Mrs Husker

Dianechef, I hope this isn't to harsh, (although it is and was said with love) but I want to give you the same advice a friend of mine gave me about 20 years ago when I was in the Air Force: "You can either sit on your a** and b***h about it, or get off your a** and do something about it. But remember this, if you take the first choice, all you get is a flat a** and a sore throat". Hope that helps. And please remind me of it often after I am banded and I slip up.

LMBO!!! I had to stop and e-mail it to everyone I know (even my mother).

I tried, I really tried. I make it to where they just did the first puncture and were getting ready to put in the scope, and I couldn't do it. I love to watch this stuff on TV, but it is always something that I don't think I will ever go through. I will try it again after I have my band.

I live in Gretna and am happy to see other "Huskers" here. I am still waiting for insurance approval. Hope to find out soon.

[ My doctor would like me to do a sleep study because she feels my insomnia is due to apnea, but it will likely cost me over $1000. Any thoughts?] Get the sleep study done, but make sure that nothing is said about it being weight related. My insurance will not pay of anything (other than surgery) if it is weight related.

I have found that writing an appeal letter to very difficult. I kept forgetting things and had to go back and add to it. I also didn’t know what all needed to be put in it. Hopefully this will help others when they are faced with a denial. Maybe you "pros" can help "tweek" us first timers. Please indicated what insurance you have/had, and what, if any, where the results you received after sending your appeal.:help: I have BCBS of NE and I and just trying to get all my information together right now before I send in my letter. Any input would be most helpful. __________________________________________________________ Name Street Address City, State, Zip Member ID: XXX XXX XXX June 9, 2006 Blue Cross and Blue Shield of Nebraska PO Box 3248 Omaha, NE 68180-0001 Attn: Appeals Department Re: Request for an appeal Dear Sir or Madam, You recently denied pre-authorization for laparoscopic bypass surgery (I am wanting Laparoscopic Adjustable Gastric Banding, Lap-band, surgery) stating that it was not medically necessary. I was referred by my primary care physician, Dr. Stephen Budd to Dr Corrigan McBride for a consultation for this procedure. This referral is being requested because the lap-band is a medical necessity for me. I am 39 years old (DOB 2/3/1967), 5’ 1” tall, weigh 230 lbs, BMI 43.5. Desirable BMI is between 21-25 and desirable weight range for someone of my height and build is between 95-115 lbs. A BMI over 40 classifies me as being very severely obese. My morbid obesity has caused me continuing health problems such as high cholesterol and triglycerides, sleep apnea, colon polyps, irregular menstrual periods, shortness of breath with any excretion, bile acid reflux, urinary incontinence and pain in my back, feet, legs, hips and shoulders. Even with the c-pap machine, I can not lie flat while I sleep. I must sleep in an elevated position or have trouble breathing and wake up with such back pain that I need assistance to get out of bed. Lately I have notice that I have swelling in my feet, ankles and fingers. I also have kidney stones. My obesity has been affecting my job. I have to be on my feet most of the day and must be able to pick up and move heavy boxes. The obesity interferes with my ability to have a normal life. It is difficult to clean house, to do yard work, stair climbing, exercise, sit in a theater seat, go for walks, and participate in family outdoor activities such as camping, hiking and kayaking to name a few. I have tried many diets, exercise and medication over the last 20 years and just ended up heavier and heavier. In 2005, when I hit 212 lbs, I went on L.A. Weight Loss. I did lose close to 30 lbs and was down to about 180 lbs. In less than one year, I put the 30 lbs back on and have added 18 lbs. And after each failed attempt at weight loss, my medical problems mount. The surgery would enable me to lose weight, improve my mobility, enable me to stop taking or reduce the amount of my medication and I would no longer need my c-pap. I have the full support of my physician and family. They all feel this is the best decision for me to improve the quality of my health and my life. Sincerely,

Welcom Dr C. It is nice to know that you will be here when my time comes.

