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I think after they have all the info for an appeal they submit it to the insurance co. then the insurance company has so many weeks to respond. Then the attorney has so many weeks to respond. (I know, absolutely no help, this is why I am not in the legal field, either bad guys would be running loose or good guys would be behind bars!!) It took approx 6 to 8 weeks to hear from the insurance company that they had denied me the 2nd time because I did not appeal within 30 days of my 1st denial. I was denied the 1st time because I had not completed the supervised diet; therefore, I was doing the 6 month supervised diet.

Spent the last few months battling in court over officers who "assumed" without facts. My son fell asleep at the wheel of his truck one morning while going to work. He crossed the medium and hit an empty (thank God) parked car. When the officer got to the site, my son was getting out of his truck, dazed. The officer booked him as DUI, took him to the local hospital for a consented blood test, then took him to jail. When I bailed him out the officer told me they were not looking at alcohol but for drugs. This happened the middle of Dec. and we had a court date the middle of January. My son plead not guilty but requested to retain the right of an attorney until the blood evidence returned. The judge instructed him to return to court 02/01 with legal council although he knew the blood evidence would not be back. $500. for an attorney, and blood was not back by 02/01, continued till 03/01. Blood evidence came back 0 alcohol and 0 drug. The police officers notes said no evidence of alcohol/drugs in the vehicle nor on his person. During all this ordeal I sat through alot of traffic court hearings. In my state, if you can prove it was 70 mph speed limit, they will drop the 3 miles over. 100 ft signal before lane change, whats up with that?? As you said, you are SOL about the license being expired. Bring proof of insurance that was current on the day of the traffic violation with you to court, judge should throw it out. Remember us when you become the police officer, my father and brother were both on the force so I do have encouraging memories. Luck to you.

I am currently appealing my denial through Kelly and Walter Lindstrom. From what Kelly told me, the makers of the lap-band (Inamed?) believed in their product enough to "fund" (for lack of a better word) people who qualified for the procedure by paying for the legal fees. I was originally denied by Humana because of lack of a 6 month diet. After completing the diet I was denied because I had not appealed within a 30 day time period. Each time Kelly would call/e-mail me and say, "No stress, if they do blah, blah, blah, we will do blah, blah, blah. She always has a game plan and is always thinking. She instructed the surgeons office to resubmit the information to the insurance company and told me to wait the 30 some odd days to receive information. If I was denied again she said she would immediately appeal. On Tuesday the surgeons office contacted me and said the insurance company said I had 3 days to get them an "official" weight and bmi. On Wednesday I was @ my pc doctor's office who faxed that info to the surgeons office. Maybe this is good news and Humana is finally doing what they are paid for.

Never broke the scale but went to a picnic one sunny afternoon, sat down on the seat of the picnic table (no one was on the other side) and the whole table flipped over!! I cried I was so embarrassed, it's funny now. One of those "that was then, this is now" moments.

Lisa Good luck on your visit tomorrow. Let us know what happens because we are all praying for you. PJ

Shelby, I had a little of the same problem. 1st I was denied because I did not have 6 mths of documented diet, then I was denied because I did not have life threatening co-morbidities. Through my doctors office, I was put in touch with Obesity Law, (Walter Lindstrome) There is a program that will pay the attorney fees for your appeal. But we found out through this process that after a time period, (don't know how long) you are no longer allowed to appeal; therefore, I had to re-submit my info to insurance and now am waiting for my denial letter so we can appeal in THEIR time period. (Choosing my battles) If you have not already taken steps, get on line and get the # (I don't have it immediately with me) and contact the agency to see if you qualify for this program. What do you have to lose? Luck to you! PJ

Congrats and I am envious. Waiting, waiting, waiting on approval. How long were you off from work and was recovery hard. One day it WILL be me!! PJ

I want to wear heels again. I think they make all women look sexy. Everytime I wear them now my knees scream for days. I want to walk up stairs without thinking I'm going to have to schedule a heart attack once I reach my office. I want to walk down the hall without hearing the "swish swish" of my thighs rubbing together. I want to walk by construction workers and maybe hear just one of them making an apprecative "unappropriate" remark I want to live in onederland!!!

