Challenging Insurance for Coverage/Approval on Uncovered Procedure?

KittysarusRex
on 10/23/15 8:20 am

Hello Everyone!

I had a general question and wanted to see if anyone had challenged their insurance who covered other gastric surgical procedures, but not a one you specifically want/need? I want the sleeve and it's the best fit for me but it's not covered by insurance.

I have good reasoning, and I think my doctor will agree that none of the covered services are a good fit for me. My insurance covers the traditional gastric bypass, the band, and the old vertical banded gastroplasty (which I don't think is even done anymore to be perfectly honest). I want to challenge them and have my doctor back me to see if they will give and cover the sleeve with a letter of recommendation from him and why he thinks nothing else is good for me.

Anyone else have similar experiences?

MsBatt
on 10/23/15 9:41 pm, edited 10/23/15 2:41 pm

Not personally, but yes, many, many people have appealed and gotten the procedure they want. I suggest your go to www.bariatricfacts.org and get in touch with a woman named Diana Cox. She's a lawyer and a biochemist, and she helps people with insurance appeals pro bono.

KittysarusRex
on 10/24/15 7:17 am

Thank you! :)

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