pain NOT THAT I'D EVER SUGGEST YOU LIE!!!!!

HW 312, pre-op (RNY) 255, current weight 217.2

[Ms_Kb718 22]

How can they possibly find the RNY medically necessary but not the band removal? That makes no sense! You can't have the procedure that they determined is necessary if you still have the band. It's usually the other way around and the band removal is approved, but the RNY is denied. My insurance company took a total of 2 weeks to approve my surgery. I later found out that the band removal was approved in 2 days, but the rest of the time was spent gathering more info and determining whether or not the conversion to RNY was medically necessary.

Insurance companies are full of it. The sad thing is that because it's 2 procedures in one, the insurance company probably won't even have to pay that much for the band removal. Do you have the option for an external review? My insurance offers an external review if your appeal is denied.

[bb00024 21]

How can they possibly find the RNY medically necessary but not the band removal? That makes no sense! You can't have the procedure that they determined is necessary if you still have the band. It's usually the other way around and the band removal is approved' date=' but the RNY is denied. My insurance company took a total of 2 weeks to approve my surgery. I later found out that the band removal was approved in 2 days, but the rest of the time was spent gathering more info and determining whether or not the conversion to RNY was medically necessary.

Insurance companies are full of it. The sad thing is that because it's 2 procedures in one, the insurance company probably won't even have to pay that much for the band removal. Do you have the option for an external review? My insurance offers an external review if your appeal is denied.[/quote']

Well, great news. I met with a new surgeon and he agreed to do the revision and not charge me for the Lapband removal. Therefore, I am all set and ready to countdown to my surgery. I hope to have a tentative date set ASAP. Crazy insurance......

[Ms_Kb718 22]

Congratulations!

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[kiwiladydee 402]

Congrats!

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[ElleG 394]

That is the craziest thing, but I'm glad the doc is working with you he will make his money on the revision Best Wishes!!