I also have Humana PPO, a KY state employee. I completed the 6 month supervised diet, (insurance company will want copies of the doctor's notes and not that you have completed the supervised diet). After I completed the 6 month diet Humana denied my surgery based on pre-existing co-morbities. Talk to as many people as possible at Humana to determine exactily what they desire to qualify you. PJ

Welcome Lydia! Glad to meet another Kentuckian. We are few and far between! Good luck in your process. I also am in Western KY, a little town called Hopkinsville. A far drive from Louisville. PA

I contacted obesitylaw.com for legal advice and talked to Kelly Lindstrom. She told me there is a program backed by the makers of the lap-band that if you are denied based on "none life threatening co-what evers", obesity law office will do the appeal and not charge the patient. (I am assuming the manufacturers of the band reimburse the law office or maybe they are that supportive of the band) Anyway, the request for their help has to come from the surgeons office; therefore, I contacted my surgeons office today and gave them the information, they contacted Ms. Lindstrom in CA, she faxed the info to the surgeons office who faxed info to me. I have already completed the application and will fax it back Monday morning. Ms. Lindstrom said very few people were aware of the program and she wish more were involved. Sounds like an oppertunity. PJ __________________

Becky, thanks for the well wishes, looks like you are doing fabulous on your weight loss. Myturnow, my comorbities are arthritis in my knees and hips, gerd, high blood pressure and tired of being fat!!! I expect we will know something within the next few months but I have been on this journey for over a year now. I am at the point that I am researching self-pay just to be ready if things don't go my way. What about yourself?

I got an e-mail from Obesity Law this morning saying they were finalizing my appeal and were preparing to fax it to Humana. They sent me some forms to sign and fax back to them giving them permission to represent me and to request medical information. Would be nice to have surgery in January but I don't think things will move that quick if I get approved. The waiting is killing me. So are you fighting the denial??

Babs Thanks for the response. I will be watching the responses you get just for future information. I also have group insurance, (state employee) but was unaware that I would be considered high risk for 10 years if something happened to my job and I was no longer covered under the group insurance. I consider that valuable information. Good luck with your search and thanks for the info. PJ

Babs, First, I do not have an answer to your question, wish I did. But are you saying that you cannot find an insurance company that will insure you since you got your band or they classify you as high risk? Currently I do not have a band but am trying to get one. The insurance thing does concern me. PJ

I received an e-mail from them on Wednesday and was told they had accepted my case and were in the process of writing a letter to my insurance company. Somewhere I heard they have had very good results and usually within a 30 day time period so I'm thinking maybe the beginning of the year for surgery if this works out.

Contacted my insurance company today to inquire where they were with approving my surgery. The lady on the phone said they had not received any information from my doctor's office since 01/06, so I called the doctor's office and they insisted they had faxed the insurance office 32 pages on 10/21/06. The doctor's office contacted the insurance company and found out since the insurance had denied surgery 01/06 because they required 6 months of supervised diet, they sent the newly submitted info to the Appeal Department and I should hear something within 30 days. I do not think they realize my heart already has enough stress because of my weight, now the waiting process is adding additional stress. I may "stroke out" before they make up their minds!!! :faint: Prayers Please!!! PJ

Update, I contacted obesitylaw.com for legal advice and talked to Kelly Lindstrom. She told me there is a program backed by the makers of the lap-band that if you are denied based on "none life threatening co-what evers", obesity law office will do the appeal and not charge the patient. (I am assuming the manufacturers of the band reimburse the law office or maybe they are that supportive of the band) Anyway, the request for their help has to come from the surgeons office; therefore, I contacted my surgeons office today and gave them the information, they contacted Ms. Lindstrom in CA, she faxed the info to the surgeons office who faxed info to me. I have already completed the application and will fax it back Monday morning. Needless to say, I am tickled and trying not to "count those chickens before they are hatched", (my mother's favorite saying) Ms. Lindstrom said very few people are aware of the program and she wishes more would participate.:clap2: PJ __________________

Lerasi, I went through your online album..WOW, beautiful work!!

