cat lady

Hi all: thanks for your support with my appeal to BCBS. I took some time and put together an extensive appeal with letters from my Drs stating that I have HBP for 20 years which is not always under control, back pain, knee pain, etc. They finally approved me after a Level 2 appeal. I'm happy about this but now scared at the thought of getting banded.......am I insane. Its been 1 1/2 years since I began this process and really kind of thought it wasn't going to happen. Now I must get my head back in the game and get prepared to do this. I'm seeing the surgeon again on tuesday.....since I have not spoken to him in over a year. I have new questions now that this is a reality. thanks again for your support CAT Lady

Great Job Cynthia -- Your words are very encouraging to me. I am waiting to be approved by my insurance co. I am at 225 lbs my highest weight ever and don't like myself this way. Its so great to hear you had a good year with the band. I am concerned about complications. Hope I get approved and in a year can speak like you. Would love to get down to 168 lbs. Keep up the good work. Chris

Thanks girls for your honest support. I don't know what the cost would be from my dr. and if it includes after care and fills which is also important. Also what if there are any complications??? Does the insurance then pick up the fee? These are the reasons I am hesitant about getting it done without the insurance coverage. My doc did call them to try to convince them I would be a good candidate but they refused to approve it. Don't want to come back and try again after I've gained alot of weight and have a BMI of 40 which they then would consider. Seems counter productive to my goal of better health and losing weight. cat:mad:

Okay so after 7 months of all the testing required and out of pocket monies....I officially got denied by BCBS. they are saying my BMI is too low at 35.5 for this surgery. I do have high blood pressure and back issues...but they said that the HBP is under control with pills therefore not considered a co morbidity. They are now saying my BMI would have to be 40 or above to get approved. I appealed and got the same denial. My surgeon, Dr. Geiss felt I was a good candidate for this and he even called the ins. medical director without success. Why is it that my HBP is not considered a comorbidity when I hear everyone else on this site is considered for approval. I cannot afford to pay for this surgery so I guess I am finished. I am disappointed to say the least. I am trying to rationalize this by saying maybe this is God's way of telling me not to do this. I must try to do this on my own...AGAIN. I had my date of august 19th so I decided to go on the liquid diet anyway and try to lose on my own. I have to try to exercise and do this for myself. I only wonder why they let me do all the testing and doctors, etc. just to deny me. They knew my BMI and HBP stats from the beginning. It was a waste of time and money also for the ins company. I think they should send it for approval to the ins company earlier...Not after you have your surgery date. Sorry for rambling on but I am discouraged. cat lady:confused::party::smile2::thumbup: Good Luck to all !

Hi all: My BMI is at 35 and I have high blood pressure. My doc thought I was a good candidate for this surgery. Did all the tests, saw all the drs required by my ins...even got a date in Aug for surgery then BCBS said my BMI is not high enough and they do not consider Hi Blood Pressure a comorbidity??? My Dr. called in support of doing the surgery but BCBS denied it. After seven months of preparing for this I am disheartened. I did send an appeal letter to them but don't have too much faith in it.cat lady

Having a similar problem here. On Wednesday BCBS told me everything looked fine for approval. Sent them the weight for 2008 that they requested. On Thurs. got a call that I was denied bcause the weitht was too low in 2008. I then submitted three other weights for 2008, since I have constantly tried to lose the weight without success....my weight varied from month to month. I don't know why after the 6 month diet that I followed they are going back 2 years to my old weight. I am now at my highest weight ever. So disgusted that after 7 months of following all their rules this happened. My surgeon is calling them for a "peer to peer" discussion to try to reverse the denial. I have my date and everything. Not happy at all. cat lady:thumbdown:

Don't want to discourage anyone but after 8 months of doing all the required testing my file was complete. MY surgeons office sent it to BCBS and I was told this am that it was denied bcause of low BMI. I weigh 220 and am 5'6 with high blood pressure. I can't believe they denied me. Yesterday they said it was ready to be approved....but after getting my weight chart from 2008 (when I weighed 205) they denied me. Tomorrow my surgeon, Dr. Geiss in NY will personally call BCBS and have a "peer to peer" discussion with the supervisor to see if he can change their minds. Hoping for the best. Discouraged to say the least. cat lady

Not so lucky here. Yesterday heard from ins and they said they only needed my pcp to send them my weight from 2008 and everything else looked okay. I went to pcp last night and faxed them the weight report from 2008. Got a call this a.m. from nurse at BCBS and she said it was denied bcause my weight in 2008 (2 years ago) made my BMI too low. I told her I have been trying to lose the weight for many years and have been up and down on the scale. Currently I am at my highest weight ever 220 lbs. She said my surgeon can make a call to the insurance supervisor called a "peer to peer" call and try to reverse the decision. I already have my surgery date....went for all necessary tests....even went to hospital for meeting with nurse who will be in operating room. Why did they make me do all of this if my BMI was too low? I do have comorbidities also, high blood pressure, low back pain, knee problems, etc. Not too happy tonight. cat lady:mad:

Have surgery date set for 8/19. Have only told hubby and daughter so far. I will tell my son and I think that will be all. My boss is a health fanatic and exercise freak. He's 81 yearls old and keeps telling me I have to lose weight because its unhealthy. I definately will not tell him bcause he will be very judgmental about my decision for surgery. I do not feel the need to explain to him my reasons for doing this. I need to take 1 week off so I'm deciding what to tell him. I don't get paid for sick days but I have to give him some excuse. Any suggestions? cat lady

Hi BG: Have followed your blog for a while. Sorry you had that bad episode recently. I am still not banded but have a temp date of 8/19. I am scared and hate to hear stories like yours. Did you ever experience anything like this before in the past year. You did so great with your weight loss....I hope this issue is resolved by now. When did you have your last fill before this spasm incident? Do you think is happened because you were too tight? I would have thought I was having a heart attack for sure. What made you think it was the band and not your heart. These are the things I'm concerned about. As an older person (62) I hope I can lead a somewhat "normal" lifestyle after the band. I see that you do...and this gave me confidence. I remember you saying that you eat out alot and eat most everything in smaller portions. That is what I am hoping for. I don/t need to be skinny.....just healthy. Sorry for rambling on but my head is going a mile a minute.....and the nerves are kicking in. Pls let me know how you are feeling after that incident and if it is completely resolved. I hope so....you look teriffic! ! !

