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Deb, keep us posted on your fills. Do they hurt? How do you feel after having one? Do they numb you before a fill? Almost 60 lbs lost! I think thats great!

Hey Lady Q! where have you been? We missed you! How is everything going?

Deb, Do you still have to chew, chew, chew everything that you eat? Do you ever get anything stuck or PB or any of these other things that some people have a problem with? Are you always aware that the band is there or do you just forget about it most of the time? You can tell I have my hopes up again....I'm just full of questions! BACK AWAY FROM THAT CANDY CORN!!!:bandit

:update: I think I got some good news today. I had my follow up at the sleep center and was told that I do have sleep apnea! I am hoping that now I will be approved for the surgery!! I'm not out of the club yet!!

Can someone please tell me where to find forms or advice for filing an appeal with the insurance company after being denied?

Sorry but I don't think anyone is understanding what I am asking! I have already jumped through all the hoops....I have had the cardiac and phsyc evaluations and a sleep study. No problems with any of them. I have seen the surgeon..she submitted all the paperwork to the insurance company...the insurance co. turned me down because I am 11 lbs. under their required weight with none of the co-morbids that they require. I am actually surprised that she even submitted it since she knew what my ins.co. required,but it's to late to change that now! I have not lost any weight...in fact I have gained a couple of lbs since I first started trying to get the band. This is my question..... If I now gain the extra weight.....go back to the surgeon and have the paper work re-submitted...does anyone know if I have a snowballs chance in hell of getting approved???? :cry

gingerbug, had you already submitted a claim and been denied and then gained more weight?

Thanks for all the feed back... but I'm not sure I asked the question clearly enough. It is not a question of gaining it back..I have never lost it. What I need to know is this......has anyone on here ever had a Dr. submit a request for them to have the surgery, been turned down because they did not weigh enough, gain more weight, (11 lb needed.) re-submit and get approved? Same Dr., Same insurance.

I was turned down by BC/BS because my BMI is only 38 with no co-morbids . I have a year to appeal. I'm wondering........ if I should happen to put on the 11 lbs sometime soon (which I'm sure I will) and had the Dr. to resubmit the claim....has anyone done this? I wonder if they would approve me then. Any thoughts on this?

Deb...losing weight the old fashioned way is what got me where I am today! That kinda felt like a smack!:Banane30: I was looking for a hug.:think

Charlene called this morning...Dr. Choban was not able to persuade them. Then I called BC/BS and spent 20 min. having them tell me that LB was not covered in my policy! I said ( among other things) then why was I denied because of BMI and lack of co-morbids? Finally they decided that I did have coverage but just did not qualify! I have a year to appeal. I do have arthritis in my back and foot and joint pain...but those are not qualifiers for them. I think my B/P is through the roof right now! I will appeal but without much hope.:think

It sounds like you had a fun week end. I painted and papered the bathroom. Had one of my grandsons here ( 6 yrs old) and we went to watch another grandson play football . He's in 5th grade and plays for Newlexington. It was verrrrry hot...and they didn't even score...but we had a good time!

No news yet. I called Charlene twice today and got her voice mail. I'm hoping that she will call me soon...I don't want to call BCBS until know if DR. Choben has talked to them. I would need to gain 15 lbs to get a BMI of 40 and beleive me I would have tried if I had known they would turn me down! My BMI 38 now and I think I have gained 5lbs since this all started! Say a prayer for me please!!

I have Anthem BC/BS of Massachusetts and they say if your BMI is 40 or above you don't need any co-morbids..if BMI is between 35 and 40 you need at least 1 co-morbid.

Charlene is the one that gave me the bad news. She said that Dr. Choban would talk to them "peer to peer" on Friday and see if she could get them to change their mind. So far I have not heard from anyone. I guess the problem is that my BMI is only 37 and my only co morbid is hypertension. They don't count high cholesterol. I'm not giving up totally yet but I don't have much hope. Thanks for the support ladies, it means a lot! Hang in there Deb..Mr. right will come along when you least expect it.

:think The Insurance Co. denied my claim.

Lady Q, there was just some mix up about the address not matching exactly. I think they have it fixed now...I hope so any way. It's just one more delay.Feels like everything is going sooooo slow! A free gym...how nice for you!

Serena, wow I wish I could give you a big hug. Talk to us! What can we do to help? We care about you!

Awww TM,thats so sweet. :Banane20: I'm glad we all found each other too. I would have been going nuts by now if I didn't have you ladies to rant to!! Your DH sounds like a real nice guy. Deb, I agree with you...it will work for us:pray2: it will work for us :rose: it will work for us. I have never been to Octoberfest, it sounds like fun.Hope you have a good time!

Hi Goldie, I'm 62 and I am "going for it" just a soon as I get the ok from my insurance.:confused:

TM, rants are like farts!!! They feel better out then in!:bounce:So rant on!!!

Hi Don, looks like you are doing great!

TM, please don't be sad!:hug: I really think it is the stress of waiting to get banded that is making us gain weight, although you are at least trying to be good and I just can't stop eating! Yes, yes ,yes the band is going to work for us, we are going to lose weight and be looking and feeling FINE before we know it! We are in this together! And we will not give up!! :whoo: You hang in there TM...we will get through this together!!!!

There was a message on the machine when I got home from work tonight from Charlene saying that she thinks she finally got to the bottom of things. She has resubmitted my packet and hopes they don't send it back this time. How is every one else doing??It's been pretty quiet on here except for my complaining!

Whoops! The person that Charlene is talking to is still saying that they don't have a contract with Mt. Carmel....The person That I'm talking to says...yes we do and can't figure out why they would be saying no. We went over address ,spelling everything. I'm not sure where to go from here!