Need Advice on Appealing BCBS

[lmpope825 0]

I got the labband in 2007. Had had some success with it, lost and have kept of right at 60 lbs. I have struggled with the usual problems that come with the band, heartburn, acid reflux etc. Well it was determined about three weeks ago that my band has slipped. The Doc recommended removal and revision to RNY. It request was submitted to BCBS for approval. Received a copy of the letter, and they have approved the removal but not the revision. I do not meet the criteria now. I have worked hard to losse this weight and try to keep it off, and I know without the band or something I will gain all of the weight back. I have been unfilled and it is already starting to happen. My lapban surgery was with a diffrent insurance not BCBS so it would be my first WLS with them.

The criteria says that I have the diagnosis of morbid obesity for a period of 2 years prior to sugery, duh, I had the band and got my weight down;

My bmi is now 33, so still suffer from obesity but not morbid obesity with a comorbidity

I no longer have a problem with blood pressure like I did before

I am no longer borderline diabetic

I still need to loose about 50 lbs

Has anyone else had this problem and how do you fight it?

Thanks,

Laura

[TxDumplin 69]

I would say get your dr to write a letter to them explaining why the surgery will benefit you. Submit it again.