aldmb2

Well, after starting this journey almost a year ago, doing the whole 6 months, getting denied 3 days before surgery, and then being denied TWICE by the insurance appeal.....................My external review found surgery medically necessary!!!!!!!!!!!! So, does this mean my insurance has to approve the surgery?? Or can I still get stuck paying the bill??

I started my journey one year ago & just got my approval from the external review today. Just dont loose hope. Keep trucking along. Live like you normally would.

I have Highmark BCBS & they require a BMI of 50 or more. I have a 42 ....

.......are nerve-racking! My insurance had an appeal process where they waited the full 30 days to deny me, then another 2 weeks to deny the 2nd appeal. Now its with the external review. June 30th will be exactly one year that I started this journey. Starting to loose my cool!

Thank You! I have a surgeon who is about 2hrs away that offers a resonable self-pay option. I have an appointment next week. Just so Im ready if I'm denied.

Hello, Im looking for a buddy who has the same sleeve date as me (or near me)! 02/29/2012. Leap Day!! I suppose I get to Celebrate my surgery once every 4 years then?

My current BMI is 44. I was initially doing the band & mid way through the 6 months I changed my mind to the sleeve. My Dr. office dropped the ball & never checked to see if I was approved. It was definitely heartbreaking. Now, Im looking into self pay, and found out that if my insurance company's external review approves it after I will get reimbursed. So its one positive.

Body Mass Index

Thank you very much. I have read some horror stories about certain self pay Dr.'s. Thank you for the recommendation!

I'm looking for some good surgeons in the US who offer a reasonable self-pay option. Mexico is not an option. I have found a few out there that seem to have a good following. Just looking for any help. I prefer to have a Dr. on the East Coast since I'm in PA. Thanks

Did you send them the same letter you sent for the initial appeal to your insurance?? Ive read your letter & its wonderful. Did you add more?

Highmark BCBS

My BMI is lower than 50. That is my insurers policy. From what I've read online even the external appeal cannot over-ride a policy.

Well, my family has agreed to help me with the self pay... Under one stipulation. I stay in the US. They have a fear of me leaving the Country. I can't argue with them since they are willing to help me. Plus, Im a little scared of going to Mexico. I live in PA & I am a really bad flyer. I would be terrified.

Hello, I know that the insurance company has 30 days to deny my initial appeal (they have already denied the peer to peer with my surgeon), but my 30 days is up in one week & I still have no answer. Does anyone know if its common practice that insurance companies actually takes this long!?!? I've read from others they usually get the denial pretty quick. Thanks

Are you having you surgery in the States?? I am looking into possible self pay if my insurance denies me. But, all the Surgeons on my area are pretty expensive so I am also looking for a good Dr. with a reasonable price.

Well, I started my pre-op diet about 2 days ago, and I want to give up. I feel like Im starving myself. Diet consists of: 4 Protein Shakes (Breakfest, Lunch, Dinner, Snack) 6oz greek yogurt 1/2 cup tomatoe juice ( which I dont like) 1/2 cup farina ( have yet to try) 1/2 sugar free pudding. Maybe Im just being a baby, but I dont know if I can do this for 2 weeks. Ive already cheated by eating carrots!!!

My initial request was denied by my insurance (BMI lower than 50) & the peer2peer did nothing. My surgeon’s office suggested switching to an insurance that covers the sleeve. I’m not sure how I go about this or how it even would work. Anyone else ever hear or even attempt to do this. I’m fully aware the premium will be outrageous, but it’s better than paying $20k out of pocket.

That has to be the most inspirational thing I have ever seen. Goosebumps!

Since I was denied by my insurance & my Surgeons peer to peer talk has yet to take place (hopefully tomorrow), I told the surgeons office today that I will not be having the band or bypass. I have gone through 7 months of hell and Im not choosing another alternative. So, looks like I may be working overtime soon. Self-Pay may be in my future. Are there many out there who have self-paid?

Did you both have the procedure done locally or do you travel to where it was cheapest (in the USA)?

Good Luck!!! My appeal letter will be going out to highmark tomorrow if the peer to peer doesn't go well. So they will have two of us!!!!

I was supposed to have my surgery today, but on Monday my insurance denied, stating I don't meet their 'criteria' (BMI under 50). To make a long story short I woke up in the middle of the night feeling terrible. I just thought my nerves are shot from this entire process. Well, I was wrong. I have a GI virus. I'm sitting here wondering if the reason I was denied for today was because who ever watches over me knew I would be getting sick. Sometimes strange things really do happen. Hopefully my appeal & the call from my surgeon tomorrow will make a difference. All I know is I feel like sh*t & I'm really glad I didn't have major surgery today! And, that I just might believe in guardian angels

Based on my current policy (highmark bcbs) it doesn't look like I'm going to get approved. They require the BMI of 50. I have a 46. I have no comorbidity. I am healthy with the exception of obesity, which is not enough for them. I have hit a wall. I am lost and don't know where to turn. I have fought for 6 months for this, and I'm afraid I have no more fight left in me. I will write my one appeal letter then walk away. Would you have the band? Or buy the next plane ticket to Mexico?

I'm not sure my family will support me going to Mexico. So, I will be looking into self-pay options, if the call from my surgeon does nothing.