Well, maybe not...

Hunzi · October 6, 2005

Ok, I am officially bummed. I went to the WLS seminar tonight, and they told me that my insurance will only cover RNY. Not only will they cover RNY, but apparently, it's quite easy to get approved. But no lapbands.

Like I'm gonna let anyone rearrange my insides!

I'm still going to go to the consult, but if there's no hope that the insurance will pay, then I'm outta the WLS scene for quite a while until I can formulate Plans B, C, D & E (either appeal, self pay, Mexico, or wait and hope they eventually come to their senses!)

Bummer, because I was moving fast, had my support group on the 12th, my consult on the 13th, had my psych consult scheduled for the 17th, had the appt set with my PCM for all the pre-op tests on the 17th. I figured I'd have all the preliminary stuff done by the end of October.

I'll find some way,

Always

Hunzi

ain't nobody rearranging my insides!

fee · October 6, 2005

sorry to hear that

is there any chance you can swap insurance companies?

i dont know what its like over where you are

but here in Australia we can swap insurance companies and have no waiting periods.

It will all work out for you

Keep your chin up

the best me · October 6, 2005

Check your policy online. Your insurance has a website, no doubt. Sign in, and read YOUR particular plan's coverage for WLS. Ins. companies have different plans with different coverage. If WLS is covered, go for the lap band, wait for the denial letter which WILL come. They will then tell you why it isn't covered...experimental? whatever. At that point you appeal the denial with lots of evidence about why they are wrong. Inamed apparently can provide you with documentation refuting the "experimental" arguement. Many have had denials overturned on appeals that way.

If, however, your policy doesn't cover lapband, or specifically excludes it (which it sounds as if it does?) then, well, if it's your only hope then what do you have to lose? Go for it! The first place to check is your plan number with your carrier. Let us know what it says!! (Copy and paste is handy for that.)

tztmama · October 6, 2005

SO sorry to hear about this. What is up with these insurance companies????? If they only spent a fraction of the time that we do researching WLS procedures maybe they would see the light here!

Don't give up, you sound determined. It will happen.

ReneBean · October 6, 2005

Inamed has a "Hotline" number with medical release forms so that they can review your file and help you with your appeal. The service is free. It is in their best interest to get the insurance companies to cover as many of these procedures as possible to pave the way for the future.

Submit for pre-approval and then fight if you are denied. (You have to have a denial in writing before you can use the free service). Future Bandsters will thank you for it.

Hunzi · October 6, 2005

Well the "insurance company" is Tricare Prime from Triwest. I'm definitely not going to give up, but I do know convincing a vender of the federal goverment to change a policy is an arduous task. I will appeal, with all sorts of documentation, and I'll contact our local Congressmen and Senators for assistance if needed. I've seen policies "bend" before when a congress critter gets involved.

It is discouraging though to have to fight for the right to have a safer procedure or have to consider going to Mexico to get it. How ironic is that?

Always

Hunzi

every hopeful

Infaith · October 6, 2005

It is discouraging though to have to fight for the right to have a safer procedure or have to consider going to Mexico to get it. How ironic is that?

Always

Hunzi

every hopeful

You are SO right Hunzi! My mom even agrees....WHEN are these doctors (that argue against the lapband, but are okay with bypass) and these insurance companies going to realize how much safer this is!

Yes, I had to get my band removed because of a nasty stomach virus that made me throw up so violently for todays that my band slipped. But that's just it, it could be removed so I could heal.

I met a gal who had the bypass and she was happy with it, but had 2 surgerys since...one for blockage and one for perforations. Her insides will never be the same. You wonder how many other times she'll have to have surgery to patch her up. She was fascinated by the lapband procedure and asked all about it.

Maybe someday people will wake up.....

ReneBean · October 6, 2005

I don't understand it either. Sure, there are people who experience complications with the band - lots of them have posted here - but it seems that when the band "goes bad" it is something easy to fix - non life threatening.

When the ByPass "goes bad" it is very VERY bad. And you can't fix it...

You would THINK that the insurance companies would be lining up for this - clamoring for the band - since it is so much safer.

Instead we get "insufficient literature to support the safety & efficacy" of the band. What a load of *&^%! GRRRRR.

If I were a Martyr - I would HAVE the By-Pass and then SUE the crap out of my insurance company for any major lasting complication that I had. AND I would win - since they pushed me toward that surgery over the band due to their stupid crappy restrictions.

Sorry to all those future bandsters out there - I am not willing to be a Martyr for the Cause.