MiniBand

My experience is whatever they tell you on the phone, they lie. LOL. I asked the first time and they told me no. I have Horizon BCBS of NJ. First I called and asked if it was covered and what I would have to do. The woman basically said, just get pre-determination. She didn't give me any other details. I said are you sure, and she said yes. Well I found out later that it was not true. Then I was denied anyways but I am appealing that right now. I have open enrollment right around the corner and I am so tempted to switch to Cigna or United but I don't want to mess myself up.

Same happened with me but with BCBS. I am appealing through obesity law though. It will take a while I guess. I hope this happens for me before the end of the year. I hope it happens for you even sooner!

That's what I am attempting to do right now. I wish you all the best.

I struggled with this as well. I have not been banded yet. I looked at both and I felt one was better than the other. I also asked in terms of surgery which one would be be more efficient. (how long would I be on the table, in the open air, how efficient was the suturing vs, the staples, etc..) That made a difference for me knowing that. You should ask your Dr. those kinds of questions. Also I am in the appeal process. I am getting help from one of the manufacturers with paying for legal fees, so whoever helps me, I am going to get that band. I understand that both bands will eventually have support websites. I am not saying which one I chose or will choose because I really think it is a decision you and your Dr. should make together. BTW there is a whole section devoted to this. http://www.lapbandtalk.com/f278/

I am appealing. I am getting a lawyer, etc.

I think as long as the person is a certified trainer it might count. You may just want to check with your insurance to make sure though. I'd hate for you to go do something and then find out you jumped through the wrong hoop.

I haven't had that one yet. I was denied because I didn't demonstrate medically necessary multi disciplinary approach or something like that. I didn't even know what to do so I contacted the obesity law firm and see what they say. I don't know what to tell you about the radiology folks. They aren't really allowed to say anything. I had an aortal scan last month and I asked the lady and she said well she wasn't really supposed to say anything. I would just follow up as soon as you can, and please let us know.

Hey could you PM me as well with that information? I was just denied last week and awaiting the letter. I have diabetes and have been on meds for at least 4 years if not more (two kinds, byetta and metformin) and a host of other drugs for other problems. I was really pissed off when I heard that but not surprised since it took them forever to give me an answer. I think I will probably get a lawyer though.

When I saw this I had to laugh, then I see we've posted about doo doo drawers, I was thinking more like windy pants...

Gee I don't know what to do at this point. It sure is disheartening to say the least. I haven't gotten the letter. I guess I will appeal. Maybe I'll try that obesity law thing I don't know. M:thumbdown:

Hello, My insurance sent my stuff in the middle of July. I have been calling to find out what the hold up is. I am assuming it can't mean anything good to wait this long. I had posted about this a while ago... I have Horizon BCBS PPO and it went to the medical director a week ago whatever that means. I do have TT2 diabetes, GERD, high lipids (metabolic syndrome), depression, infertility and pre-hypertension. All those are documented. My BMI is somewhere between 36 and 38. Is waiting long a bad sign? Thanks, M

Man I am tired of BCBS of NJ. All they do is tell me they have expedited my file but I know they haven't. Because when I call and get one guy he says, they shouldn't have told you that, but today I will expedite your file. They have had it over 30 days now and with the long weekend it will be like another whole week or so. My BMI is 37 and I have GERD, tt2 diabetes, metabolic syndrome, fatty liver, pre-hypertension, IBS and if I probably went to take a sleep study I think I have mild sleep apnea... My diabetes is not well controlled but I am trying to do a better job for myself. I don't know what it takes. I can lose like 5 or so pounds and then my metabolism stalls and I get frustrated and I gain it back. Plus I am about hit that big change in my life and I know it is going to be much much harder to get it off. It already is!!!! COME ON NJ BCBS, please approve me, and all us other people that need to have this technology!!!!! Let me know what you do, and I let you know what happens with me ok Baby-Lyn! Edited to add... Baby-Lyn where I work we have several choices of health insurance, one girl wasn't big enough and she gained enough weight to get the surgery, you might consider that since you are almost there. She had United though.

Hello, I am new here although I have been lurking for many many months as I did research. I know this will sound strange but I was afraid of jinxing myself and hoping that my insurance packet landed on a kind stranger's desk... It was submitted around Jul15 or so, and so I am getting kind of nervous that it's getting to be a pretty long time. About me: I am 185 lbs at 4'11 I have: T2 Diabetes (on Byetta and metformin) High cholesterol Borderline hypertension GERD (that's 4 unfortunate things isn't it?) I am a yo-yo dieter and I am about to go into the big life change so I'd like to get this weight off me before my hormones call me crazy. So there it is... please Mr./Mrs/ Insurance please be gentle and kind and send some good news my way!!!! Miniband

I submitted my packet in July around the 21st to BCBS of NJ. I called yesterday and the first guy said they didn't have the packet. They transferred me and the second guy told me it was under review. He said a standard review takes up to 30 days and could take longer. The pre-authorization people can't help you, it was the member number I spoke to the second guy. The very first time I called I was told, oh its covered blah blah blah... and I timidly asked what the requirements were and the person was like on there's not any just ask and see what happens. Seriously I knew that wasn't correct but seriously sometimes I think they just say what they think you want to hear. In the meantime I have started an exercise regime and I'll go to my Dr. by the end of the month to keep going with my supervised visits if I have to.

Thanks for the warm welcome. I am in FL. Largo area. The Byetta makes me kind of sick I had to stick with the lower dose so I am really hoping that I get approved so I can get off that med. I sure won't miss that or the Metformin. I am going to look at everything and try to take it in and hope for the best. I wish everyone the best of health, luck and happiness! :thumbup: