KayleighsMommy

Yep, I have to agree with you. Dr Mel is a really nice guy. The first time I saw him, I was in the exam room with him for 1 1/2 hour. He is very personable, and seems to really care. I would highly recommend him.

wow..beautiful pics julie

I've had the hernia for about 6 months already..part of me says "Hey, what's another 6 months?" But it is starting to hurt a bit more. The surgeon told me to be somewhat careful...that if it starts to strangulate and I go to the ER they are going to do a full open surgery to repair it. I had the last 2 repaired openly...not a lot of fun. <sigh> I just don't know what to do...

OK...I'll see what I can find out. I am quite unhappy, not that I want to have severe apnea...I have all the symptoms. I tend to have a lot worse time on my back (as most people do, I know) and I was never observed that way. I wake up more often than not with chest pain...that leads me to believe there is an issue. I will PM you if/when I get the results. julie

The day before yesterday I talked to my surgeon a couple of times, by phone. One time for almost an hour!!! He basically told me thatn if BCBS demands a diet, they are not going to waive that. I pretty well knew that...it's just that I was all ramped up to go through with this...also I HAVE to have hernia surgery..soon! I just don't see why they won't authorize the lapband to be done the same time as the "medically necessary" hernia repair. BTW, this is my 2nd hernia in less than 4 years (3rd lifetime in the midsection...I know I have one or two more in the pannis (the hanging down belly area) hoping once I lose the weight I can get those repaired...and possible a tummy tuck. Anyway, the reason I keep tearing and herniating is because of the weight I am carrying in the belly. So.....they can keep paying for hernia repairs, they can have me jump thorugh their hoops, and ultimatley (hopefully) pay for a second full surgery in 6-7 months... or they can...dare I say it?? pay for the surgery now. Makes sense to me. Too bad I don't work for BCBS IL, huh?? I could save them some money. Nope...it's not going to happen :frown: The doctor called the medical center, and told me he could do the lapband at the same time. It's going to cost me about $5.500 out of pocket. My husband was not thrilled about this, he wants me to jump through their hoops. I was sooo upset. I just want to pay it and move on. Not to mention...I really don't want to have to go through 2 surgeries. He had the attitude that "if you pay for it, the insurance co won..you are doing exactlly what they want you to do" WTH??? It is an insurance co..not a person..this is my life we are talking about here. He told me "can't you just do Weight Watchers for 6 months" acording to what the docotr infered from the rejection letter..there is more than just going to Weight Watchers needed...you need to be in a "medically supervised program" And, they seem to be quite expensive. I was so upset, I couldn't stop crying. Last night we talked about it, and he told me to go ahead and schedule the surgery (we are going out of state for about a month) when I get back, and just charge what needs to be charged. His biggest concern is that if BCBS sees I had a lapband done at the same time, they may reject the hernia surgery (knowing BCBS of Hell, er..I mean IL) that could actually happen. Guess I will have to ask the doctor how is going to bill it, and if he will consider it 2 seperate procedures. So...hopefully I am on my (self payed) way!!!

Congrats to you, too :party:

yayyyy..congrats. I would call that a BIG victory

I heard from the doctoe today...he told me they said I had mild apnea (I'm not sure I agree with this...since I usually do OK on my side, it's when I flip onto my back I start having problems) and I slept on my side the half hour they were able to monitor my sleep. The only thing they reccomended is oxygen at night set to 1 litre. I am quite bummed about this... 1) I doubt "mild sleep apnea" is going to help my cause when it comes to having the lapband approved. 2) There is a chance I am going to have to pay for this study. 3) I truly believe the test was wrong, seeing as I was only observed on my side 4) I wake up with chest pain most nights, and during the day I feel like I am going to drop, I am so tired. <sigh>

I went for my sleep study last night. I probably slept an hour-an hour and a half all night. Early on I fell asleep and the tech came in to put oxygen on me, I wasn't in REM yet. I could not fall back asleep. I layed there from midnight to about 4 AM. When she cam in to wake me at 6:20 she said I finally did have about 1/2 hour of REM sleep. She gave me the impression (though didn't come out and say it) that my REM sleep was OK. I know they need 3 hours of REM with so many occurances to consider you having apnea. Has anything like this happened to anyone...and were you called back for another test?? I am really hoping this happens...since having apnea will help in getting my insurance to pay for the surgery, as well as the fact that if I do not have apnea the insurance co will not even pay for the test (they consider it "cosmetic"...of all things..since it is pre lap band testing!!!)

Actually, the tech asked is there was anything she could do to help me sleep... I told her "not unless you have a sleeping pill I can have" she told me she can't give me anything..it would have to be ordered by my doctor.

