Health America denied my surgery in Dec (I did it anyway-self pay) I hired Walter and Kelley Linstrom from Obesity Law to assist in my final appreal (I appealed twice myself). Found out this week that HA will REIMBURSE me for all charges and cover me for fills, etc.

My advice to those of you fighting for coverage is DO NOT GIVE UP (I almost did after my second appeal). The BEST thing I ever did was hire Walter and Kelley for my final. They were wonderful.

You can reach them at:

walter@obesitylaw.com or kelley@obesitylaw.com

P: (619) 656-5251

F: (619) 656-5254

Best of Luck all. Contact me if you have any more detailed questions!!!

Maggie, You go girl!!:clap2: Don't let anything stop you now!

Mona, I'm so sorry your insurance company treated you this way, I can't understand, with a BMI of 60 why they wouldn't approve you, are they crazy?:faint:And your AC1 at 20? You are in such danger. I will for sure remember you in my prayers but you don't give up!Things will work out!

okiegirl

______________________

Banding 9-1-06

Dr. Ortiz TJ Mexico

Hi all. Just like Maggie, I got denied twice and went ahead and self-paid. I hired Gary Viscio to appeal for the third time and just found out recently that the insurance company was overturned. YEAH!!! They have to reimburse my costs. I started the process in March, had the LapBand in August. It was worth it every step of the way. I didn't care if I had to pay or not, I wanted and needed the LapBand. I'm just so happy the insurance denial was overturned. They shouldn't make it so miserable! My advice to all, hang in there and keep the appeal process going to the end.

Maggie, I was just wondering if you ever got your appeal letters together to help someone going through an appeal for "experimental" denial.:help:

I have Excellus Blue Shield Blue Cross (New York) and I was just informed of the denial.

Any help would be much appreciated.

Jordyn:confused:

I have the exclusion problem. I'll have BC/BS New Jersey, although we live in Texas, in January. They have stated that there is an exclusion for obesity surgery which was put in place by my fiance's employer, Hoovers.com. We're both planning to have lap band surgery.

Is there ANY way to appeal or to get around an exclusion?

Jordyn-

I would be happy to share my appeal letters with you. PM me and I will be happy to send them along.

Not sure about the exclusion problem. I would talk to either my lawyers (info in an earlier post) or New Days lawyer. They will give you advice whether it is even a possbilitity that you would win.

I found out great news yesterday. I was the first (according to my lawyers) to win my lapband appeal against Health American. Many others have fought and won. Health American has changed it's policy for federal employees and will now cover lapband effective sometime in 2007....you have to fight to win!!!!

Best of luck to all.

Maggie it's great you started this thread. I'm sure you're helping many by letting them know there is still hope. Congrats to you!

There is hope SherryW. I never thought I could win my appeal. It was not a pleasant process (insurance companies can be hateful sometimes....) but I feel so good that I did. If anyone needs help or wants to talk about the process, feel free to PM me.

Hi Maggie,

Just caught this post. It's very interesting. I was denied twice from Health Net and I decided to call Kelley Lindstrom. While she and Walter were working on my 18 page appeal letter, I decided to go self pay. It turned out that the letter Walter wrote to my insurance company got my appeal overturned. Five days before my surgery, I got it approved through insurance.

That was a $23,000 savings for me. Thank God for them. I can't say enough about Walter and Kelley Lindstrom. They were just wonderful. The appeal letter they sent was just unbelievable.

So to all who are in the appeal stage... Don't give up!!

Good luck.

I have not been on here in a while, because I'm selfish. I haven't been on here because it kills me to watch everyone else lose all this weight and I can't even get my insurance to do right. I've been fighting Blue Cross of Tenn since July 05. I filed 3 appeals to Blue Cross and then a grievance to my husband's employer. My attorney sent a demand letter and now I am suing them. I go to court on Thursday. I meet all of the qualifications and they are still denying me. Mona, I'm curious to find out what they told you that happened in April 06 that caused approval to be tougher. PM me if you want. They are hoping that I will die before they approve it. Dying is the only way that I will stop trying.

Thinjen-

I am so sorry. You have been fighting for so long. How did your court date go? Let us know what happened.

My thoughts and prayers are with you.

Our court meeting went fine. It's not over. The other side is playing hardball. Hopefully, I will have a resolution by next spring. Please keep me in your thoughts and prayers.

not sure if I am doing this right, i just found this thread. I have TRICARE PRIME insurance, have anyone of you been able to get them to approve this surgery. I know they do bypass, but I really don't want to be cut open. I much rather the banding.

not sure if I am doing this right, i just found this thread. I have TRICARE PRIME insurance, have anyone of you been able to get them to approve this surgery. I know they do bypass, but I really don't want to be cut open. I much rather the banding.

Tricare Prime only pays for the gastric bypass and a couple of other weight loss procedures that involve cutting, stapling and/or rerouting. The adjustable gastric band (lapband), CPT Code 43770 is an excluded procedure.

If you want the lapband and the only insurance you have is Tricare, you'll have to either self-pay, go through the appeal process, wait to see if Tricare changes it's policy in 2007, or try to find a military treatment facility (MTF) that does banding. Currently, the only MTF I've heard of doing banding is Walter Reed.