KayleighsMommy

The insurance company... can ya believe it??? It went from "oh, yes, she is completely covered..no prerequisites or co pays" to... "we need 5 years medical documentation, as well as the sleep apnea study" (done), to " she needs 24 months documented diet" The insurance girl in the doctors office absolutley cannot believe this bull.

They already got my 5 years of medical records (I have been overweight for 40 of my 46 years) It has to be a documented diet...Jenny Craig, Weight Watchers, whatever...but it has to be fully documented. I do not have this.

The girl at my surgeons office told me she would put in my request for authorization on a Friday, and call them on Mon or Tuesday. I didn't want to bug her... so I waited a week and a half to call. She hadn't even sent my paperwork in yet!!! She told me she is so busy, she needs me to call constantly!!! Who knew?? So...now I am still waiting for an answer (and my surgery is in 9 days!!!!)

I am scheduled for the 26th, so I can't tell you anything that will happen in the hopitsl/preop, but I can tell you the only pre surgery diet my doctor calls for is 3 days clear liquids prior to surgery. I am really concerned about my liver being too big also...even witht he 3 days liquids.

I must admit, as I read posts my eye automatically goes to peoples tickers. I have been known to think "Wow...she/he only needs to lose 78 pounds...what is she/he doing having surgery??" Now I must admit... I wish I had had the surgery when I had had to lose less than 100 pounds!!!!! :cursing: I am reading what everyone has written here, and I see their points. Will I still look at peoples tickers and wonder why they are having surgery...perhaps (hey...I can't change my complete mindset over night) But now I will also also think: smart, lucky person...making changes before they are 300+ like me. Just my 2 cents.

Update... I went to see my regular doc for my surgical clearance today. I told her about my chest tightness. She sent me for a chest X-Ray and EKG. Hopefully those will be both fine, and I will be on my way

I was afraid to tell my hubby too. He was engaged before and she died on the table (she was heavy, but it wasn't WLS) He took the news quite well. He understands this is something I need to do for me, as well as our 4 year old daughter.

Dynamom, Was your surgery today?? How are you doing??? julie

Thanks for the advice. I am seeing my regular doc tomorrow. I will mention it to her. julie

You're welcome. Please let me know how you are doing, too. Also... feel free to PM me if you would like to talk some more. julie

Karen, I wish I had some words of encouragement...all I can say is you are not alone in your feelings. I am 46 and have a 4 year old. I am also doing this (in large part) for her. I am scheduled the 26th of June and I am so worried about something going wrong. I am so worried that if something happens to me she will be alone (though my husband is a great father, I just don't want her to grow up without a mother) I have been having "pressure" in my chest (not really pain) for months now...I am so afraid I am going to have a heart attack during surgery...or just not wake up. I am seeing my regualr doctor Friday for a medical clearance, I will mention it to her. On the other hand...I am afraid she will not give me a medical clearance until I see a cardiologist (I saw one about 5 years ago after having a pulmonary embolism) and was told my heart was fine. So I am almost tempted not to tell her. But... being over 300 pounds for a long time...perhaps the chest tightness is inevitable?? Not to mention pre op jitters. So, Karen, all I can see is the mortality risk for this surgery is quite low...and I am sure we will both be just fine...and here for our little ones for a long time to come :thumbs_up:) julie

Love this thread!! I am 46 (yikes!!! :tongue2:) over 300 pounds and wondering how I got here...OK, OK, I know. Anyway, I am scheduled for surgery on June 26th. I am so excited, and, of course, a bit scared. It is great to read all the sucess stories on here. I have a question though... was anyone afraid of having a heart attack during surgery??? I do not have any heart issues (medically diagnosed, ay least) I wake up most nights, though with a heavy feeling in my chest. Not pain, it's kind of hard to explain, sort of like a slight pressure. I did see a cardiologist a few years ago after having a pulmonary embolism, and was pronounced heart healthy. I keep telling myself if there is something wrong..it is only a matter of time, and I might as well be in the hospital. Maybe this is just preop jitters kicking in???

I am still waiting for my surgery, but a year or so ago one arm seemed much bigger than the other (so much so I went to the ER thinking it might be a blood clot) turns out I have a lipoma (a fatty tumor, totally benign) in my left bicep. It just looks weird. Perhaps this could be your "problem" ??

