RobinGirl

I am so excited! I have finally been approved for the Lap Band by my insurance company. After 235 days, multiple insurance submissions, lots of blood tests, insurance denial, a sleep study, eight doctors appointments, and a pre approval claim addendum, my insurance company has finally approved me for Lap Band Surgery!!!!!! I am so happy!!!!!! This has been such a long journey and I haven't even bought my ticket to Onederland yet. I am ready to get on this train and not stop!

I just went throughout the same thing. Don't give up. After I was denied I had a sleep test and another A1C test. Low and behold I DO have sleep apnea and insulin resistance. Plus my GERD has worsened. My surgeon filed an addendum with the new results instead of an appeal and I was just approved today. Do what you can and don't give up!

What is your BMI? Most insurance companies require a BMI of 40 or a BMI of 35 with comorbidities. If you haven't done so yet, I suggest having a sleep study done to test for sleep apnea. Most of us that are overweight also have sleep apnea and insurance companies consider it a comorbidity.

Has anyone filed an addendum to their denied pre approval request? Since I was denied for a 39.6 BMI I have since been diagnosed with sleep apnea and insulin resistance. My Doctor has filed an addendum instead of an appeal with Anthem and I am wondering if anyone else went this route to get approved?

Black BM's are supposed to be really bad (blood in the stool). I would call your doctor asap! (Sorry I hope I don't scare you, could just be a byproduct of the liquid diet, etc)

I love my "Super Shakes". Full of super foods! - Spinach, blueberries, strawberries, pineapple, fage plain yogurt, ground flax, coconut water, and BiPro unflavored whey protein. I love them. I can't taste the spinach or the protein. I also take a probiotic and vitamins at the same time.

I am sorry that you are having troubles. Are you allowed to eat non fat greek yogurt or cottage cheese? My Dad is also a diabetic and has trouble keeping his blood sugar up while sleeping. His solution is to eat 3/4 cup of cottage cheese with fruit or some other topping right before he goes to bed. As for broths- have you tried straining broth based soups? You can get all the flavor of the soup without the solids. I really like low fat broth based tortilla soup. Num Num.

I called my insurance company this morning to check on my case and they told me I was denied. The reason - a BMI of 39.6 with no comorbidities. I am really confused as to why my BMI was listed at 39.6 as the doctor said I had a 41 BMI. Even with that, I still can't believe they denied me because of 4 pounds! Ridiculous! I am waiting for a call back from my doctor's office to discuss this. I am pretty sure they are going to act all confused as they always are. The front office is so incompetent! I am thinking of going the cash route but with a different doctor. This doctor doesn't deserve my money after working with them for 6 months and having nothing but issues with the front office. Also - Can I appeal? Can my doctor resubmit with my BMI at 41? Is there a "typo" clause in the appeal process?

I had a breast reduction about 9 years ago. It took me about 3 days to be up and around and about 10 days before I went back to work. I wasn't in any real pain (thanks to percoset), I just had trouble with sitting up and my stamina. I did have drains and those were a pain. I wore a zip up hoodie and put the drains in the pockets so they didn't get in the way (and I didn't have to look at them). There is a great website similar to LBT but for breast surgery called Breast Health Online. It is a great resource! If you have any other questions PM me and I will be happy to respond. One more thing - make sure have a topical analgesic called traumeel cream to apply after the incisions are closed. Life saver for me!

I am sorry that you are having a reaction to the dressings. I am also allergic to the sticky tape they use for dressings. However - I am okay with the steri strips that go directly over the incisions. Benadryl (Diphenhydramine) is an antihistamine that comes in both pill and lotion form. They are pink oblong shaped pills. I am not sure what they are called in Australia but they are generally used for all allergic reactions. They can make you very sleepy so use caution.

@Letsdothis- I am not sure what I am planning on doing. I really would like my surgeons office to fix it as they are the ones that submitted the incorrect weight for me. They also didn't submit the paperwork properly and I have had to follow up with them on a weekly basis for the past 10 weeks. I might just go to Mexico for my surgery. I doubt you will have the same issue as me. As long as your policy (set by your employer) includes a WLS benefit I think you will be just fine. Just keep following up with your doctor's office and you will be good. BTW- where in California are you? Is your doctor affiliated with a Bariatric Center of Excellence?

