Ellisa

Dr. Trace Curry, Jewish Hospital, Cincinnati (area) Ohio, December 18th. So far so good! Dr. Curry's staff are awesome and the staff at Jewish were wonderful, not a single complaint.

Sue, Make a list of all your weight loss efforts (doctor supervised or not) explain what caused you to fail (i.e. cravings, hunger, lack of continued weight loss, etc.). Make a list of your health issues related to your weight. Make a list of problems caused by your weight. Once you get your facts down, put it in a letter form. Make sure that you include your yearly weight records for whatever period your insurance requires. Explain why you and your health care professionals believe weight loss surgery will help you succeed. I don't know how this works for appeals, but a friend of mine wrote a letter of that nature since she was unable to provide her medical records for the 5 years her insurance requested. (Long story.) She was approved. I'm sure others will have even better ideas.

I too found I had some gas pain in the last couple of days that I wasn't expecting since everything seemed to be easier than I'd expected. It went away as suddenly as it came. It was a little concerning when it hit. But didn't last a very long time so I figured it must be okay.

Oops, this is a thread I didn't get back to. Banded on 12/18/07. It all went very smoothly. My doc allows pureed the day after surgery for 2 weeks before soft foods for two weeks. I'm not hungry at all, but I'm sure that will change once the swelling goes down and the gas is absorbed. I'll keep checking to see how you ladies fare with insurance.

Banded 12/18/07, on pureed. I've had eggs with gravy, chicken salad (even the veggies cooked), fish, mashed pototoes & gravy, quick oats, yogurt, pudding V8, bananas. I'm also using Isopure. While I'm able to eat a pretty good variety of food, I'm not very hungry so only eating about 1/4 C of food at a time.

Instructions from my doc's office said no baths or swimming/hot tubs for 2 weeks. Showers were okay.

You are right, you haven't been denied and that's huge. When I called once and they told me that I hadn't met certain requirements, I thought that they must have lost 1/2 of my paperwork (which they had) and I thought it was a denial. When I got the letter that said "pended" I was really confused. But once I realized that it wasn't actually denied, I was relieved but still very concerned that it still could be denied. Eventually it all came together. I certainly hope it does for you. The waiting for approval seems eternity! But once you get it, things move along pretty quickly. I felt like I didn't really have time to get nervous about the surgery because of all the preparation.

I'm continuing to feel better all the time. (Banded on the 18th) But that being said, I don't have to do much besides take care of myself. My DH has been fixing most of my meals even. He was banded 2 years ago, so he understands what pureed means. LOL If I had small children to take care of or otherwise a lot to do, I might not think I was feeling so hot. LOL I'm making sure I get enough Protein. I'm still not really hungry, so most of my protein is in the form of Isopure. When I eat I do good to get 2 oz. of anything down. I just feel really full all the time. I suppose it's the gas and swelling... at least it isn't hurting a lot. Today we went to Red Lobster, I got grilled fish with Alfredo Sauce and mashed potatoes. I ate maybe 2 tsps of mashed potatoes and about 1/4 of the fish fillet and brought the rest home. It tasted wonderful, but that was all I could eat. That was around 1:30, it's after 5 now and I still feel stuffed.

You are not whining. You have every right to be frustrated. And 20% of this surgery is a lot of money. It's just a shame that we are at the mercy of their slow wheels turning. It seems like they should have some responsibility for a maximum amount of time they are allowed for a response. Come here and complain all you want. That's what we're here for. Folks helped me just by understanding.

I hope that you do find that you qualify. But if you don't... weighting down? Please don't take that advice. It's fraud. If you happen to gain weight, that's one thing, but please don't consider doing anything dishonest. I know it's frustrating, but people who do such things are part of the reason the insurance companies make so many hoops for us to jump through. What next? Will they require that one of their reps personally frisk people before accepting their weight as fact? How long will it take for others to get approval if they have to wait in line for that? Can you blame the insurance companies for trying to protect themselves? I agree the insurance companies should logical about preventing further health concerns, but the policy is what it is, that's what we pay for. Not what we think it should be. I'm not trying to be judgemental to any who have resorted to that, believe me I understand the frustration. I was denied 4 years ago and never really knew why. I didn't know about boards like this where I could have come to perhaps learned about the appeal process. I just let it go. But I do fear that people resorting to fraud will only make it more difficult for those who follow. I was approved and banded on Tuesday, with a different insurance company.

