so my employer and its insurance provider has covered more than 25 lap band patients and im the first to be rejected because im too heavy to have weight loss surgery get that lol my benefits coord called me and i can not get a hold of her in the 5 calls i have made and messages i have left i actually found this out by the doctor im dealing with at a lap band seminar that i volunteerily went to to compound matters worse i was going home and hit a curb at 60mph on the highway while going off an exit ramp denting both left side rims severly to warrant me purchasing new tires and rims

Hey Big Thunder, Sorry to hear this. On what grounds did they reject your application? Safety issues related to your current weight or another reason? Don't give up Thunder.

Susannah

That just doesn't make sense, does it. I'm sorry. I was denied the first time, also, but provided additional documentation & received approval 2 days later. Do whatever you have to do to get the approval! Good luck!

im not even shocked to be honest im more of an even keeled type of individual but inside im hurting its almost as if i knew i was going to be rejected somehow nothing ever seems to be easy for me /end rant anyway what kind of documentation do you think i should provide i was thinking about doing a scare tactic hiring a lawyer for an hour or two to draft me up something that i can send and my doctor is also sending something on my behalf stating that they will be responsible for making the medical decision. i just have to wait 2 weeks b4 i hear back from the doctor on that letter. they said that i cant be over bmi 50 or id die on the surgery table heres the funny thing they approve gastric bypass which is more fatal than this surgery.

AWW all these posts for people undergoing or already banded i see so many happy people :cry wish i could be talking about my band :help: someone give me some ideas on what type of paperwork i should gather to resubmit to insurance

I'm so sorry they denied you, but that doesn't mean it's all over. If you can't get ahold of the coordinator, call and tell any and everyone in that office. If the coordinator is dodging you, she'll stop if everyone in the office tells her to call you back because now you're calling THEM now, LOL.

Find out exactly what the grounds were for denying you. Then you'll know what you're up against.

Big Thunder, I am not sure where you are located, but my doctors that are in Fountain Valley, California have done many surgeries on people that have a BMI higher than yours. As a matter of fact, Dr. Peter LaPorte was in the news paper just last week being acknowledged for doing WLS on a man 700+ pounds sucessfully.

It can be done. It sounds like your doctor is more fearful rather than helpful. Get as much info on Doctors who do surgeries with people over the 50 BMI. You should have a pretty good arguement to your insurance company and the doctor....

Best of luck you you.

bigthunder, go to www.obesitylaw.com

Walter Lindstrom is a lawyer who had RNY and has successfully helped many many many people. For a few hundered doallars he will draft what you need.

Check his site out, he says to contact him after the first denial, which you are at.

big thunder, dont give up! If they give you a final no, and you really want it, make it happen anyways! Get a loan, borrow money, sell stuff, cashpay for it if you have to. Many docs in the US will do it cash pay for 12-17 thousand, I self paid in Mexico for 8000 dollars and did not have to jump through any hoops. In fact, July 1st, 06 I decided to do it, July 21st three weeks later I had surgery. The only criteria they had there was passing the EKG. I am not pushing self pay only giving you hope, if you really want it you can make it happen some way! Good luck and check out the lawer Faith Md wrote about above.

AWW all these posts for people undergoing or already banded i see so many happy people :cry wish i could be talking about my band :help: someone give me some ideas on what type of paperwork i should gather to resubmit to insurance

Perhaps your doctor could start you and a supervised diet to get you down to an exceptable weight that will allow you to get banded.

Where do you live? My weightloss clinic is in St. Louis, Mo at DePaul Hospital. The Dr also has a clinic in Columbia, Mo that handles the more problematic cases and is a Prof. there at the University. His name is Dr. de la Torre. Go online and see if there is something they can do to help you!

I notified my doctor who said he woudl send another letter to insurance for a 2nd look i requested he send that letter to me for my records to make sure it gets done also to possibly send it along to that lawyer that faithmd listed above ty so much for that link btw

Same thing happened to me. Anthem's coverage specifies that lap band has to be BMI 49 or lower. They even said in the letter that they could immediately approve me for gastric bypass but not lap band until I was under BMI 50. I was BMI 52-53 at the time so I had to lose about 20-ish pounds before I could reapply (sadly took me 3 months to do that). When I did, they reversed the denial in 2 days and I had my surgery scheduled in less than a month.

I think their reasoning is this...when looking over a short period of time (2-3 years) Lap Band loses less than RNY. In their (perhaps flawed) perspective they won't make their money back unless we lose the most amount possible. They have to look at statistics (which I don't know off the top of my head and therefore cannot quote) and the statistics just don't show them that losing enough overall weight from higher BMI to get them to the point where they profit from it.

Sad but true. My surgeons office wouldn't make an appeal on my behalf because it was considered "not meeting requirements" rather than their medical board saying I wasn't a good candidate. Once I got to the right BMI, they resubmitted. And boy I will tell you I was on the line for 49/50BMi the day of surgery too. Whew!

i dont know if i have teh will to lose 150 pounds or so to get to bmi 50 that would be realllllllly tough

Damn it bigthunder.. you helped me get the job there and talked so positive to me about this so you will NOT give up!!!!! i won't let you! so there!

bigthunder, again I suggest you contact Walter Lindstrom (a WLS attorney), ASAP. He has had RNY and now has the band as well. He fights a good fight from what I've heard and is very knowledgeable. His website is www.obesitylaw.com</p> <p> </p> <p>Here's a link to his FAQ's:

http://obesitylaw.com/faq.php

His site says the sooner you get an appeal to him, the more effective he can be, if you appeal two, or even three times on your own, you may have exhausted your appeals with the insurance company. I remember reading on his site once that he prefers to get your case in your second go-round.

Good Luk!

yes faithmd i will deffinately keep that in mind i have three hopes first being doctor submitting something effecting changing their mind me contacting that lawyer and having him draft me up something and if all else fails continue to eat healthy which i have not given up on yet and trying to get down to bmi 52 or lower