Make sure that you get a reference number from Anthem from your doctor when they submit the application. I just went through craziness as my doctor's office is totally incompetent. Once the forms were properly submitted I called with my reference number and was able to get an answer within 10 days. Since you have a BMI over 40 you will be approved as long as you have jumped through all the hoops - psych eval, nutritionist, physical exam, evidence of past weight loss failures. I was only denied because they calculated my BMI different than my surgeons office and I fell below the "yellow line" by a few pounds.

I spoke with my doctor's office this afternoon and they said that most likely my insurance company used a different BMI calculator to calculate my BMI. I am really frustrated because according to my calculations I do have a BMI of 40. I know that I am right on the edge, but seriously to deny me for 4 pounds is ridiculous! My doctor's office said that my only option is to appeal with a letter about how unhealthy I am. They can't resubmit or adjust the numbers, I can only appeal. I am not sure how this will work as they denied me because of 4 pounds and if I don't meet the requirement, I don't meet the requirement. My other concern is why didn't my doctor consider that they may use a different calculator? They submit to Anthem on a daily basis and they should know the ins and outs. Argh!!! I am seriously considering going to Mexico as an option. I spoke with Dr Ortiz's office today and I can be in surgery in just two weeks! All for less than my deductible/ copay and my doctors stupid $3000 program fee. I should have just gone to mexico in the first place. Sorry for the rant but this is 6 months of frustration.

I have Anthem Blue Cross PPO California and I have been in insurance limbo land since January 13th! My surgeon's office has submitted for approval at least 4 times (or so they say) and the insurance company keeps "losing it" (so they say). This last time they finally provided a reference number, so I have hope that I will have an answer soon.

Awesome Non Scale Victory! Congrats!

I am not sure if its my surgeon's office or my insurance company that can't get it right. My application has supposedly been submitted to Anthem 3 times. The office said they submitted my first application to Anthem CA on January 17, 2012. During this time my company downsized and I opted for COBRA coverage. Unfortunately that caused a hang up and my policy was canceled on Feb 1, but reinstated by Feb 3. Of course during that time Anthem denied my application as I was not insured. Needless to say I was not happy! The office resubmitted my application on Feb 6 for the second time. I have been calling the office once or twice a week to check on the status. All they tell me is that they haven't received word yet from Anthem. Then a week ago she says that they are receiving info back on other patients and I should be approved soon. Well another few days go by and nothing. By this time I am beyond myself and I am beginning to believe that I am getting the shaft for some reason. So I call the office again (I feel like a stalker) and she says that she did call Anthem and guess what- they said to resubmit the application again. This is the THIRD time. I don't know who to believe. Is the insurance company or the Surgeon's office incompetent? By the way my surgeon's office is a Bariatric Center of Excellence so this should not be an issue. I have called my insurance and I can't get through to anyone who can help me. I have been given quite the run around and I am really at my whits end. Has anyone else had this happen? Could it be because I have COBRA coverage? Does Anthem think I will just give up and go away? Any advice would be very helpfull.

At 220 and 5'2 you have a BMI of 40.2 so you should qualify. If the Lap Band is what you think will work for you talk to your surgeon and see if they can submit for approval. Doesn't hurt to try.

Stephyanders- Thank you so much for your help, unfortunately that devision of Anthem does not support mine - Elements Preferred. I was able to get through to the correct devision this morning but of course they do not have any information on my case. They suggested that my doctor's office could be sending the info to the wrong department or the like. Argh! I called their office but of course the person I am working with was on the other line and would need to call me back. I am not holding my breath. Is there any other option for me? Should I ask to speak directly with the Doctor (doubt I could get through to her) or call the medical board or the insurance board? I would go to another surgeon but there isn't another BCOE in my area. Should I just go to Mexico and get this over with?

Thank you thank you thank you!!!!

It is very common for Doctors to bill the insurance higher than cash pay. I think they do it for two reasons. 1. They are trying to establish a higher negotiated rate even though they are only paid a small portion of it. 2. They get to write off the difference as a loss come tax time. Bigger losses than profit equal less taxes. I also think the insurance companies like it when they are billed such a high rate because they can then show the policy holder a larger savings, even though it is just an inflated price.

Thank you for your info. I am just so disgruntled. I am tempted to make an appointment with the surgeon just so I can ask her about her incompetent front office staff.

Hi Everyone- I have been lurking on here for a while, but I am just now getting around to introducing myself. I have been working through the process since October 2011. I am in the final phases of insurance approval. It hasn't gone as planned but I am hopeful that I will have my surgery in March. Wish me luck!