mrscrash2u

I am 3 years out from having my Realize band surgery and have lost 78 pounds and am at my goal weight. Almost 2 years ago, my job relocated and now I commute 72 miles to work. I sit in a cubicle for 10 hours a day, that's 13 hours a day on my butt!!! I have a terrible roll over the top of my jeans, and just an overall blubbler belly. I can't stand it any more and want to get a tummy tuck. Plus, after the first of the year, seriously look for a new job. I am looking for PS in the Mid-cities area, that YOU have used, and would recommend. Any help would be welcomed.

Hello, I too have BCBS of Ill and they rejected me in Dec 07. BMI not high enough without 2 other things wrong. Kept testing and have high cholesterol and sleep apenea, re-summitted this past Monday. If they deny me this time I will seek some legal assistance. We are supposed to have great insurance coverage and we pay a hefty premium for it every week but what good is it if they get away with rejecting everyone. We all keep paying more for everything and getting (and accepting) less that there will come a time that you just have to put your foot down and do something about it. Good Luck. Let us know what happens.

Hi, When they denied me in Dec. I only had the high cholesterol and my BMI wasn't high enough (around 36.5 I think). Since then I have been tested for the sleep apenea and my doc. measured my height 2 weeks ago. Turns out, I'm not the 5'6" that I was in high school, I am exactly 5'5" now. That also made my BMI go up since Dec. So, we'll see what happens.

Hi all, I went through the consult, 6 month diet., meeting with dietision, (sp?) only to be rejected in December 07. In Feb. 08 I met with my Primary Care Phys. to begin the appeal process, he checked my heart, liver, blood, etc....Yes, I have high colesterol and he suggested I pay for the surgery my self. I insisted on the Sleep Apenea test. Well guess what, I've got it and pretty severe. Now, my doc. and the sleep clinic both want to "cure" me by making me sleep with a stupid mask on my face every night!! The sleep clinic isn't on my list of providers either so now I also have a bill from them close to $900. for the 2 sleep studies. (the part my ins. won't cover) My question is, do I have to do this "cure" for the insurance company to proceed with the appeal for the Lap-Band or can I put my foot down and refuse (I'm not going to sleep next to my husband looking like Darth Vader!!! :huh2: and being so confined I can't sleep anyway!) I already told my doctor I couldn't tolerate the mask and 3 days later he called in the order for the machine. They called me today to let me know the cost. Has anyone else had to do all of this nonsense too? Now we are mid way through April and I'm still not getting anywhere...Help

Thanks for all of your input on using the CPAP. At least now, I am considering it. I did call my doc and they sent in my appeal on Monday April 14th. Don't know how long it takes to hear something. I am thinking about calling BCBS on Friday to check on it. I hope it's good news this time. I'll keep you all posted. Thanks again.

Hi tweety63, Don't give up, I also got denied but am going to my Primary Care Phys. on Wednesday to start an appeal. My BMI is 37. We are going to see what co-morb. I have etc. I posted a thread in the Insurance area of this site and have recieved great feedback on appeals. Just got one today of a company that professionally handles your appeal at no cost to you. Check it out under my thread titled "Rejected by BCBS of Ill. Hope this helps. Keep us posted.

Just before leaving for holiday vacation, I got the letter from my insurance. They rejected me for not having 2 things wrong along with weight. I called the lady at my doctors office and she said I needed to get sicker. She said I could appeal it or be a self pay at almost $16,000. I have a herina at the same place where the band goes, but she said that didn't count. Couldn't they have told me 6 months ago before paying the $300 for the classes, etc.? I am supposed to see the Phys. next week, don't know if I should go. Any suggestions?

Is it just me or is anyone else having trouble getting around this site? No matter which tab I click on, every page is the same. Hope someone is checking on this.

Here's the phone number for self-pay at $9500. 1-800-RXBARKER I don't know anything else about the doctor or clinic, just heard it on the radio. Does anyone know who this is? They are in the Dallas area.

Hi, another one here from N. TX. I am in the Gun Barrel City area. I am going to Tyler Bariactrics, Dr. Babineau. I am trying to go thru BCBS but they just denied my claim. I am in the process of appealing it. The dr. in Tyler charges around $16,000. I have heard on the radio and have also seen some TV ads from some doctors in Dallas, for self-pays $9500. If I can't get ins. to pay, I'll probably check into them. I will find the phone number and post it. Good luck.

Hi All, I just went to my last class tonight. Spoke to the nutritionist and she didn't understand why my info was summitted to the Ins. because I am still finishing everything up. I am meeting with my primary care phys. next week to start the appeal process. I also double checked what my BMI is and it's 37, not the 35 that I thought it was. So we'll see what happens. I think even if I can't go through BCBS, I may end up being a self pay. I am so ready for this change in my life, but don't really know if I am ready to go into debt. Thanks for your responses.

Thanks for all of your input. I am not giving up yet, I have one more meeting to go to complete my 6 mos. supervised weight loss, if I miss it, I'll have to start over. I'm going to talk to my Primary Care Dr. because I know my cholesterol is very high and has been for some time now, and we'll see about a couple of other things. I'm not sure what my BMI is, I think it's 35 and I believe it took them about 2 weeks to reject.

Just before leaving for holiday vacation, I got the letter from my insurance. They rejected me for not having 2 things wrong along with weight. I called the lady at my doctors office and she said I needed to get sicker. She said I could appeal it or be a self pay at almost $16,000. I have a herina at the same place where the band goes, but she said that didn't count. Couldn't they have told me 6 months ago before paying the $300 for the classes, etc.? I am supposed to see the Phys. next week, don't know if I should go. Any suggestions?

Hi All, I have one more meeting to go in January and should find out soon after about surgery. Can't wait! I really like to cook and try new recipes, enjoy having guests over for dinner, etc., and one of my hobbies is collecting cook books and sharing recipes. I cook very healthy foods, we just eat too much of them! My family is questioning if I will still want to cook or will they be going hungry?:hungry: They are all very supportive of me going for Lap-Band. How do others handle this. Thanks for any input. Sue

I just found this site today and I have been very informed and inspired! I had my first meeting with Dr. Babineau in Tyler, TX on July 3rd 2007. I began my 6 month meeting program (required by insurance) on July 11th. I have one more month of documenting all of my meals, already had my doctor write his letter, saw the dietician yesterday and ordered my medical records for the past 5 years. My appt. for the phys. is the first week of Jan. 08. So I am hoping to hear about a surgery date sometime in January. I am so glad I finally took the step and asked my family doctor about Lap-Band. I wanted to ask about it over a year ago, but I was too embarressed to bring it up. This past May when I went in for my yearly checkup, I had written down everything that had been bothering me or that I needed checked, and very small, in the bottom corner of my paper I had written Lap-Band. Well, I almost chickened out again, but he took the paper from me and read my list! He referred me to Dr. Babineau and I am so glad he did. Well, not going to keep rambling on, just wanted to say hi and I will be checking this site alot!