Insurance Will Not Cover Band Removal

[RoscoePColtrane 0]

Band slipped in October (clearly seen on xray from upper gi). Causing a lot of night time regurgitation issues and various other bad things that come with a slip. Bummer, because I had sustained excellent weight loss for 5 years leading up to this. Dr. wants to remove the band for sure and left the option up to me if we should convert or not. I decided that I should convert to sleeve and they submitted a claim to have the band and port removed and perform the sleeve. It was denied (bariatric exclusion), they appealed and now no one from Blue Cross will even talk to my doctor. Apparently you cannot have a face to face or discuss anyther after putting in one appeal with blue cross blue shield nebraska. I can live with them excluding the sleeve conversion, but I cannot understand why they won't cover removing the band.

Is this common? Anyone else been through this? Do I have any other recourse? Any and all ideas would be helpful at this point.

Edited February 19, 2014 by RoscoePColtrane

[Jerziegirl 42]

I would contact the President's office. That's ridiculous! I would also consider the doctor sending a certified letter advising of the risks showing they outweigh the money spent doing the surgery.

[msmitch 1]

That doesn't sound right to me. I had an emergency band removal last July (2013), and I have Premera insurance. They covered the surgery, and follow up visits with that surgeon / hospital.

My only thought would be that I had my band removal done through a hospital, and not an independent clinic. I am not fluent enough in health care rules to know if that would make any difference, but there are serious health risks when your band has slipped and it doesn't sound right that your insurance would not cover part of that surgery cost.

I has the sleeve surgery in January, and had to pay out-of-pocket to do so. The recovery time seemed longer (but maybe I forgot how long my band recovery process was the first time around), but I am very happy with that decision.

Wishing you the best...