Access Denied

[DaisyGirl 0]

Well I guess I will not be banded on the 27th. My insurance company denied me.

I am getting a lawyer and will appeal.

Anyone ever get a denial overturned?

Amy

[Alexandra 55]

Daisy Girl, don't give up!! I had a denial overturned by external review in NJ and I know of people who have done the same in NY. Why was your request denied? What was the reason the insurance carrier gave?

[DaisyGirl 0]

Thanks Alex,

It was denied for insuficiant medical notes. and because they feel the surgery is ivestigational.

So now I am trying to get the medical noted that they want then I can work on the investigational part.

How long did it take you to get approved.

Thanks for the reply

Amy

[Marimaru 7]

I was self pay, so I don't know much about the insurance part of all this, but I am amazed that they can deny something as "investigational" when it's been approved by the FDA. These insurance companies are amazing. Do you have any co-morbidities? If you do, maybe you could do some research on the cost of caring for them in the long term. Example, if you have diabetes, the cost of insulin over 10 years or something to show that the band is cheaper in the long run or something. There's a lot of people on these boards who have done the insurance fight. You should be able to get some good help from them.

Good luck

[claraluz 2]

If you are going to get a lawyer, you might think about going to obesity law. It is a law firm that specializes in this sort of thing. I didn't challenge my insurance denial. I just paid for it myself. But now I wish I had at least taken it one step farther.

Nancy

[seanmama 0]

I was also denied amd then appealed the denial myself and got approved. I basically wrote a really long and detailed letter about my obesity history and the related medical and psychological problems, attached a whole bunch of medical records relating to my "comorbidities" and was approved about 3months later.

Good luck!

[seanmama 0]

Also go to the following groups on Yahoo Groups:

BandsterInsurance

Smartbandsters

Venting-bandsters

This is where I got a blueprint for my appeal letter.