Denial

[Brttnyj89 30]

I am at my wits ends. My pre determination of benefits were denied. My doctor did a peer to peer review this morning and it was denied. I filed an appeal as soon as I got the denial call. The reason I was denied was because my current EGD shows no sign of erosion, slippage, or reflux. I wrote a pretty lengthy letter and faxed to the insurance company. The letter detailed all the issues I have had with my band over the last two years. I have had horrible reflux and port pain. I faxed over 132 pages. Yes I know that’s a lot. Has anyone had to appeal?

[GirlShrinking 110]

I am at my wits ends. My pre determination of benefits were denied. My doctor did a peer to peer review this morning and it was denied. I filed an appeal as soon as I got the denial call. The reason I was denied was because my current EGD shows no sign of erosion, slippage, or reflux. I wrote a pretty lengthy letter and faxed to the insurance company. The letter detailed all the issues I have had with my band over the last two years. I have had horrible reflux and port pain. I faxed over 132 pages. Yes I know that’s a lot. Has anyone had to appeal?

They want people to jump through the hoops.. I know someone that had a similar problem (she’s in the process of getting revision to the sleeve) her doctor had to write a letter of necessity and submit documentation from the time she got it until today. There are a lot of people coming back from lap band having similar issues as yours...acid reflux and tolerance to certain foods.

I hope you get a resolution... acid reflux is not fun! [emoji57]


[emoji991] Instagram: milaalmodovar
[emoji317] SC: almodovarmila

[Brttnyj89 30]

1 hour ago, 1Mila said:

They want people to jump through the hoops.. I know someone that had a similar problem (she’s in the process of getting revision to the sleeve) her doctor had to write a letter of necessity and submit documentation from the time she got it until today. There are a lot of people coming back from lap band having similar issues as yours...acid reflux and tolerance to certain foods.

I hope you get a resolution... acid reflux is not fun!


Instagram: milaalmodovar
SC: almodovarmila

I have been an emotional wreck with this. I have reached out to a lawyer this morning. I read about them on here, Lindstorm.

[GirlShrinking 110]

I’ve heard good things about them. Good luck with your approval process. Time will tell for me.. I’m not a 100% sure I’ll be approved for surgery but so far it looks like it’s in my favor.


[emoji991] Instagram: milaalmodovar
[emoji317] SC: almodovarmila

[Brttnyj89 30]

2 hours ago, 1Mila said:

I’ve heard good things about them. Good luck with your approval process. Time will tell for me.. I’m not a 100% sure I’ll be approved for surgery but so far it looks like it’s in my favor.


Instagram: milaalmodovar
SC: almodovarmila

I talked with Kelley today and I’m very happy with how she thinks things will go! They are very knowledge and I feel that they will be well worth the money.

[GirlShrinking 110]

I talked with Kelley today and I’m very happy with how she thinks things will go! They are very knowledge and I feel that they will be well worth the money.

How did everything turn out ? Or does it take time for the whole process to submit?


[emoji991] Instagram: milaalmodovar
[emoji317] SC: almodovarmila

[Brttnyj89 30]

10 minutes ago, 1Mila said:

How did everything turn out ? Or does it take time for the whole process to submit?


[emoji991] Instagram: milaalmodovar
[emoji317] SC: almodovarmila

Never heard back from them! So I'm taking a different approach! I'm going to pay out of pocket for my band removal.

[GirlShrinking 110]

Best of luck with everything.. I hope everything goes in your favor


[emoji991] Instagram: milaalmodovar
[emoji317] SC: almodovarmila

[Debbir 5]

I am at my wits ends. My pre determination of benefits were denied. My doctor did a peer to peer review this morning and it was denied. I filed an appeal as soon as I got the denial call. The reason I was denied was because my current EGD shows no sign of erosion, slippage, or reflux. I wrote a pretty lengthy letter and faxed to the insurance company. The letter detailed all the issues I have had with my band over the last two years. I have had horrible reflux and port pain. I faxed over 132 pages. Yes I know that’s a lot. Has anyone had to appeal?

Sadly .... you sound like me . It all sounds familiar. I dont know how much more fighting with the insurance company I can do. I’m emotionally and mentally exhausted!!! My surgery is set for May7 and I’m on day 5 of my 2 week liquid diet. I havevto continue in case they approve it ( I know they won’t ) and if they do ( that’s a big if ) it probably won’t come back before the 7th. For now I’m in limbo !!!! Both my surgeon and I requested an accelerated appeal. I’m truly exhausted !!!!!

[Brttnyj89 30]

3 hours ago, Debbir said:

I finally found a way around mine. I'm having to do self pay for my band removal, then my surgeon will submit everything back to the insurance company for RNY. It's a bit of a lengthy process but worth it. I had to find a surgeons office that would look at my insurance policy and find a way to get this done. The surgeon I started with refused to do anything beyond a peer to peer.

Sadly .... you sound like me . It all sounds familiar. I dont know how much more fighting with the insurance company I can do. I’m emotionally and mentally exhausted!!! My surgery is set for May7 and I’m on day 5 of my 2 week liquid diet. I havevto continue in case they approve it ( I know they won’t ) and if they do ( that’s a big if ) it probably won’t come back before the 7th. For now I’m in limbo !!!! Both my surgeon and I requested an accelerated appeal. I’m truly exhausted !!!!!