How to win an insurance appeal?

[Cabelltech 0]

I have been denied coverage from BCBS insurance company for requesting lapband to bypass revision. Because they can find nothing wrong with my band, they won’t do the surgery. Even though the band is okay, I’m not. It has caused esophageal dilation and dysmotility. I lost weight with the band but I was vomiting a lot at night. Id wake up from a dead sleep vomiting out of my nose and mouth at least three nights a week. Very scary due to possibly getting that into my lungs. Has anyone else filed an appeal that was accepted by insurance?

[Recidivist 1,141]

My insurance company initially denied coverage for my RnY. I had my surgeon contact the company directly to explain why I needed the surgery and that did the trick. (Mine was not a revision, which might make a difference.)

[Cabelltech 0]

Unfortunately, I think having a revision does seem to make a difference even though I had weight loss success with the band. I always vomited with the band but I was twelve years out before the vomiting was happening during the night while I was sleeping. That is very scary and the main reason I chose to have it removed.

[learn2cook 587]

On 06/27/2022 at 07:34, Recidivist said:

My insurance company initially denied coverage for my RnY. I had my surgeon contact the company directly to explain why I needed the surgery and that did the trick. (Mine was not a revision, which might make a difference.)

Mine was the same as this. The two doctors got involved one to one. The surgical doc explained to the insurance doc why it was necessary due to extreme GERD. It sounds like it may happen if your surgical doc graduated from Harvard and the insurance doc was a retired pediatrician let’s hope. Crossed fingers!