Very discouraged right now

[Shannyn 0]

Hello, this is my first post but I have been coming here for awhile. I started the lapband process in August of 07. I finally got everything together that I need to submit to insurance at the end of Dec 07. My BMI is 37, I have high cholesterol, high triglycerides and am pre-diabetic. My insurance company approved me the first week of January and I have a surgery date set for 2/11/08. I am supposed to go Tuesday for my preadmission testing. Friday I got a letter from Anthem stating that the surgery is not medically necessary and they will not cover it even though it was already approved. Does anyone have any advice on what I should do next? I am so discouraged right now, I am beginning to think I will never get the band:mad:

[tyme4change 1]

That's bull crap how can approve and then change thier mind? if I were you I would call them back and find out why they are changing thier approval. If that doesn't work file an appeal and if that doesn't work, GET A LAWYER! My point is do not give up!!!!!!!!!!!!!!

[reif78 0]

they cant deny you once they approve you!! have your doctor write a letter of recommendation and then file an appeal and threaten them with lawyers theyll change there mind!

[ronwifey 0]

I agree, send them the copy of the approval letter, letter by Dr. or the letter the Dr. got from Anthem, send those copies of those approval letters and a nice little note about retaining an attorney! You can win this. Hang in there and keep us posted.

[Shannyn 0]

Thanks for the encouragement, I need it right now. I just spoke with Dr Shumachers office, they are doing a peer review with Anthem on Friday, so hopefully I will have good news. The insurance lady at Dr Schumachers office said they usually are successful when they do the peer reviews, so I am keeping my fingers crossed. They did have to cancel the surgery scheduled for next Tuesday because I was supposed to go tomorrow for my preadmission tests, and I cant even do that until they approve it. I will let you all know when I hear something