Lap band removal-approved,but RNY denied

[jodie1961 77]

Finally heard from my insurance company Anthem BC BS. They approved my lap band removal (out-patient) and denied my RNY bypass (in-patient). They were actually both requested as one surgery and in-patient. It has been 5 years since the lap band was put in. They said I had no current documentation of other required classes or current psych evaluation...and then it stated that the by pass was not medically needed because I had weight loss surgery before (lap band). But, because of my trouble with the lap band, they were approving the removal of the band.

When I spoke w/the insurance person at the Doctors office, she said that what they meant was I have to go thru the 6 mos of dietary classes and a new psych evaluation before they will approve.

Does this sound right, has anyone else gone thru this? I just wondered, will I go thru the classes again, etc and still be denied? I am feeling a bit un-nerved now. The surgeon wants to wait on the removal to do as one surgery in a few months. Won't I have to re-request the removal again with it being months later and a new year?

[Mid West 99]

Oh dear, that's rough. I had my band removed and RNY done on 10th October. I'm so glad they did it in just one operation (one recovery period etc.)

I'm self pay as we don't have health insurance as you know it, over here.

Can you/your surgeon appeal that decision?

[jodie1961 77]

Haven't gotten a chance to talk to him yet. Just the insurance person. I would think they could appeal it, but it the criteria needs to be met i.e. dietary classes, etc, I don't mind doing it. I just don't want to put off the removal, go thru the classes, wait 6 mos and have them deny me again.

I will get thru it, just another something to go through....always something. But, I am feeling better now that the band has been un-filled.

I have followed your posts as well, and have to say I hope you find some answers soon yourself. Has to be frustrating to go through all of this surgery, etc to not feel like you have any tools to help you lose the weight. And I know the weight is something we all have fought so hard. I will be 53 this coming year, and now I am thinking I wish I had not given up so easily 4 years ago....just lived w/the problems from the band and regained what little weight I ever lost. I want to be healthier before I get so old it doesn't matter anyway!!