Texas Teacher

I'd say it is a YES! It frames her face more and doesn't weigh it down so much--really makes her features stand out. She's a beautiful young lady. No reason to hide it. Renee

I have been looking at being banded for a while. I was actually approved by my surgeon back in November, but got a last minute denial from my insurance due to a written exclusion in my policy. I attempted to fight it, to no avail. Fast forward to now. I finally decided to bite the bullet and go self-pay to Mexico. I've been very excited about it and THOUGHT my husband had been really supportive. However, last night I was telling him about my pre-band diet (basically the same diet as if I were banded b/c I'm low BMI) and his comment was that if I could just follow that NOW, I would lose weight without going through surgery. Now I'm in turmoil all over again. Yes, he is right. I am now at the point that I'm doubting myself again. Have I honestly tried my best to do it alone? I am a "Lifetime" WW member, but then gained it all back plus some. I did Atkins for a while also and did really well, but again gained it all back plus some. Maybe my issue is just motivation and will-power. I've read other bander's posts that claim they have not been as successful b/c of a lack of both of these. Am I wasting my time, energy, and money by going through all this? Maybe I would be better served by just dropping my money into a nice treadmill and making an honest attempt at using it. Or maybe that would be throwing my money down the drain as well. AUGH!!! Renee

Well, I received the second denial letter. I expected as much, but it sure didn't help the feeling of depression when it arrived. I'll probably go "underground" at least for now since I know there is NO way for me to do this without the insurance. Thanks for all the encouraging words and advice!

Thanks! I have considered consulting with an attorney, but I wanted to say that I honestly had given it my best shot before I spent the extra money knowing that I STILL might lose. Unfortunately, money is the issue in the first place, so I'm not real excited about the idea of trying to find more. Now, if I could just find that ever elusive money tree I have heard of... :girl_hug:

Thanks for your message! I know that the liklihood of me actually being able to overturn the denial is pretty much zilch, but it sure helps to know there are people out there actually listening. I also know that I will not be able to have the surgery without the insurance, so it's going to be pretty depressing when I get that final denial letter. Thanks so much for the support and understanding!

Has anyone EVER had any luck overturning a denial based on an exclusion? WLS is excluded by my insurance, but I have appealed on the grounds that I am NOT having the surgery to treat my weight, but I am having it to treat the MULTIPLE co-morbid conditions I have. Do I have a shot in the world, or am I beating a dead horse:deadhorse:? Thanks for your input!

I used to try to blame my husband for my weight. He complained every time we went out to eat because I couldn't finish a meal and was wasting it. No problem with that now:hungry:. Now that I'm mentally ready to deal with my weight, I have really started evaluating my issues. The last time I actually threw up was when I was 13 and had binged on a box of some sort of snack cracker/trail mix. I ended up eating the entire box. In addition, I have a very difficult time with chocolate and it has been my downfall on every "diet" I have ever tried. As long as I go "cold turkey", I do ok, but if I eat even a little bit I go completely over the edge. I've realized that this love affair with chocolate goes waaaaay back. I recall sneaking baker's chocolate out of the fridge and dipping it in sweetened condensed milk before eating it when I was 8 or 9. During this same time frame, I remember climbing up into the highest cabinet in the kitchen to get some sort of chocolate flavored appetite suppressant candies my mom had stashed away up there and even going so far as swiping the chocolate flavored X-Lax from the medicine cabinet. I know...pretty sick. Fortunately for me, I was pretty thin when I was younger. Unfortunately, it didn't stick. I graduated high school at 120. Here I am nearly 20 years later at 220 with pretty much every co-morbid condition available.

I am addicted to Nora Roberts. I have read most all of her books and am not sure what I will do once I finally get through them all:omg:. Another great site to trade your paperback books is... paperbackswap.com If you decide to join, please consider entering my e-mail addy as a referral (nrh@ev1.net) since you get book credits for referring others. I have already traded several books this way and have really enjoyed it.

That is actually one of my three "can't miss" shows, but hubby asked me out on a date and I forgot to record it :cry. I was so excited that I was actually getting to go out without my children that didn't even think about it until after 9. Maybe they will run it again sometime?

I called customer service again today to attempt to obtain a little more information. First, I specifically asked if CPT Code 43770 is a covered. I was told that it WAS covered pending "clinical review". This is exactly what I was told the first the first time I contacted them PRIOR to my initial consult with the surgeon (I didn't have the CPT Code then.). I then asked if they could give me specific information about why my pre-cert was denied due to an exclusion when I've been told twice that it IS covered. She attempted to locate information, but she was unable to find anything that would indicate why this happened. So, she submitted a request for review of my case, asked that the person in charge contact me personally by telephone AND to send the specific explanation for the denial in writing. I'm not getting my hopes up too high, but wish me luck anyway!

I got my official letter and it stated... " I have determined that at this time morbid obesity surgery is/are not a covered benefit under the benefit plan. This determination is based upon the following plan language, found in Intranet Benefits at a Glance in the section entitled "Morbid Obesity": "The following services are not covered: Surgical and non-surgical treatment of obesity, including morbid obesity." " They also gave me information about how to appeal and forms to request an independent review. Do you think I have a chance at all? I'm not sure the business office at my surgeon's has much experience in getting these approved. Any advice? I have considered writing my own letter listing all the co-morbidities, etc, but didn't want to create any additional confusion. Thanks!

I am hoping for some guidance from those much more knowledgable than me :help:... I received a call from my surgeon saying that UHC had denied my pre-approval. As of right now we are waiting for the letter with the reasons, etc. so we can begin on the appeal process. However, before I even went for my initial consult I contacted UHC to see if it was covered. I was told that there was not an exclusion, but that I would basically have to have all my ducks in a row to show medical necessity for it to be approved. I spent the next month gathering every medical record I could find proving the necessity and submitted it to the surgeon. He reviewed everything, said I was definitely qualified, and said he expected no issues with the insurance company. Then comes the denial. After hearing this, I went to the website to see what I could find, and found this exclusion... The following services are not covered: Weight loss programs whether or not they are under medical supervision. Weight loss programs for medical reasons are also excluded. I am so depressed about the entire thing and am not sure whether or not I am wasting my time. If there is a chance, I will definitely keep trying, but if it is pretty much hopeless, I don't want to get my hopes up again just to get another letdown. So, what do you guys think? Is this the exclusion that will prevent my insurance from paying? BTW, for those who have UHC, I found this info under "my coverage and costs" in the "Special Services" section at the bottom under "reconstructive procedures". Basics about me: 5'4" -- 220.5 lbs -- BMI 37.6 sleep Apnea, High Cholesterol, Asthma, Fluctuating BP, Lifetime Member of Weight Watchers , chronic back pain/muscle spasms, plantar fasciitis, borderline diabetic Thanks for any advice you can offer!!! Renee Richmond, TX