serenity55

Was it only a little over a week ago that I was sad because I'd been denied? I saw my doctor a week ago, on the 14th. She told me that the medical group I belonged to had been bought out so I now was part of another one. She resubmitted the paperwork, and on Saturday, I got a letter saying that I'd been approved for a consultation with a surgeon! I'm so excited I don't know what to do. But wait! There's more! :-) Just before I left work today I got a call from the surgeon's office saying they had a cancellation tomorrow morning at 11, and did I want it? Well yeah!!!! I really feel like my journey's beginning now!

Thank you, April. There's more to the story. Today, just before I left work, the surgeon's office called to say they had a cancellation for tomorrow morning at 11. Did I want it? What do you think?! I'm either going to ask someone from work to drive me there, or I'll take a cab. Not cheap, but I don't care. I'm going! Debbie

Hi all, I've been posting on other threads since I joined this site, about how my insurance company's been uncooperative, to say the least. When my doctor first submitted the request for a surgeon, the medical group said I would have to travel at least an hour's distance to their surgeon. I am blind, and, apart from movies, I don't know of any blind folk who drive on a regular basis. (Well, I drove a friend's car when I was in college, and I'm still here!) :-) Anyway, I wrote back and explained that I wasn't willing to have my friends drive that far, and I didn't think it would be a good thing for a post operative patient to risk public transportation. Then they said I didn't have a psychological evaluation. So I had one. Then they said I needed five years' proof of attempted weight loss. So I had my personal trainer, who is also a friend, write a letter. Finally, they said I needed six months proof. And that was the fourth denial. I intended to go to obesity law.com and ask for help; in fact, I'd begun correspondence with them. Last Tuesday, I went to see my doctor. She informed me that the medical group had been "bought out" or words to that effect, and I was now with another one. She resubmitted everything, and on Saturday, I was approved for a consultation with a surgeon. I'm so excited, and I just can't hide it! (Hmm! Sounds like a song!) It's for November 17, and though it's a month away, it gives me a chance to really start exercising again. I haven't posted much here, but I did want to share with my sistas!

Oblong, I think that what's going to make this time different is that you have a tool that will help you. I haven't been banded yet, and believe me, I can relate to what you're saying, especially not fitting in airplane seats, or needing extensions, and feeling like you're crowding out the passengers beside you. I know that I'll probably have those same fears, but what helps me is to think about the end result, and then, take it one day at a time. The reason you're doing this is because, as you said, "Zero, here I come!" I also find that it really helps to do just what you've done, come to this board and talk, talk, talk. There are people all around you, those who've gone before, and those, like me, who will follow, who really do know what you're feeling. You can do this!

Thank you!

Not too long ago I posted that I'd been denied, and was looking for support. Weeellll ... I went to see my primary care physician on Tuesday. She told me that the medical group I belonged to had been "bought out"--or words to that effect--by a larger one, so she was resubmitting my request for a consultation. I got a letter yesterday saying that I was approved for a consultation with a surgeon! I'm so jazzed! I've been trying for six months to get this far, and I don't care what I have to do now, because I feel like I'm on my way to band land!

No, as a matter of fact, I felt better after deciding not to do the gig. The music was pretty awful, and it's taken me a long time to realize that I get to choose what I want to do. I haven't always felt like that, and now that I think of it, I have turned down other gigs, because either they didn't pay, or I felt that I was being taken advantage of, meaning it was just assumed that I'd play. I think the hardest thing with this one was saying no, because the person I talked to was so nice, and it was obvious that she, (she's the librettist) knows nothing about music, vocal, instrumentation, anything, and the composer, according to her, knew nothing about writing vocal music.

Hi all, I think this may be the first time I've done something like this. I was approached to be musical director for something which was called "an opera with jazz influence." I agreed to listen to the music, and decided it wasn't something I was interested in, so I turned it down. I didn't hear the influence from either genre, and the melody lines for the songs that were written seemed to have no shape; no theme, none of the traditional stuff I'm used to hearing in the music I've played. Has anyone else dealt with anything like that? Or have you ever simply turned down a music job for any reason?

