I have B/C B/S OH and they have denied me because my BMI 39.4 and I do not have two (even though my policy does not say I need two) medical conditions.

They did the Peer to Peer and denied again. I wasn't sure how that works since the only thing they could talk about would be the paper work they already had when they denied me the first time.

Too much stress so I waited until after the holiday to start going 100% with this appeal again but I don't know what I can do. My dr office is sending me a package so I hope that helps me understand. My dr office said to keep calling my insurance, but what am I supposed to be saying or asking if I call daily???

My BMI is now 40 with the stress and of course the holidays just ending. I also round up saying I'm 5'4" when I'm really 5' 3.5" and the half does make a difference with BMI, lol. I told my dr office that today and she said we could do a new weigh in and send it but since I have not had a BMI of 40 or more for the last two years that we shouldn't go there, I don't understand that, it doesn't say in my policy that I have to have a BMI of 40 for two years but I know my dr office knows what they are doing.

I'm just feeling no hope at this time, I'm so depressed and stressed out. I was so excided thinking I would be banded by Jan and now I'm wondering if I'm ever going to win this. I know I wont give up but I just don't know what I should be doing, writing, saying when I call, I feel lost. I guess I don't have any of the medical conditions even though I have never been to a sleep study but my dr said not to do that right now so I don't know what to do.

Any help would be great!! One of you had emailed me your appeal letter and it was great but I guess I don't have medical conditions to add even though I am a 40 BMI now.

Thanks, I really need this. I have other issues and I cant even hardly walk due to my weight but that is not life threatening they said. I am in pain daily due to my weight, I need some off to even start working out.

Before appealing on your own or having your surgeon appeal remember that if you are getting an Allergan LAP-BAND® our office works in conjunction with you and your surgeon's office to handle LAP-BAND appeals at no cost to you. You get the benefit of our 13 years of experience handling bariatric surgery cases (not to mention any personal tidbits I can offer having had an open gastric bypass in 1994 followed by a LAP-BAND® in 2003!) You should contact your surgeon about getting an Appeals Program application before doing anything else since we can only take these cases on at the time of the first denial.....in case you're wondering, our success rate in 2008 with this program exceeded 92%. Hopefully we can help you or others in your position overturn that denial. Good luck.

Walter, thank you. They did a peer to peer and then sent me the package to do my letter.

Nan, I HAVE HER LETTERS, THEY ARE PERFECT!! She emailed them to me and I am doing the same thing, using hers as a shell letter and filling in my own info and yes, crying as I am doing so. I just pray my end result is the same as yours.

Teresa, I also got my letters from my pcp and rheumatologist, but I know in my heart that it was MY letter that made the difference! Good luck; PLEASE let me know how you make out! I will be thinking of you! Nancy

Can I still appeal through the Allergan program if I was denied by my insurance company and than I scheduled my surgery and paid cash? Can I file for the appeal and possibly get some reimbursement. I was so frustrated with the insurance company and I was so upset I just kept my surgery date and financed it. Thank you.