Just found out BCBS denied my request for Lap-Band stating it wasn't a medical necessity.

I'm going to call my surgeon in a few minutes to find out more details about it.

I'm really bummed out. :thumbup:

Just found out BCBS denied my request for Lap-Band® stating it wasn't a medical necessity.

I'm going to call my surgeon in a few minutes to find out more details about it.

I'm really bummed out. :thumbup:

Don't lose hope. With a BMI of 48, they cannot reasonably state it is not a medical necessity. Perhaps there's an error in the records your doctor sent...like they recorded the weight wrong.

Rather than call the doctor, I'd call BC and ask them how they can justify it as not 'medically necessary' because the doctors will only be able to tell you what the insurance told them. Go to the source.

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Well, it seems my doctor's office still has a couple of documents to send to the insurance. The authorization admin will fax over those documents and speak to the pre-cert nurse to find out why and call me back this morning for the details.

I am hoping they are only needing this information in order to approve the request.

Documents they will be sending are Dietician Letter and Docter Letter.

Don't be bummed. BCBS denied me twice claiming the same thing. The program that I went through had legal counsel that helped and I was finally approved. I can give you some helpful tips as well. The process was long and frustrating, but don't give up.

Have u decided your surgeon and place where u want to get it done? If not, think of Mexico.The cost of lap band surgery comes in between $6000 to $10000 in Mexico. Adding other additional costs such as-airfare, car rental, hotel stays etc. to it also, you can save up to 40 to 50% of your cost compared to U.S.

My surgeon is meeting with the Medical Director at BCBS tomorrow afternoon. I should know more after this meeting.

This really sucks big time.

Don't give up, if they don't reverse their decision, APPEAL. I had a BMI of 35.1 at first and was denied. I ate like there was no tomorrow, gathered letters of support for each of my doctors, wrote two letters from myself and my surgeon submitted the appeal package for me. By then my BMI was 38.1 and with my letters, I was approved the second time through.

Don't give up!

I wouldn't get too whipped up over this until the rest of the paperwork is submitted. The insurance companies really don't want to pay for anybody's surgery so any excuse is good enough. "What, we're missing a piece of paper?!? Well, we're not asking for it. Just deny the claim...."

If, after meetings and submitting paperwork, they still deny then I would insist on WRITTEN DETAILS as to why they think it is not medically necessary.

I'm pretty sure that at least the letter from the physician is a *requirement* to be approved by BCBS for surgery, so I am not surprised that they denied you without that and the dietician info. (why did your physician's office even submit your info without these important things?) I'd be willing to bet that as long as you have all the necessary stuff and have dotted all your i's and crossed your t's they will approve it no problem.

hi,

Can somebody help me?My BMI is 42,but my request for Lapband surgery has been denied i want to get operated as fast as possible but i donot know what the problem is?

Thanks,

Regards,

Kate George

Just got the letter yesterday. Here is the reason for denial:

Edited October 20, 200916 yr by junbug178

I am just confused, is it two reasons for the denial:

1. Not a Medical Necessity
   
2. No Medical Evalutation
   

It sounds as if you need to be evaluated by MD's that can write letters explaining the dangers of your weight. Such as a cardiologist, pulmonologist. Some documentation to verify that you have obesity related disease's. They may also want you to be evaluated as a preop to rule out any possible problems that may occur during surgery

Good Luck

Andrea

It sounds as if you need to be evaluated by MD's that can write letters explaining the dangers of your weight. Such as a cardiologist, pulmonologist. Some documentation to verify that you have obesity related disease's. They may also want you to be evaluated as a preop to rule out any possible problems that may occur during surgery

Good Luck

Andrea

It seems the Medical Evaluation letter was sent yesterday afternoon. Now it seems I'm only dealing with the "not medical necessity" reason. Which should be resolved after my surgeon meets with the Medical Director at the Pre-Cert.