Obesity law is an organization that helps people who have been denied WLS, and are appealing. (They also deal with discrimination, and probably other things, too. Anyway, their website is obesitylaw.com. I've read quite a few posts on this site from people who have been successful in getting approval for lap band surgery. (There may be someone else who can explain what they do a little better than I have.) :-)

Well, it’s official, I was denied, because I didn’t have the six months’ attempt at losing weight. Before that it was that I didn’t have five years’ proof, or the psych eval. I’m really depressed and feeling like there’s no one to help me. Pacificare, or at least the physicians’ group I deal with, gives me reasons, one at a time. I know that if I really want this I’ll have to keep fighting, but right now it really sucks! I know that I can appeal, and I know that I will, but I’m just so sad right now.

Missybelle, thank you. It's really easy for me to get down and ask myself why I'm fighting so hard, but when I'm in the place I am now, just waiting, it's just as easy to feel hopeful. There's part of me that simply will not give up, even though I ask myself just what I think I'm doing. Bikini Beachy, that was kind of creepy for the psych doctor to call you on your cell. My doctor was a little strange too, but my doctor read his report to me, and basically it said that I could benefit from getting the lap band. Thanks again to you both. Debbie

Bikini Beachy, thanks for asking. I had an appointment with my doctor this past Tuesday, and the first thing she said to me was that the physicians' group I was with has been sold to another group, so she's resubmitting everything. I'd contacted obesity law and they thought they might be able to help me, but when they learned I hadn't even allowed to see a surgeon, they wrote back to say that I was "caught" between my medical group and the surgeon, or something like that. But I was given the name of a doctor to contact to see if there might be a "fit" by which I guess they mean something could be worked out. I'm not giving up, but boy! this is so frustrating!!!!

I live in Van Nuys, and though I'm not banded yet, I love the idea of a group for bandsters, and if we were welcome, though of us who are waiting to be banded.

Hey there! I haven't posted here for quite a while either, as you can see, and I've been trying to think of something to keep us going. So thanks, marie! I'm still fighting with my insurance company, but my psych eval went well. 567 questions, plus the oral part! They've denied me, and the medical group I was with was sold to another one, so my doctor is submitting everything again. I also wrote to obesity law.com because I've read so much about how successful they've been. I've just been asked to be a musical director for an "opera with jazz influence." I've listened to the music and it's, um, interesting. If anyone has any ideas about how much to charge let me know, because, although I've done this kind of thing before, the fee was set, because of budgeting. It really is great when students catch on to music, isn't it? Chime in, anybody, please! Debbie

I posted this on the insurance thread, but I guess I really want encouragement and support. I’ve been dealing with insurance for months now. First they told me that I wasn’t elegible to get a lap band because they didn’t have office notes from my doctor. Then it was because they didn’t have a psychological evaluation. Then it was because they didn’t have five years proof that I’d tried other weight loss methods. (Or maybe the weight loss thing was first.) Anyway, my doctor sent office notes, I wrote a letter explaining why I couldn’t show proof that I’ve been trying to lose weight, not just for five years, but for over twenty. Oh, my insurance company also wanted to send me a very long distance from where I live. I don’t drive, I use public transportation, and I explained that it wouldn’t be good for a post operative patient to travel such a long distance. So I’ve been denied, and I’m so depressed I just want to crawl in to a hole, or in to bed, and stay there, eating myself to death, because that’s the one way I know I won’t feel anything. But I am feeling, because I’m upset. I think, Well, maybe I just don’t want the band, but then why the hell am I fighting, and why am I so upset? Answer: Because some part of me does want it. I will probably feel better tomorrow, and hopefully I’ll find the strength to do what needs to be done. I guess I just need some encouragement, support, or a good talking to? But be gentle, please?!

Hi Bev, It’s nice to know I’m not alone. Thank you for your post. I did contact obesity law because I’ve heard positive things about them, but I wasn’t sure if I should have my doctor appeal or just let them do it. I asked for an opinion about that, and am still waiting. But I’m thinking I’ll just let them help me. My physicians group told me they were denying me because I didn’t have six months’ proof of weight loss, and before that it was other things Let me know what happens with you. How long ago did your doctor’s office fax everything? Good luck, and thanks again!.

