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wash

LAP-BAND Patients
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Everything posted by wash

  1. wash
    Hi Kris, That's great! Nina gave me the 6th & 8th and then 4 days the following week to choose from. Will let you know when I finalize my date. Are you going alone? Priscilla
  2. wash

    Over 60 and having the sleeve

    wash replied to ginnylee's topic in Gastric Sleeve Surgery Forums

    Hi Ginny, My name is Priscilla. I'm 61 and in the process of scheduling my VSG with Dr Alberto Aceves in Mexicali Mexico during the 1st or 2nd week of January. My sister is 66 and she just had a Gastric Bypass in Aug'10 in the US. She is doing great now but she did get a very bad infection in one of her laparoscopic sites which was no fun at the time. She WAS diebetic but doesn't even have to take medication anymore. I just don't care to have my intestines rearranged so I'm going for the sleeve which has much fewer risks anyway. I haven't heard about too many people having complications with the sleeve but of course a lot depends on the skill of the surgeon. Good luck to you and Happy Holidays! Priscilla
  3. wash
    Happy Holidays to everyone! Your contributions to this board are "priceless." To 'My Journey Begins,' I haven't been on this board in quite a while but noticed that your surgery with Dr Aceves is on Jan 5, 2011. I'm in the process now of trying to schedule mine for the 1st week in January too! I had an original date of Dec 8th but had to cancel at the last minute because I came down with a Staph infection on Dec 6th...already had my boarding passes and everything! Are you going alone? I am. In case you're on some of the other boards, I am pas03064 on Dr Aceves' yahoo board and ecf1947 on the Obesity Help forum. Would love to hear from you. Priscilla
  4. wash

    Hi...me again. Saw the Cardiologist today to get results of the 30 day monitor I wore. Says I have extra heartbeats at night which can be caused by sleep apnea so now I have to have another sleep study (last one was 3 yrs ago). My pulse rate runs 100+ so he changed my HP medication which is supposed to help both problems. He asked me when I'm having the surgery and I told him I'm having 2nd thoughts. How are you doing Katie? Are you still glad you had it done? Please let me know...I just can't seem to decide. Priscilla

  5. wash

    Hi Katie, sorry it's been so long! Haven't been on for quite awhile...meant to answer much sooner than this. So how is the solid food going? Still hungry waiting for your 1st fill next week? Congrats on your 27lb loss...that is so awesome. Haven't gone to anymore support groups...still a little difficult to drive all that way (still in a splint). I heard from Verizon...they decided to keep benefit the same...min. of 40 BMI so I still don't qualify. VZ advocate told me to go ahead and file a grievance against Anthem due to the fact that Anthem gave me incorrect information and if they still deny, then I should appeal it. I'll write that up this weekend and send it to Jayne who will then send it to "LapBand Reimbursement." Their lawyer will get involved and file it since they were given incorrect info also. Jayne calls it "LapBand Reimbursement" so I think they also verify that the patient is eligible and then reimburse SWLS when they put the LapBand in for that patient. Priscilla

  6. wash

    Hi Katie,

     

    How are you these days? You must be on solid food now! Are you still glad you had it done? I'm getting ready to file my appeal (have to write my story) on the advice of my Verizon advocate. She said Verizon and Anthem are supposedly talking with one another as to what benefit policy to finally adopt for Lapband and bariatric surgery. She has no idea when that will final be decided so she said I should just go ahead even if I get the lawyer for Lapband involved. My Echocardiogram came back fine and on my third week with the heart monitor. I have to wear it 30 days so that will be out of the way soon too. I got my cast off and now I have to wear a splint day and night except when I do my OT exercises or to take a shower. I'm going to OT 2x/wk. I haven't lost any weight and need the surgery! Write when you get a chance. Priscilla

    PS. Have you gone to a support group meeting yet?