Once mine got to the review stage it moved quickly. Hopefully yours will too.

Hey RonKat, I hope your surgery is as easy as mine. I'm a little sore, but not bad at all. My DH had his done 2 years ago, he also got along very well. His surgery was laparoscopic, but took a little longer because he had a lot of scar tissue from an old fashioned gall badder surgery years ago. I had a hernia repair, so have a little extra discomfort, but honestly, not horrible. I don't feel like running the sweeper. LOL But truly not bad at all. Wish you well!

Hang in there, and next time you call, firmly but politely insist on being transferred to a nurse. Once the nurse was involved things moved at lightning speed!

Shelly, Yes you are still young and how awesome for you to have it done now! You are going to look and feel so good!

The gas pain was only for about an hour. I have some soreness in the area where the hernia was repaired, but that's not very bad. Nothing Tylenol can't keep at bay. I'm allowed to eat pureed foods, but I'm really not hungry. Ate some mashed potatoes & gravy yesterday, it tasted good, but I only ate it because I thought I should not because I really wanted it. Drinking 1/2 a low carb slim fast now. I guess knowing I can have other stuff makes it less desirable. LOL. I haven't really been hungry since I started the pre op Clear liquids. I think when the ketones kick in the hunger wanes. After my surgery I could actually smell my keto breath. Yuck!

Sounds like you are doing great! I had mine yesterday and feel pretty darn good too. I expected to be vomiting...my usual response to anesthesia, but the good doctor made sure I had meds to keep that from happening. I hope everyone has it as easy as we did!

My surgery was yesterday. I got home about 1:00 p.m. today. (Due to my distance from the hospital, I had to stay over.) The surgery was quick, although Dr. found I had a very large hernia in my diaphragm. He repaired that. Basically most of my stomach has lived in my chest cavity all my life. That explained a lot! The worst of it was that for about an hour my right shoulder in the joint area hurt so bad I thought they must have ripped it out of socket moving me onto the bed. But that's the referred pain due to the gas that's pumped in. But it became considerably better after an hour. I only used Tylenol with out any "good stuff" added after that. I did take something stronger for the trip home, just in case. But we stopped at a WalMart about halfway home so I could walk and we picked up a few groceries. I enjoyed the walk. Now I'm going to be lazy and copy and paste this on all the appropriate threads.

My surgery was yesterday. I got home about 1:00 p.m. today. (Due to my distance from the hospital, I had to stay over.) The surgery was quick, although Dr. found I had a very large hernia in my diaphragm. He repaired that. Basically most of my stomach has lived in my chest cavity all my life. That explained a lot! The worst of it was that for about an hour my right shoulder in the joint area hurt so bad I thought they must have ripped it out of socket moving me onto the bed. But that's the referred pain due to the gas that's pumped in. But it became considerably better after an hour. I only used Tylenol with out any "good stuff" added after that. I did take something stronger for the trip home, just in case. But we stopped at a WalMart about halfway home so I could walk and we picked up a few groceries. I enjoyed the walk. I'm using a laptop in a recliner, don't think I'd like sitting infront of a regular PC. Now I'm going to be lazy and copy and paste this on all the appropriate threads.

Read the thread started by Dustout "Approved by BC/BS. You'll that my experience was very similar. But I was approved after 6 weeks. And was banded yesterday!