I just HATE BC/BS of IL!!! :smile: I just spoke to my doctor and found out my sleep study results came back as mild apnea. I guess this is good news, even though I am probably going to have to pay for the test. I told him I got a letter from them stating one of the prerequisites is a 6 month diet. He told me even after the diet, they may deny me..jumping through all theri hoops is not a guarantee. I talked to him about my need for hernia surgery (he was planning on fixing my incarcerated hernia at the same time) I asked him if we can put the lapband into insurance as a procedure secondary to the hernia repair (assuming, of course, they:scared2: consider a hernia repair "medically necessary") I also questioned him about my doing a self pay on the lapband portion of the surgery. He told me the actual lapband hardware is $3400.00 He is going to check with the hospital today, and see what (if anything), can be worked out. I'm not going to hold my breath.....

I am actually in CO, just moved from MI. My husband works for AT&T and BC/BS IL was one of the very limited choices for insurance. The most annoying thing is that when my surgeons office first called, they were told that bariatric services were covered.. no prerequisties, no copay, no deductible. Now they expect me tho jump through flaming hoops in the hope that they will deign to authorize this (in my mind) potentially life saving surgery.

They got my sleep study results back. They said I have mild sleep apnea. The only reccomendation was for 1 liter oxygen flow while sleeping <sigh> Not only am I probably going to end up paying for the test (I'm just assuming..since I was only labled "mild") this in probably not going to help at all when it comes to my insurance (hereafter known as "those lousy cheap bastards") paying for the lapband. I am so tired of worrying about this. :smile:

I know what you mean about it being embarrasing asking for an extender... I actually permanetly "borrowed" one from one of my flights...I keep it in my bag...just pull it out and slap it on, then make sure I put it back in my bag before the plane even stops rolling (I am afraid of losing it!)

Yayyyyy.. good for you.

Oh, man...that sucks!!!! I thought I was the only one having problems with the sleep test issue. I was told that if I DO have apnea they will pay for it, though now I am wondering..... :cool2: What kind of crapppy insurance (And isn't BC/BS supposed to be the best???) Won't pay for a test that is common (it's not like we are having some back room, off the wall test done) that can be potentially life saving??? Geez....:coolgleamA:

I'm just so bummed. I had myself all excited about this...now I feel BC/BS is jerking me around. I could just cry. Not to mention...I have a incarcerated hernia that HAS to be repaired...so I am going to have to do 2 seperate surgeries???? How insane.

Wow...that's annoying.

Oh, OK...since I needed O2 (within probably a half hour of going to sleep...not even in REM yet), they are most likely going to consider that having apnea of some sort?? Will they still need to do the 3 hours of REM sleep (assuming I understood that properly) With the need for O2 will I most likely need a CPAP? I am glad we have a trained professional here I can ask questions :smile2:)

I'm sorry you are so frustrated, I know how tough and annoying insurance can be. I went through the same thing years ago w/ BC/BS I wanted (at the time) bypass surgey. I fought and fought, all the while jumping through all their hoops. I was finally denied. I should have looked at a lawyer (though it sounds like that is not an option for you right now) I am fighting with my insurance right now (BC/BS again...this time of IL) so I know how you feel doubly. All I can say is hang in there and good luck

When I first went in, the tech had me try a couple of different masks (evidently at this place if they notice you have x number of occurances in a 3 hour period they come in and put a CPAP machine on you) There are quite a few different types/configurations of masks, hopefully you will find one that is comfortable for you. My surgeon requires 2 weeks of CPAP usage before surgery. I am just concerned they will decide I do not have apnea when I do, and there will be an issue during surgery (since we all know that sleep apnea makes surgery more dangerous) I guess I will just have to wait for the report to come back. julie

How insane is that?????

Yep, that's why I'm hoping they are able to document it...one less hurdle...seems like insurance co's are more likely to pay for the surgery if apnea is among one of your many co mordities (or at least that is how it sems for BC/BS IL.

Yep...true. I just know she had told me she needs 3 hours of REM sleep (I had about a half an hour) I am just concerned that if she didn't see any problems it will be marked as "no apnea" I really want to be told I have apnea, for insurance purposes (sad, isn't it??? :thumbup: Guess I'll just have to wait and see.

You would think so, wouldn't you?? The surgeon ordered the test. The insurance co wanted 12 months of documentation of sleeping problems to pay for the test. They don't consider the test "medically neccessary" since it was ordered before a lap band surgery, they are calling it "cosmetic" How the heck they can consider a potentially life saving test cosmetic is beyond me, I told them I also have a incarcerated hernia, which will need repair, but they really didn't care. I have to keep wondering, "what the heck chance do I have of them paying for surgery when they won't pay for this test?????" <sigh>