Denied...need help

[GA peach 1]

Insurance stated band didn't show any malfunction. So I guess vomiting & food getting stuff is not justifiable. I'm so irritated & stuck with this piece of plastic until I can get something done. I plan to appeal. ..any suggestions on how to write the most justifiable reason to get this thing out of me.

Thanks in advance

[LI Gemini NY 607]

Insurance stated band didn't show any malfunction. So I guess vomiting & food getting stuff is not justifiable. I'm so irritated & stuck with this piece of plastic until I can get something done. I plan to appeal. ..any suggestions on how to write the most justifiable reason to get this thing out of me.

Thanks in advance

How does the insurance company know that the band isn't malfunctioning....that's what I would ask

[Dannipo 86]

I wonder if your doctors off wrote something up wrong. I would start with them to see what they submitted. Good Luck

[GA peach 1]

I called my advocate but she had left for the day. I did leave a detailed message. Hopefully I can see what's going on & start the denial process immediately.

Thanks for the replies and advice!

[inarakatra 51]

I agree with Dannip ... maybe your docture needs to write up something explaining better.

[GA peach 1]

Thanks for the advice!

[Nursebarbie 392]

I say keep showing up to the doctors office, urgent care, and ER for the vomiting and choking. Magnify your complaints don't minimize them. Trust me they will recognize its cheaper to take the damm thing out. Also file an appeal with your insurance company and a medical grievance as well with the medical group you belong too.

[GA peach 1]

Thanks for all the advice. I have an appointment next week with surgeons office. I will follow up as much as possible to document a malfunctioned band & file my appeal. I am hoping & praying I can have the revision before this year is over.

[marfar7 1,531]

If you continue vomitng, your band is likely to eventually slip (as mine did). Then you'll have a medical reason! Just sayin...

[Jacinda Martin 0]

I too was also told that there wasn't anything wrong with my band, even though I can't keep a fill in and haven't for several yrs, I tried it a few months ago AGAIN and ended up making an emergency trip on the weekend to get an unfill so I could swallow liquids again. I am so frustrated with this whole situation, I was banded in Mexico in 05 and I had no problems the first yr then all hell broke lose, never did find my sweet spot as they call it!

[Fixerupper 335]

Have you been scoped? My scope showed esophagitis and gastritis from band issue even though there was nothing wrong with the band. Also even unfilled I kept throwing up all the time and developed terrible acid reflux. With these things my insurance covered due to band rejection. Also the band can slip and go back into place one you are unfilled so they don't catch it. That's what my doc told me at least.

[Nursebarbie 392]

They really can't tell until they look inside. File an appeal with your medical group. Sometimes the squeaky wheel gets the grease.

[GA peach 1]

Have you been scoped? My scope showed esophagitis and gastritis from band issue even though there was nothing wrong with the band. Also even unfilled I kept throwing up all the time and developed terrible acid reflux. With these things my insurance covered due to band rejection. Also the band can slip and go back into place one you are unfilled so they don't catch it. That's what my doc told me at least.

Yes, I've had an EGD. It showed gastritis. I am going to the surgeon's office next week. Hopefully they will document enough this time to win an appeal. I'm so sick of this band. Can't get a fill because it causes issues & at the same time, I keep gaining my weight back because I need one.

[Nursebarbie 392]

You can appeal more than once and at different levels. Fyi.

[GA peach 1]

You can appeal more than once and at different levels. Fyi.

Ok thanks!