I won't be able to post tomorrow or probably Wednesday, but will get back with you on Thursday. I will be watching this thread to see WHEN you get your approval. The waiting is absolutely the worst of the approval process. Take care,

You are so right Freebird! This is an accomplishment. Just making the decision is huge! I'm never home during the day, so as I'm puttering around and sipping my clears, and checking in here... I've got the TV on for noise I guess. My goodness how many programs are about cooking and commercials are about food! And I live in the sticks, don't have cable, so it's just basic local channels. We did have Dish Network, but it seemed like everytime the weather was... well, being weather, it went off. We really aren't home much to watch it anyway.

Frisky, That's awesome about your surgery time! I don't know if I would want mine any earlier. It's at 12:30, but I have to be there at 9:30 a.m. and live 3 hours away. So we'll probably leave about 5:30 a.m. so DH can get something to eat on the way. Well aren't we all a basket of nerves? LOL Actually the only thing I'm nervous about is not messing up on my Clear liquids. So far it hasn't been too bad. strawberry SF Jello for Breakfast. chicken broth for snack... Oh my what shall I have for lunch... beef broth? I too have so many things I want to get done before I leave. I think I have everything packed except my makeup. Probably packed too much stuff. But oh well. I'm also making sure I have a pillow and blanket & liquids for the ride home. I'm on pureed the day after, so slim fast and pudding should be okay. I'll also have some bottled Water. Oh that reminds me, I'll need to put some plastic spoons in the cooler. We brought a comfy cushy recliner to the living room yesterday. It's been in a spare bedroom for a few years now because it doesn't match the rest of the furniture. But it's in good shape and I will love having my feet propped up in it. It's sitting right next to the fireplace. Hey, I might think about buying a slip cover for it and leaving it here permanently. The color really isn't bad, it's the style. Not sure what a slip cover will do for that. I'm rambling...

Becky, I'll be banded tomorrow. I got my approval, about the 20th of November (give or take, my memory isn't the best... especially on clear liquids). Paperwork was originally sent in around the 8th of October. If you'll read that thread started by Dustout, you'll see the details. I don't know of course if this made a difference, but I'm going to Cincinnati, to Dr. Curry. I had to pay a $300 program fee. That was to have the insurance paperwork filed. The lady who handles it (Tracy) was just awesome. She makes sure the i's are dotted and the t's crossed. She was sure that it would be approved. Had I needed an appeal, the $300 covered one appeal with an attorney. That's how sure they are that they know what they are doing. Now that being said... if there's an exclusion on your policy, they tell you up front that it will not be covered by your insurance. Also she lets you know if you don't meet the company's requirements. I didn't pay anything until she saw what I sent in and was confident it was adequate. Once she have me the thumbs up, I paid the program fee and it was submitted. All of the snafu's were on Anthem's end. (I.E. separated paperwork, information not being entered into the data base, etc.)

Becky, While I was approved in about 6 week, it wasn't all smooth sailing. Some of my paperwork also got "separated." In the end I called and while I remained polite, I was also firm that there had to be a mixup. Finally the customer service rep transferred me to a nurse. She got to the bottom of it and I had an approval the next day. Before that, I couldn't get past the customer service reps who kept transferring me to a voicemail that no one ever responded to.

I am certainly no expert, but I have Anthem BC/BS Ohio. I had to have my weight history, but I didn't have one for each year, but provided 7 years. I don't kow how much of that my surgeon's office sent in. And there were times when my BMI was below 40. I have no co-morbibities. Didn't have to do a 6 mo. diet. But perhaps they counted the times when I was dieting and therefore my BMI was below 40. I did have a few months, but not 6 months where I was under my doc's supervision and using adepax. My understanding is, if you don't have an exclusion on your policy that BC/BS uses a national center to determine benefits.. I don't think the state matters, but the policy does. I may be wrong. If you haven't done so, look at the thread started by Dustout regarding his approval with Anthem BC/BS. I think there's a link there to BC/BS. When I asked them (Anthem) to send me a copy, what they sent was exactly what's on that web page. If you self pay, your surgeon charges you more than the amount they agree to accept if they are in-network with your insurance. Is there another facility that's more successful at getting approvals? Your are right, you do pay too much for it. If you have no exclusions, I wouldn't think it would be denied.