Any way to get around denial?

travelinsnorkel · April 17, 2008

I called my insurance company, Care First Blue Choice, and they said that they don't cover the lap band surgery. Does anyone know if there is any way to have the doctor appeal this? I haven't met with my surgeon yet, so I'm sure they'll have some ideas, but thought I'd check here first. Thanks!

llcarlos48 · April 17, 2008

Hello!!..I'm Chuck, a newbie sort of too..Why did your ins. co. refuse??..Most require a minimum of 35 as a BMI, plus a couple of co-morbities..I am in Pa., and here you have to go through 6 months of testings, workshops, exercise recommendations, meal planning etc. before the surgery....And they expect you to lose some weight too..Additionally, you must get all that other stuff--letters from Dr. etc...My body mass was 33.8, and I had "4" comorbities, but if I went through the program, it would have sent my BMI even lower....I had no choice, as 92 percent of diets fail....I researched and found a 'reputable' online site that schedules you for surgery out of state and quickly--usually around 2-3 weeks, and you don't need all the stuff you do with insurance companies....I flew to Detroit on Feb. 26, and had the surgery the 27th....The total cost, with flight, was around 12,800....The Dr. was fabulous, and found the largest hiatal hernia he had ever seen, the size of a football, repaired it, and never charged me for that....I have lost 30 pounds, and feeling better each day, with NO HUNGER PAINS!!....I eat just to eat!!!!....And finally----YES!!----Your Dr. can certainly appeal the decision of the insurance company, but I don't know the criteria you company requires....I got mine out of state because they only require a 30 PERCENT body mass index with "2" co-morbities....Questions????....Just ask!!....My best, Chuck....In the hospitals around here, the cost is around 22,000 without the hernia repair!!!!

detroitdame75 · April 17, 2008

I'm from Detroit where and who did your surgery?

llcarlos48 · April 17, 2008

Dr. Garzyleri(spelling??) at Detroit Med. Center....Has an office in Troy....Think Harper Hospital was where I got it done....All sound familiar?....Chuck....Questions????....Just ask!!

laurenwhite82 · April 17, 2008

So they didn't deny you, your policy does not cover the proceedure to begin with? Correct? If they did deny you, but they do say that they sometimes cover it, you could appeal. There is a whole thread about how you go about an appeal on this site. However, if they enver covered the proceedure to begin with, I am not sure how you would go about getting them to cover it. My prior insurance did not cover WLS, but I knew I was going to be switching insurance so I just waited it out. Good luck to you!

Lori in Cali · April 17, 2008

Yes, you need to call Walter Lindstrom at the Obesity Action Center. His law firm specializes in handling that situation and keeping their work affordable for working class people. Walter, himself, has had weight loss surgery and understands how beneficial it is. Before you decide he can't help or you can't afford him, you should definitely give the firm a call. Getting an approval isn't a cake walk for a lot of people so you have to do everything you can. He can help more effectively at this stage than he can once they've really dug their heels in and thrown up more barriers. Everybody in the industry knows him. He's been a godsend for a lot of people.

Here's his website: Obesity Law and Advocacy Center

Obesity Law and Advocacy Center