I am so excited. I am scheduled for June 26th at 1PM :wub: I am having a hernia repair done at the same time (an incarcerated umbillical hernia) I have BC/BS of IL :confused: I have already gotten one denial from them. My doctors office has gotten together the requested info (5 years documentantion of weight, sleep study, psychologists report...just waiting on letters from my personal physicians (my old one in MI, and my new one here in CO) I do not however, have the required 6 month medically supervised diet history...sooo...I am expecting another denial. We are just going to pay the lap band portion of the surgery out of pocket (about $5500.00) instead of doing the hernia sugery now (which can't wait) then doing the 6 month diet and going through another surgery. So...I'm almost there. I can't wait :thumbup:

I know you said you were taking an antibiotic, just wondering if you started any new meds in the last couple of months? I had an issue with metformin... a med used for diabetes, as well as given to women, by some doctors, when they are trying to get pregnant. I had a terrible sense of taste and smell (and we are talking simply horrible) for ab t 8 months. It has been over 5 years and still bugs me occasionally. What you have is called "anosmia" (I'm pretty sure on the spelling). There are bulliten boards for this. I would say (in my opinion) go ahead with the surgery...the taste will most likely come back. julie

Cathy, This is a wonderful thread. Thank you so much for doing it. I just scheduled my lap band/hernia repair surgery for the 26th. I am so excited, and looking forward to see how all my fellow June bandsters do :confused: Julie

I have to agree with everyone. Your doctor is definetly anti lapband. For him to tell you that was wrong, wrong, wrong. Hopefully you have gone (or will go) to a different surgeon.

I so hope they come through for you.

I am still waiting for the preauthorization request to be sent in (again) My surgeons office is waiting for a letter from both my doctors (my old one in MI, and my new one in CO) I fully expect a denial. :thumbup: After all...it is BC/BS of IL , and because I do not have the 6 month diet history. I am just going to bite the bullet and pay the cash ($5500.00) and have the surgery done at the same time as the hernia surgery (which is getting worse every day...it is past time for the surgery) I am scheduled for June 26th at 1PM. Wow....3 weeks from tomorrow. I am soooo geeked. :thumbup:

I went last night for my "cosmetic" sleep study. I still can't get over the fact the insurance co may not pay for it because they consider it cosmetic (since it's being ordered pre lap band) Darn BC/BS IL. Anyway, I barely slept. I had about a half hour of REM sleep at the end of the night, the rest of the night I just layed there like a log...an awake log :thumbup: The girl who did it would not tell me what the conclusion was (I fully understand, it's against policy, and she is not a doctor) but, the impression she gave me was that it was OK :sad: I was really hoping it would show I had sleep apnea. Furst and foremost..it would really help my chances of getting the surgery OK'd (they are waiting on my study results, as well as 5 years weight documentation. Secondly...if the study is deemed medically necessary (I have apnea) the insurance co will pay for it too. Otherwise, I am on the hook for it. I hope they call me back for another study if this one was inconclusive in any way (I fell asleep pretty quickly, though the tech had to come in and put 0xygen on me before I went into REM, so perhaps that is enough to show a potential problem?) I guess a girl can hope.

I have not seen the EOB yet, since I am in MI (we finally sold our house here), but my husband told me we got the EOB from BCBS/IL for my sleep study... and it appears they paid it. Yayyyyy. He said the hospital billed $3400.00, $1650.00 was paid and $1750 was not. It says amount you may owe: 0. I feel sooo much better about this. Now I just have to wait on the approval (or, I suspect , denial, for the lap band) I will go ahead and schedule the procedures (the hernia repair I badly need, and the lap band I will self pay for on that portion of the surgery) <sigh>.....We really can't afford $5500 out of pocket... but I am NOT going to go through 2 surgeries. :thumbup:

Its possible you are going to have to do the Minnesota Multi Phasic Assessment (I believe it's called) some psychologists still believe in doing it for an assessment. My surgeon told me he does not believe its needed, and that psychologists just use it to jack up their fees.

I know you can apply through carecredit.com for a loan. Dr Kirshenbaum, here in Denver is who a lot of self pays goes to. Not sure how it would work with no income...maybe someone in your family can cosign??

Good for you...and the dog. You are almost there!!! Consider it a small price to pay for the new, improved you

I'm no expert... but it sounds like you probably have sleep apnea, which is usually a comorbidity, as well as High Blood pressure and highish cholesterol. At 100 pounds overweight, you most likely (I'd say definetly) have a high enough body mass index. Have you looked at the insurance website to see if there is any info on what is needed?? Sorry I can't be more help. julie