Post by cindy1976 on Sept 11, 2013 16:21:11 GMT -5
Hi there. This is my first time posting on this board, I'm hoping someone will have a similar experience they can share with me.
Has anyone ever had any luck getting their insurance to approve a revision in spite of a 1 WLS per lifetime exclusion?
I've had a lap band (read: miserable life, typical issues) since June 2008 and am ready to get a revision to a DS. The problem is my insurance (self-funded employer policy with United Healthcare) only covers 1 WLS per lifetime.
I've contacted the Lindstrom Law Firm and they indicated that there may be some hope and suggested that I get the process started so I can get the denial letter and we'll have something to appeal. I've had a consultation with Dr. Ayoola (Dr. Stewarts colleague) and am scheduled for an EGD and some other tests with him on Friday. He's aware of my insurance exclusion and my plan to work with Lindstrom to appeal when we get to that point.
A while back (when I was looking into bypass with another surgeon) I had an EGD and they found a hiatal hernia and possible slipped band. I'm hoping those two things will help my case but my guess is this may be sufficient for my insurance to cover band removal but probably not the DS. If not, i'm not sure what my grounds for appeal will be other than "pretty please". I have basically no co-morbidities (mild sleep apnea) and my BMI is just barely above 40. On the plus side (maybe) my employer is REALLY pushing these new healthy lifestyle programs and offering insurance premium discounts to employees who have normal BMI's.
Anyway, if anyone else has had a similar experience that you could share with me I'd really appreciate it. Good, bad, ugly, whatever. Suggestions? What worked / didn't work for you, things to look out for? How long did it take? Really anything, I'm just looking for information, support, thoughts, whatever you've got.
Thanks in advance!
Cindy
Edit: My employer has a SELF funded plan though UHC.
Has anyone ever had any luck getting their insurance to approve a revision in spite of a 1 WLS per lifetime exclusion?
I've had a lap band (read: miserable life, typical issues) since June 2008 and am ready to get a revision to a DS. The problem is my insurance (self-funded employer policy with United Healthcare) only covers 1 WLS per lifetime.
I've contacted the Lindstrom Law Firm and they indicated that there may be some hope and suggested that I get the process started so I can get the denial letter and we'll have something to appeal. I've had a consultation with Dr. Ayoola (Dr. Stewarts colleague) and am scheduled for an EGD and some other tests with him on Friday. He's aware of my insurance exclusion and my plan to work with Lindstrom to appeal when we get to that point.
A while back (when I was looking into bypass with another surgeon) I had an EGD and they found a hiatal hernia and possible slipped band. I'm hoping those two things will help my case but my guess is this may be sufficient for my insurance to cover band removal but probably not the DS. If not, i'm not sure what my grounds for appeal will be other than "pretty please". I have basically no co-morbidities (mild sleep apnea) and my BMI is just barely above 40. On the plus side (maybe) my employer is REALLY pushing these new healthy lifestyle programs and offering insurance premium discounts to employees who have normal BMI's.
Anyway, if anyone else has had a similar experience that you could share with me I'd really appreciate it. Good, bad, ugly, whatever. Suggestions? What worked / didn't work for you, things to look out for? How long did it take? Really anything, I'm just looking for information, support, thoughts, whatever you've got.
Thanks in advance!
Cindy
Edit: My employer has a SELF funded plan though UHC.
We have a few very savvy insurance folks here, can I suggest you cross-post this on the DS board, use the exact same subject and post, just put x-post first in the subject. I think our insurance savvy folk will probably see it there more than here on this board. Hang in there!