Help!!!

kat72 · August 25, 2005

I just called my insurance carrier (Pacificare HMO) and found out that they cover RNY and vertical banding, but NOT the lap band. I haven't heard much about the vertical band. Does anyone out there have any info. about this procedure? Isn't this the stomach stapling thing? I thought that was done away with. Why would my insurance cover that and not the lap band, which seems safer? I am so upset, all I can see right now is red! Just when I had decided that the RNY was not for me, now I find out that it may be all that I can have done since I am not financially able to pay for lap band surgery on my own. I just feel like crying.

i2candoit · August 25, 2005

It is a cross between stomach stapling and the band. The difference is....the band is made of mesh and it is not adjustable.

http://www.medscape.com/viewarticle/464924_print This page has a lot of reading but its a good study on the two in comparison

http://www.cstobesity.com/fobi_11(6).pdf#search='vertical%20gastric%20band'

here are some pictures to help you out.

Good luck.

kat72 · August 25, 2005

Thanx so much for the info. i2candoit. I called my insurance co. today and was able to get a little bit more info. from a different gal. She told me that my doctor can put in a request for me to have a specific type of weight loss surgery done if he feels that it would be of better for me, even if it is not approved through my insurance, and it is possible that it would be approved. While this is not a guarantee, at least it's better than being told that I will not be covered at all for the lap band.

the best me · August 25, 2005

Keep trying Kat! You will no doubt get a denial letter, but in that letter they have to tell you why. At that point, all you do is appeal and many many people have won on the appeal. Don't mean to make it sound easy, it isn't. It's a real rollercoaster. But it can be done, and it has been done. Keep checking on it! First step, band doc appointment, which I think you did already? Chin up, it ain't over yet!!

kat72 · August 25, 2005

Thanx so much for the encouragement. I spoke to Don Mills today, and he told me to keep going through with the process. I have not seen the surgeon yet (hopefully soon). Don Mills basically told me that it may be possible that I will be approved if the surgeon does a good job of explaining why the band would be best for me as far as health issues go. This frightens me, because at this time, the only health issues I have are anemia and PCOS. Other than that, the only thing that prevents me from having RNY is the fact that I want to have children in the future. To me this is a BIG issue, but the ins. co. may not agree. I'm afraid that they will deny coverage. Don explained that if I am not covered, I could simply call the office and inamed would be more than happy to write an appeal letter for me (up to 3 times) free of charge. So, I'm trying to be more positive about things, but it's difficult.

Mellie · August 26, 2005

If you don't mind me asking, how did you get up with Don Mills? I have went to the website several times but can't find any information about contacting him.

I have spoken with Walter Lindstrom with Obesity Law. Has anyone else had any success with him? I would really like to know before I hire him for my appeal.

kat72 · August 26, 2005

Mellie, not a problem at all! Don Mills can be reached at 1-800-624-4261 ext.4546. He is the nicest person!!! He'll be more than happy to help you out. He told me that inamed will actually write an appeal letter for you (up to 3, I believe). I wish you all the best in your endeavors to get the band.