Michee, thank you for the encouragement. I’m going to try everything I can. I’d thought about self pay, but that’s just not an option for me, or at least, I didn’t think so. I believe my insurance will pay for it, and if they don’t they’re going to give me a good reason why. Skinipete, as you live in Florida, you have no idea how bad the transportation is, nor how difficult it might be for me, because I am blind and don’t drive. I don’t use my blindness to get pity; I’m simply stating a fact. Even if I were to get to a doctor closer to me I’d still have to travel for whatever classes or groups that were required, not to mention post operative appointments. I wouldn’t ask any of my sighted friends to drive me that far, not with the price of gas, and the time it would take. When I said it was an hour away, that’s in a car, directly from my house to the doctor’s office, not sharing a ride with others, which is what I’d be doing. Yes, I want to get a lap band, and I want it badly, and I also know that my insurance company has sent people to doctors closer to home. All I’m asking is that they do the same for me. I think that’s my right.

Yes, I’m definitely going to appeal. I think the fault lies with the insurance company. My doctor told me to be prepared for a fight. I’ve written to obesity law.com to ask if I should let my doctor appeal first or just go with them. I just learned I might only have one chance to do that.

I guess because she didn't think she could send me to one without authorization from the insurance company?

Beth, I know it's very confusing. My insurance company has different plans, and the one my employer has chosen makes me start with my primary care doctor. I couldn't even get a referral to a surgeon, but in talking with the support person, I was told that bariatric surgery isn't excluded. I'm confused because most people on this site have been sent to a surgeon, but I can't even get that far, so I've just done what they've told me they needed, the psych eval, the cardiology exam, whatever. I'm not giving up, but it's very frustrating because I feel like I'm not being given the same treatment as most people here seem to get, i.e. going to a surgeon and doing all the pre op testing and nutritional guidance under that person's guidance. I've made an appointment to see my doctor, but that's not for another week and a half. I have six months to appeal, according to the letter I got yesterday, but I want things to happen now, and I hate waiting for another week. I was also told that the insurance company would appeal for me, too, but it was suggested that I first go to my primary care physician. If I had my way, I'd go to her, the insurance company, and obesity law. Can you tell that patience isn't a virtue? I'm just going to try to keep searching and learning, as my signature says.

Thank you both. Karen-Karen, I've never heard of the body bug. Interesting. I'm really intent on making my insurance company pay for the surgery. I spoke to the liaison, or support person that deals with my employer, and she suggested that i have my doctor appeal for me, or call the member number on my insurance card and have them appeal. I've also read about obesity law.com on this site, and am seriously considering applying to them for help. I went on their web site last night and liked what I read. Veronica, I wish you lived closer to me. You said you'd be calling every day, or writing letters every week. I really think that's how you get things done, and it's not something I'm good at, but i guess I'm learning. that's great that you didn't have any trouble with your insurance company. anyway, I feel better knowing that I have options--not that I didn't knowthat last night, but I was just so bummed everything seemed hopeless, and i thought, why am i trying so hard? Debbie

Thank you, BikiniBeachy. I called the insurance company, well, actually, i think the woman I talk to is sort of a liaison between my employer and Pacificare. Anyway, she gave me some options: 1. Call my doctor and have her appeal, because, she says, that might carry more weight--no pun intended. 2. Call the member number for Pacificare and have them do the appeal. and 3. I told her about obesity law.com, which she thinks is wonderful. So I'll leave a message for my doctor, maybe go to see her, or maybe I'll just contact obesity law. Like you, I've been doing this since March, and while I know that many people deal with this crap for much longer, I don't want to if I don't have to. Debbie

Hey Beth, thank you for the words of encouragement. I know that some insurance companies just don't want to pay for weight loss surgeries; in fact, my best friend was saying that this evening. It really makes me mad, because, like you, I take medication that i'm sure I wouldn't have to, if I lost weight. I might even be able to lose my CPAP machine, which I know cost them a pretty penny. It all adds up. Thanks again. I needed to read what you had to say. Debbie

Thank you adamsmom and April. I know I'll keep fighting, my best friend tells me I'm a true Capricorn, stubborn, and a climber, whatever that means. I'm just not used to going for something like this that I really want. But I must really want to be banded, otherwise why would I be so upset? Thanks again, to both of you.

Sooner, that's fantastic. I'm still fighting with insurance, so I think I'll check out their web site. I hope they're nationwide! good luck! Let us know how everything goes! Debbie