Laylas Grandma: Sorry to hear about your port redness...but do you think the lightheaded feeling and cold sweats had anything to do with a possible reaction from the rednesss in the port?? You mentioned that you thought it was from not enough protein. I'm glad your dr. put you on antibiotics and I'm sure it will clear up the redness you are experiencing. I'm not banded yet and scared about possible complications during and after surgery. I'm 62 years old and hope everything goes according to plan. Pls let us know how you make out. cat lady

Thanks Sandi, that does clear up the question of being nauseated. So its not like having a stomach virus where you are completely sick and can't think of food. Its more like if you over-indulge it will come back to bite you -- and you will feel the effects. Okay I think I got it. BTW, I looked over your blog -- AMAZING!!! You should be so proud. I am proud for you. cat:thumbup:

Hi Sockmonkey: I'm trying not to focus on the date b'cause I know it might not happen. But, on the other hand they gave me my pre-op testing date at hospital & was told I have to see my reg Dr. for my pre-op clearance within 1 week of surgery date. I don't understand why they do it this way. Its frustrating.....trying not to think about it till I get the call from BCBS. BTW my file has been sitting on a desk at my Dr. office. It has been there since last Tues and they still have not submitted it yet to BCBS. They told me it should be sent into the ins. today!! Guess they do it all the time so they must know the procedures. Its kind of out of my hands right now. Keep the faith cat:confused:

Hi all: Just got my tentative date of Aug 19th. Afraid to get too excited -- still waiting for BCBS to approve. Surprised they give a date w/o ins approval. Hope it holds up. Has anyone tried any protein drinks? If so which one tastes the best. I see that many have to be ordered online and I didn't know which one to choose. My doc requires 1 week liquid pre op. Hoping I can do this. cat

Thank you all for your honest replies. Will B, Doddie, & Sandi -- you all did so incredibly well with the band. I can only hope to be half as successful as you. My concerns are about not feeling well while we are out. I know I must change my choices...but hope I will not feel nauseated or sick. Were you ever embarrassed by the band? Guess these are small concerns in the scheme of things but my mind is all over the place. Hope you understand. cat

Hi all: You all have done such a great job. I'm pre-op -- have a tentative date for 8/19. Without the band 30 lbs seems impossible for me to lose. I hope I have as much success as all of you. Now that time is approaching I am getting nervous -- but still excited too. Do you all live a somewhat "normal" social life as far as eating out with friends. We socialize alot and I know I must make some real changes in my choices...but I hope I don't have to give up even healthy choices b'cause of vomiting and getting stuck (which I really don't know what this means). Some of the stories make me concerned about the lifestyle I will have after the band. Again - congrats to all of you for doing a terrific job. cat:scared2:

Hi Wickwit: Thats great to be approved so fast from BCBS. Mine should be submitted to my ins next week -- hope for a fast approval like you. I have BCBS of North Carolina. They told me they approve or deny within 72 hrs. Keeping my fingers crossed. I got a tentative surgery date of August 19th. Getting excited and scared at the same time. I'm beginning to research which protein drinks are the best tasting. I know I'll be drinking alot of them. Good Luck. cat

Hi all: Just got my date for August 19th being banded with Dr. Geiss on Long Island, NY. Scared, nervous, excited all at the same time. Did all the testing before I got my date. It still not approved yet with the ins. but they give a date after you finish all requirements. Hope all goes well with the ins. I have BCBS of North Carolina. Anyone out there with this insrance plan? Good Luck to all August 2010 Bansters. cat lady:confused:

Hi Phyl: Happy 3rd Bandster Anniversary! You did a teriffic job in three years. Keep it going. Havn't told anyone except my hubby, daughter & grandaughter. Didn't want to until I'm sure its going to happen. Looks good so far! cat

Hi all: Went to seminar for Dr. Geiss' patients last night in Long Island. Very informative. Today rec'd the call to schedule my date. ITS AUGUST 19TH. Don't want to get too excited bcause it still needs to be approved by my ins. Can't understand why they do it this way. Seems backwards to me...but what do I know. Now this is really happening....I'm nervous, scared but also very excited! ! ! :confused::thumbup:

Hi all: Thank you for all of your honest replies. It is amazing how well you all have done. I only hope I can do half as well as you guys. Sandi: I read your blog - it is truly amazing. Will: your well written analagies to this lapband journey are so true. I know that I have tried many times to lose the weight and cannot do it on my own. Naturally, I don't enjoy thinking about the risks of surgery, but I have faith in God and trust in the doctor and his staff. I will try to follow all the rules so that I might be as successful as all of you. All my tests are completed and my file is in for approval. Hope to get a date some time in August. cat lady

Thanks Majj for your encouraging words. Will use hubby as much as I can for help. When were you able to drive? and did you get Heparin shots to prevent clotting? It seems as though some do and some don't. I must ask my Dr. about this. Just saw him once at original consultation -- but will ask one of his staff at a seminar I will be going to prior to surgery. Cat lady