Anyone approved after an appeal

[pumpkin73 21]

Insurance denied my 1st attempt for revision; band showed no malfunction (although I was vomiting & food was getting stuck. I was hoping for band to sleeve; however latest upper GI says I have a paraesophageal hiatal hernia...reflux is bad. Sleeve is no longer an option. Now my doctors office is going to send an appeal letter for revision to RNY. Bariatric coordinator says it may not be approved just because it is a hernia & may not be band related. Of course, I'm hoping she is wrong. I sit here thinking should have done RNY in the 1st place instead of the band. I am 30 lbs away from gaining my weight back i lost with the band; which was 90 lbs. I'm just frustrated with the negative thoughts of the coordinator.

[ShineBright724 70]

Even though I didn't have a revision or anything I was denied because I hadn't taken prescribed meds for weight loss. I appealed then I was approved within four days. I think it all comes down to the people at the office if they really push for you they will jump through to make it happen

[pumpkin73 21]

Thank you for the reply. I hope I get approved too after the appeal.

[bb00024 21]

I was denied and then denied again with my appeal and then the surgeon scheduled something called a "peer-to-peer" review. That seemed to do the trick.

Apparently, this peer-to-peer review is my doctor scheduling a phone call with an actual doctor from the insurance and my doctor explaining all the problems I was having with my lap-band and that I now have a hernia, which could cause bigger issues.

It worked and I was approved. It wasn't a quick process by any means, but it worked. Between each of the appeals and the doctor review the insurance has 30-days to respond.(Response time could be different based on ins. company rules.)

My whole process was 8-mths long, but I started with one doctors office and changed due to his horrendous staff and poor bed-side manner, so the process started over.

Good luck!!! I am having surgery 09/16th and I am soooooo excited.

[TinyMamiOf3kids 1,280]

I'm glad it's working out now & you have a date.

[pumpkin73 21]

I was denied and then denied again with my appeal and then the surgeon scheduled something called a "peer-to-peer" review. That seemed to do the trick.

Apparently' date=' this peer-to-peer review is my doctor scheduling a phone call with an actual doctor from the insurance and my doctor explaining all the problems I was having with my lap-band and that I now have a hernia, which could cause bigger issues.

It worked and I was approved. It wasn't a quick process by any means, but it worked. Between each of the appeals and the doctor review the insurance has 30-days to respond.(Response time could be different based on ins. company rules.)

My whole process was 8-mths long, but I started with one doctors office and changed due to his horrendous staff and poor bed-side manner, so the process started over.

Good luck!!! I am having surgery 09/16th and I am soooooo excited.[/quote']

Thanks and good luck to you as well!

[pumpkin73 21]

Even though I didn't have a revision or anything I was denied because I hadn't taken prescribed meds for weight loss. I appealed then I was approved within four days. I think it all comes down to the people at the office if they really push for you they will jump through to make it happen

Yes that's true. Hopefully my coordinator sent off my appeal paperwork. I haven't talked to her since last week. So now I'm just waiting.

[ShineBright724 70]

Good luck!!!!! I'm sending you positive vibes!

[pumpkin73 21]

Thank you!!

[pumpkin73 21]

Good luck!!!!! I'm sending you positive vibes!

I got approved. Thanks for those positive vibes : )

[ShineBright724 70]

I got approved. Thanks for those positive vibes : )

Yayyyyyyyyyyyyyyyyyy! I'm so excited for you!!

[pumpkin73 21]

Thanks!!

[sunshinekaye 5]

I was approved after my appeal. I wrote a letter I'm addition to 10 years of paperwork showing when I started having troubles.

[drobinson1 13]

I was just approved for band to rny revision after a peer to peer denial, and cpt code denials. My band is in bad shape..had been for over 2 of the 3 years having it...my surgeon told me I am band resistent..I have an 11cc band but I have me than 4cc in my band, I will be to right causing reflux/GERD issues. I have had hiatal hernia repair, band repositioning, multiple unfills, extreme wright regain...I'm back to my pre band weight... I went to a new surgeon..wonderful lady...very informative..very knowledgeable and willing to help fix what another surgeon did. She requested revision to rny...

After 3 long months of dealing with this insurance company, I have been approved after an appeal...I have my revision 1/16. A week before my birthday. Im excited....im miserable with this band...extra weight..just miserable.....GOOD IS GOOD

[jodie1961 77]

After my approval on band removal, and denial on RNY...my Doc's insurance gal said she spoke w/BCBS and I have to go thru the psych eval. and nutritional classes again. She felt that it would be approved then. Since then the Upper GI showed a hiatal hernia and a small stricture that my surgeon wanted to check out (plan is to do both removal and RNY in one surgery)...so I had an EGD last week and he said the stricture is not big enough to worry about, definitely having bad reflux, he took a biopsy to make sure no bacteria infection in stomach, and nothing too bad to make us do 2 surgeries. I see him again next week, hoping to get all scheduled and on my way soon. Congrats on your approvals! It is such a relief to know that denials can be turned around. Thanks for sharing.