Help getting approved?

[Sara.G 2]

I have an appt next week with a surgeon to discuss revision surgery- the removal of my lap band and revision to gastric bypass. I have Anthem BC/BS and I was wondering if anyone was aware of anything I should say or point out or discuss that may help my chances with getting approved? Thanks in advance for any suggestions

[jodie1961 77]

Hi Sara G....I have BC/BS Anthem. I just got approved for lapband removal and revision to rny bypass. It took a bit longer because they approved the removal and denied the rny bypass first time. After communication opened up between the dr office and insurance, it was approved this past week. You should have no problems. If you do have a partial denial, make sure YOU call and ask the insurance company what you need to do next. The doc office misunderstood in my case and had me spend 2-3 months extra doing things not needed. When I finally spoke to the insurance company (and asked for a supervisor) I found out what they wanted. So stay proactive on your case if need be. And...good luck on your journey!

[Sara.G 2]

Thanks so much, I'll make sure to advocate for myself I'm worried about them saying the revision isn't "medically necessary" bc my band hasn't slipped or anything. I've gained almost all my weight back and I'm always throwing up. What was your situation? Also, are they going to remove the band and perform bypass at the same time? Thanks so much for your help!

[jodie1961 77]

My band worked great at first, but almost a year into it, I kept getting stuck. Then I had my gall bladder out, my lap band surgeon did the gall bladder. ( When I awoke, he told me he thought the band had slipped, so he completely took off my band and repositioned during the gall bladder removal. I had to go thru the whole shebang again, Clear liquids, full liquids, pureed, etc. My band never gave me any restriction after that. Had a 10cc band with 10 cc's and no restrictions. spent about 6-7 months trying to adjust to work. After 5years of getting food stuck on top of the band and having to go to the bathroom to throw up the stuck food, I went back and asked to get it removed. The rny bypass was something I decided on after making my mind up to get the band out. I am so glad to be on track now, looking forward to seeing the surgeon 5/2/14. Hoping to have surgery before June 1st or after July 15th. Coworker will be out with new baby in the middle. Good luck on your approval, and keep on them.

Keep us posted on your progress, it is always nice to share and have someone in your corner!

[mgolden1984 13]

I'm doing the same and have anthem my Dr said I could call and ask for a case manager to help me get approved. I will be calling let me know how it goes for u and I'll let u know as well

[addie1978 5]

I have anthem and was approved for removal of the band and revision to RNY. My surgery is in a week. I had to go for a year for fills/unfills documenting that my esophagus was having severe spasms all the time and I developed severe acid reflux and achalasia (I had to have an endoscopy and motility study). You have to prove the band failed (in other words, it didn't work because something was either wrong with the band or it cause complications of some sort). After my year of documentation and my studies, all of the paperwork plus a letter of medical necessity was sent to anthem and I was approved almost right away. I think anthem is pretty good as long as you have enough proof that the band actually failed or caused something serious, and the surgery is medically necessary (everything has to be medically necessary). Oh, and I had to have another psych exam - I was just honest and luckily I was cleared.

Edited June 5, 2014 by addie1978

[dawn1982002 0]

Hey Sara.G were you ever approved? I have the same insurance. Going for my first consultation on friday