I don't think it was a Last Straw moment when I decided to have WLS. Besides the pain in my knees/feet/back/legs/hips, sleep apnea and other health problems....I have three reasons for doing this, Jim (DH), David (DS) and Kristen (DD).I want to be around for them. I have cried just thinking about my kids growing up without me. My DS is 17, but even he still needs me. My DD is 10 and I don't even want to think of anyone else doing all the mother-daughter things with her. These are my babies and I need to be there for them. Also, I love my DH to much to leave him too soon because of my weight. It took 10 years for us to get back together, I don't want to lose anymore time with him. I pray for approval soon.

:wow2: WAY TO GO!!!! YOU ROCK!!!

My son named his "Willy". When he was about 2 years old (he is 17 now), I heard him get up in the morning and he went into the bathroom. I was still in bed when I heard him scream and run back into his bedroom. I thought that the toilet seat fell on "Willy" because he would hold it up with his belly and just lay "Willy" on the rim of the toilet. I jump up out of bed, run into his room and there he is with his pants still down and his back to me. I asked what happened?? My sweet little boy truns around and I see that he is crying. I also notice that he is pushing on "Willy". He said "It's broken and it wont go down!" Try and keep a from busting a gut while explaining that that is normal.

5', and I would love to see 110 again, will be happy at 150, but ecstatic at 135.

So I can go back woods camping again, go for walks without my knees hurting, get rid of my c-pap & diabetes (just found out about the diabetes yesterday). To be here for my children and their children. To not be embarrassed wearing shorts out in public. To fit in the seat at the movies. So I am not the biggest person in my family. To be able to go swimming again and not feel like everyone is thinking that I'm too fat to be in a swimsuit. To know that when people do look at me that they see "me". In other words, I am doing this not only for my physical health, but my mental health as well.

I'm praying for you.

Today I found out that I do not have hypoglycemia, I have diabetes. At this point I am going between wanting to cry, thinking how could I do this to myself, to thinking that I will beat this. Now I just want to get as much info as possible such as what not to eat and drink. I see my doctor at 8:30am tomorrow. I have to go into work tonight to get my morning stuff done so I don’t have to worry about that. I also have to take fish oil because my good cholesterol is low. Guess I can add this to my appeal letter. Any advice would help. I also quit smoking June 10 and I am having a real hard time tonight.

I reposted this under a different thread

:clap2: If someone ever invents those panties, I'll take a gross!!

They said: Benefits are not available for those services which have been determined to be not medically necessary per physician review. Therefore, no benefits are available for laparoscopic bypass surgery (LAP band), as this has been determined to be not medically necessary, as it does not meet medical policy criteria, as there is no documentation of two years of medical management. I saw my dr today, when I asked about the medical management part, he said, thats what you have been doing. I showed him a copy of my letter, he thinks it will work, and to let him know if it didn't and he would send one also. Wish he would send on now so I wouldn't have to wait. All of this has me thinking, when the LB dr sent in for approval, didn't she point out any of my medical problems? Well, got to go, I am doing a glucose(sp) test (might be able to add hyop glycimic (sp) to the list) and have to get back to the hospital in about 45 mins.

3 Loves Thank you soooo much. Reading some of the logs on obesityhelp gave me hope. I am also working on a list of my family medical history and my diet history. I have an appt with my PCP today at 9:30. Hope to get his help.

Yeaaaaaa!!!! ME NEXT!!!! ME NEXT!!!!

When I am in bed and roll from my side to my back, I get a pain in my lower abdomen. I feels as if something is ripping. It does not happen all the time, but in the last few days, I have had the same pain when standing up, pushing a chair back with my legs and just this morning, sneezing. Does/did anyone ever have this problem?

I'm not banded.

I am sooooooo happy for you!!!!

Thanks for your encourgement. I have an appt with my pcp this Friday at 9:30 to get the ball rolling. One question, dose LA weight loss count? I did that in 05, lost about 30 lbs and then gained 40 back.

Not banded yet, but I already have a dunlap (my gut dun lapped over my belt). I know that I will have a tummy tuck. I would also like to have my boobs put back where they belong :girl_hug:

Janet, Well, how was your trip? Heck, are you even back yet? Did your fill hurt? And who is Dr White with?