Mert

Freebekie and Sallyjo, I appreciate the kind words. This waiting game is no bueno! I already sent in a complete blood chemistry,that showed high cholesterol despite taking 20mg of lipitor/day, borderline glucose, depite taking 2000mg glucophage/day, a 24 hour urine test that showed slightly elevated microalbumin, a hormone assay showing testosterone elevated (polycystic ovarian syndrome) and on and on. I plan to send in more stuff from the internal specialist. And PCP doctor's notes showing discussion of diet, date/weight over a long period of time. Then I will start calling them. Gee, I'm convinced that I need the band, surely those insurance guys will be!:paranoid surely?

When I googled it up I got that LAP-BAND Advocacy Center is part of obesitylaw.com in California. ok. mm

Paula, I see. Well, I know where you're coming from I have two kids myself. I am happy for you for that weight loss. You must feel great and the kid's teeth are lookin' good too. Thats about as good as it gets. thank you. mm

Thanks Randi for that resource. In it they mentioned the LAP-BAND Advocacy Center...hmmm another lead. BTW, your awaiting approval smilies are right on. mert

I have BC/BS of Louisiana (Fed) and I would LOVE for them to cover LapBand. But I completely understand WHY they (and so many others) do not. Its still aggravating though! Paula, I see from your signature line that you have had weight loss success. :clap2: What did BCBS do for you and how did you manage to get help? I am open to suggestions Thank you. Mert

Thanks EM, I will keep Gary in my notes for future reference. Keep me posted when he contacts you. I feel hopeful again and ready for another round!

Dear NancyRN, Thank you so much for the resources and encouragement. I went to the aapeal letter and the long insurance list that you sited. It looks like others with bcbs of tx trs activecare have been approved. With that appeal letter I am armed and ready. Thanks again for the support. I needed that. I am blessed to have info and folks available to help me.

:help: I have BCBS of Texas TRS Ativecare. Do you know someone who might be able to help?

Thanks Em, I plan to keep trying. Self pay in Houston is about 15K and they are quoting me 10K for Dr. Roberto Rumbaut in Monterrey this summer. I have PCOS and impending problems besides morbid obesity with that. Thank you for the encouragement. So, are you appealing with an attorney then?

Thank you to the state of Texas for providing the teachers with this sucky insurance.:faint: I am in the process of sending and sending documentation to them. I faxed 20 pages of doctor notes and lab test results today. Had to fax it twice to two different numbers. Finally they said they got it. When do I give up and self pay a surgeon in MX? I don't have documentaion to back up years of dieting and failed attempts. I have PCOS and a BMI of 49. That they already know. Shouldn't that be enough? BCBS of TX TRS Activecare...my family will be paying them premiums of $1115/month in the upcoming school year. What's up with this company?

:angry I faxed them 20 pages to two different numbers today and stayed on the phone with someone until it came off their fax machine. I had written a note on the cover page that more documentation would follow. They called me back and said they were confused about the note. I explained that I would send more office notes from two other doctors under seperate cover. The girl said, 'oh she just wanted to know if she should go ahead and scan it before she denies you again' Am I hearing correctly? I asked 'does she plan to deny me again?" then the girl started crawfishing out of her comment. I am ready to throw in the towel. I am 49 years old and have a BMI of 49. At this rate I may not have much more time...:cry Then I read here that some people try for a year and get approved. I hate to go borrow 11K to self pay in Mexico, especially with the premiums we pay. I will try again until .... when?? I have not actually received a letter of denial. They just keep telling me they need more...

thanks for your reply Sallyjo, oh I plan to keep after them!! And congratulations on your new band. I have been wanting WLS for quite a while but all my insurance would pay for was RNY and that was toooo scarey for me. I am excited about getting the band, even if I have to self pay. I hear there are some great docs in Monterrey. Now insurance policy says it will pay if there is medical need and at BMI 49, I'd say there is! I can't wait to be the beautiful chic I was 100+ lbs. ago. Just gotta get over this darn insurance hurdle...I'm considering using Dr. Spiegel also.