Help! Can't Get Approved!

October 20, 2004

I was wondering if anyone out there has had trouble getting approved for the lap band because their insurance deems it "investigational"? My company has Anthem BCBS out of Ohio and they approve the bypass surgery but not the lap band. I'm completely distraught. I've gone through almost all the tests required and now just found out it isn't covered. I feel helpless and not sure where to go from here.

Can anyone offer any suggestions?

Thanks,

wishingonastar

whippledaddy · October 20, 2004

It is strange how different the BCBS system is from one location to another. I have BCBS State Health Plan ppo, and it pays for it. If one BCBS says it's okay, why would another deem it "investigational"

You're in the Michigan folder, are you from Michigan? If so, how close are you to alma? Dr. Cudjoe has a very efficient staff member, Janet Quinn, who will help you fight to get approved. Others might provide the same service, just check out the main forums. It's in your surgeon's best interest for you to get approved. You shouldn't have to mortgage the house and go to another country to get this now that it is so prevalent here in the states.

Good luck!

leatha_g · October 20, 2004

You might try www.obesitylaw.com They tend to help people with appeals. Also, on this site somewhere, there is an appeal letter from Alexandria that was superb.

I agree with you. If one does, the others should, but it seems to be going state by state with BCBS.

Good luck to you! Don't give up!

October 20, 2004

Thank you so much for your advice. I agree, it's crazy one blue cross covers it but another doesn't. I'm so annoyed with the whole thing I'd like to find a way to lobby the insurance industry so they stop their bureaucratic tendencies and start taking patients seriously. I could very easily have opted for the bypass surgery which is more expensive and extremely risky. You'd think they would be applauding people like me who take the time to research other options.

Good luck to all of you and hopefully i'll have good news to report soon.

Take care!

Alexandra · October 20, 2004

Wishing, I had the exact same denial and was able to win on appeal. If you look in the Insurance Issues area you'll see a thread at the top called "Just starting to explore options..."

That thread includes a discussion of just this issue and shows the appeal letter I wrote. Maybe there's something in there that can help. Good luck!!

terry · October 20, 2004

I also have bc/bs of Ga. and was told that they will NOT cover the lap-band, but will cover other surgery's such as RNY or VGB. From what I understand is the VBG is an older version of the lap-band. I getting some information from my surgeon regarding this. Does anyone have any information about this VBG? Good or bad I would love to here!!!!!

I wish you luck with you fight with bc/bs, I just went threw all of that with Cigna and was in the appeal mode when my insurance company was changed to bs/bs. I have not yet sent any information to bc/bs regarding the lap-band due to the fact they told me under no uncertain terms it would not be covered, but the VBG would be. Explain that one!!!!!

Once again I wish you luck!!!

Terry

leatha_g · October 20, 2004

I just replied to your other thread...

New Hope · October 20, 2004

Terry and Wishing, please do look up Alexandra's appeals letter. It's great and she won her appeal! Best of luck to both of you!

October 21, 2004

Thank you all so much for your encouragement and the great information. I'm definitely going to at least try to get approved and using some of the great information in the appeal letter Alexandra wrote, perhaps I have a good shot.

I'll keep you all posted and if you can think of anything else that might help, please let me know.

Katie328 · October 21, 2004

Wow Letha there is a lot of great info on www.obesitylaw.com Lots of great reading should help you all out with your cases! Best of luck to you and let us know how it turns out!