Eroded Band Removal DENIED.. please help.

[ERNJN 0]

Looking for any help or experience with this issue!

The pre-approval for the removal of my lap band has been denied as Bariatric Surgery (revisions, fills, etc.) is completely excluded from my insurance plan. So I suppose the initial denial is not surprising.

However, my stomach has a hole in it. This will eventually escalate into an emergency-ER situation -- wouldn't insurance agree to cover in this case? Has anyone had luck with an appeal even though all Bariatric-related procedures are excluded in your plan?

If there's hole in my stomach, does this not turn into something different?

Any help or advice on appeal-writing is appreciated. My surgeon has a peer-to-peer scheduled for tomorrow, if that fails, I will submit the first appeal.

THANK YOU!

[WLSResources/ClothingExch 3,444]

The refusal is crazy. Doesn't your med plan have an appeals procedure? You'll need to be armed with surgeon's and, even better, other medical recommendations for removal coverage.

If that gets you nowhere, take a shot at this law practice: http://wlsappeals.com/

The attorney, Walter Lindstrom, was often named as a resource for people who were turned down by their med plans for band surgery. Perhaps he can help in the other direction, who knows? I know of him only because his name came up often enough in the now all but defunct Yahoo group, Smart Bandsters.

________________________________

P.S. Sorry, I didn't see the last couple of lines in your note. You're already pursuing the appeal process.

Edited March 16, 2016 by WLSResources/ClothingExch

[Luckeydoo 1]

I have experience with an eroded band and surgical removal. Mine was placed in September 2008 and I had to have emergency removal in January 2016, The surgeon told me that my band had eroded 60%. I had developed an infection and went to the ER in my town (one of several trips and multiple trips to my PCP which resulted in more rx's for meds to treat symptoms). I was put on antibiotics and scoped, transferred to another hospital for emergency removal of my band. Ended up being out of work for 6 weeks! Not a good experience. If you would like to communicate further about this, contact me!

[ERNJN 0]

@@Luckeydoo -- I would love to discuss further! I'm unsure of how much of the band has eroded, going off of the photos and limited medical expertise I would say 25% percent is peaking through. Neither my gastroenterologist or my surgeons have commented on the timing for getting it removed, only that it was not a sustainable situation and needed to come out.

I will self pay/take out a loan before it becomes an emergency room situation because of exactly what you went through, just more costly in the end. I'm sticking to my April 26th surgery date no matter what!

I will DM you now -- thanks!