Carmillejoanita, Just because the doctor at the second seminar supports the bypass does not mean you have to, thats your choice. Since you are going to the doctor to get back on diet pills, won't you have to visit the doctor every month for a new script?? 2 birds with one stone, make him aware that your insurance requires 6 months of monitored diet for you to be considered for the band. Do not miss a month, when you go to the doctor for your 1st appointment go ahead and make appointments for the next 5 months. It passes quickly. As far as myself, don't count me out, I'm a KY girl and we don't give up without a fight. Monday I will start by contacting my surgeons office, then I will contact my insurances office, then I might go with legal advice. I am 47 years old and plan on living long enough to become a pain in the butt to my great grandchildren. When I do go I want my gr. grandchild to say, "man, she was fun", but I don't see it happening with me weighting what I do. The Lord says in his time, I just have to be patient enough for him to decide when the time is right. Until then I will complain, LOUDLY to the insurance company, do my research, and take a hint from kygal and exercise some, (thanks for the support kygal) So don't you punk out. I expect another voice yelling besides mine!!!! PJ

Not wearing my happy face today. After having a wonderful day off, 76 degrees outside, took my 93 year old aunt on a drive in the country, went down and got a pedicure, picked out a Christmas present for my hubby, I came home and found a denial letter from Humana. They said the denial was due to me not having life-threatening co-morbidities. I'm thinking, "no, not yet, but I am 47 years old and get rounder every year, I am attempting to prevent from having life threatening problems, hence the weight loss surgery!!" I am upset and need to know what the next step is. By Sunday I will be good and mad and ready to do what I need to do. My question is what do I need to do??:help: :help:

Carlene, I would be content with 73 lbs and my BMI is 41. The letter my pcp sent said I have high cholesterol, osteoarthritis, high blood pressure and acid reflex. I know right now none of these things are that serious...yet.

Not wearing my happy face today. After having a wonderful day off, 76 degrees outside, took my 93 year old aunt on a drive in the country, went down and got a pedicure, picked out a Christmas present for my hubby, I came home and found a denial letter from Humana. They said the denial was due to me not having life-threatening co-morbidities. I'm thinking, "no, not yet, but I am 47 years old and get rounder every year, I am attempting to prevent from having life threatening problems, hence the weight loss surgery!!" I am upset and need to know what the next step is. By Sunday I will be good and mad and ready to do what I need to do. Right now I need chocolate and a hug!!

Carmillejoanita, My insurance is Humana Choice Care PPO. I don't know if your insurance will require the 6 month monitored diet. I assume you were required to see your doctor everymonth to receive diet pills, at least that is what my doctor required. Talk to your doctor and see if he will use that time period as your 6 month diet. Of course it also depends on the notes the doctor documented in your file. When my pcp turned my information into my wl doctor's office he had to include his notes for the 6 month diet and I was required to attend every month, not to miss a month. Good luck to us all, my wl office said for me to contact them again in 4 weeks so I will twiddle my thumbs until them. I will include all of you in my prayers. PJ

Sounds like a fun position, a full day, (hope they are not all like that) and fulfilling work. You make me feel lazy, I am an 8 - 4:30 person then come home and complain on how tired I am. Hopefully that will stop after I lose 50 or 69 lbs. My husband is on disability due to MS and he does the majority of running for the house. He draws the line at cooking and only cooks (or orders out) 2 times per week. So I don't have to come home to clean and only cook a couple times a week. Yep, I think I am lazy!! PJ