Approved for band removal, not revision

hurryupandwait · August 20, 2010

So if i am approved for band removal, what are my options for revision to sleeve? My dr said bcbs will not approve sleeve because its investigational, but i gotta get this sleeve done....any advice?

Jordien · August 20, 2010

I'm in a similar boat and waiting to hear from insurance. I have bcbs too... I think Horizon. Is that yours too? My surgeon says that they DO now cover the sleeve. I am hoping but not expecting much. I thought I read on here you can self-pay it and then appeal to insurance company for reimbursement? Not sure. I hope you find some answers.

Carrie · August 21, 2010

Same scenario here. I am paying out of pocket for the difference. One thing you may do is go ahead an appeal. I decided on a more experienced surgeon and his staff refused to appeal the old surgeon's denial letter from my insurance company because they used the "correct billing code" so I use several different appeal letters around here for a reference and did my own appeal. I stated why I believed that I shouldn't have another Lap Band, in my case it was weakening of my esophagus. And that my surgeon had told me that doing RNY would not be a good idea due to scar tissue from the band, making it a much more difficult surgery. I also have the need to take NSAID's eventually and with RNY you can't do that, at the moment I can't take the medication that would help with my autoimmune inflammation and with the sleeve I've been told you are less likely to develop an ulcer as RNY surgery can cause ulcers a lot easier than other surgeries. If you would like to see a copy of my letter PM Me.

Personally, I am spoke to the surgeon's office who is going to do my Lap Band removal and asked them what the difference would be out of pocket. I am paying 8k in differences and hoping the appeal will go through post-operatively and I will be reimbursed the difference.

Best of luck to ya, it's just another speed bump on your journey with the right letter you can get over it as other have.

mila1013 · August 29, 2010

same boat here, i have BCBS also, if your insurance policy covers RNY and band you have a great chance to overturn the investigational denial, appeal, and exhaust all your appeals do not just accept what they say,