  7. wash

    Looking for May Bandsters

    wash replied to ms.rhonda's topic in LAP-BAND Surgery Forums

    OMG Katie...that is so awesome! Hope your energy level picks up soon though...Adam did say to plan to be out of work for 2 weeks so it'll probably take that long to feel normal again. I'm still in a holding pattern waiting for a call back from Verizon, hoping now by Tues. Congratulations to everyone on the board for taking their lives back with this life long commitment! I'm looking forward to my turn to more actively participate too. Priscilla
  8. wash
    Good Morning, Has anyone had any experience with BC/BS of Ohio PPO for Verizon Retirees? I was recently denied by them on the basis that I need a BMI of 40 or greater (mine is 36). Anthem only administers this self insured plan for Verizon. However, all the access materials to the benefits say a BMI of 35 to 39 is OK with comorbidities (sp?) which I have. I now have a Verizon Benefits Advocate helping me to get the actual benefit in writing but it's taking forever! BTW, an E-mail I sent from the "Anthem for Verizon website" in 2/2010 to verify my benefit was responded to me as needing a BMI of 35-39 w/comorbidities or 40+ w/o any so I was given wrong info to begin with. I faxed them a copy of the reply and they still denied me. This is a new health plan for us as of 1/1/2010 and I get the feeling that I'm the first Verizon retiree seeking approval for LAP-BAND®! Anthem claims it was my responsibility to verify my benefits with Verizon and that it is on Verizon's website. Not there...Verizon's website says to call the member # on the back of my ins card which I also did 4 times and always got the same answer of OK for the BMI 35-39, etc. Anthem says Verizon chose this exclusion from Anthem's normal contract regarding bariatric surgery. Please, can I get your inputs about how I should handle this and do you think I need an attorney? Priscilla
  9. wash
    Congrats Katie! I'm very happy and excited for you! Hope you'll being feeling like your old self soon! Write again when you feel up to it. I'm dying to hear about the whole surgical & hospital experience you had! Priscilla
  10. wash
    Congratulations Butterfly! Handy to have those wings to help you fly though your new life! LOL Priscilla
  11. wash

    continued from 1st message...

     

    Here is another thing to add to my bad luck lately...I had another hearing test today and I have lost a little more hearing. The audiologist said I will be facing the need for hearing aids within the next 3-5 years! I don't like this aging process at all!

     

    Now looks like it would be at least 6 weeks before I can have the surgery. My Advocate from Verizon called last Thurs and said she does not have any info for me yet but hopes she will this week. I've been waiting for her findings before filing an appeal but if she doesn't come up with something this week, I'm going to have to just go ahead and file it. I can't wait forever!

     

    You probably won't get a chance to write again before the surgery so write again after you get home and feel up to it.

     

    Priscilla

  12. wash

    Hi Katie,

     

    I'm sure you'll do just fine but I understand your being nervous. Close your eyes and try to relax and use your "mindseye" to picture how you'll look and feel a year from now and this should bring you joy. This is going to be one of the best things that ever happened in your life! What time do you have to be there?

     

    Went to the cardiologist today. Does not feel that I had a heart attack. My ekg showed the same today as my preop one but he said this kind of abnormal reading is actually very common with normal people so I should not worry at all about it. Have to have an echocardiogram though which would show it. Also have to wear a Holter Monitor for 30 days. Said if I get approved for the LAP-BAND???, then I would need a Nuclear Stress Test before giving me clearance.

     

    continued on 2nd message...

  13. wash
    Thank you and best of luck to you! Priscilla
  14. wash
    Mrs Plimpy - See my update today on my bandster 'MY STORY". Anthem lied about making things right if they gave me incorrect info. Arrrgh! Priscilla
  15. wash

    Hi Katie,

     

    Anthem denied me again today. Said that even though I was given incorrect info, was my responsibility to know my benefits. Told me it was on the Verizon website...NOT! VZ confirmed it was not on there either. Explained to VZ all the steps I took, they agreed I did the right thing. So my VZ advocate is still working my case. Hopefully I'll get an update on Mon. Called Jayne so she could put everything on hold. We'll probably have Allergan and their atty file the grievance next week. Lady who called me with the bad news told me I should definitely file a grievance which seems strange since I'm told it was my responsibility to contact VZ in the first place to get them to verify my benefits. When I asked what's the point...she just said I should do it. Wondering if she knows something that I don't know...like maybe someone different would be doing the review this time. It's not looking good for me to be a May bandster with you Katie after all. :(

     

    Priscilla

  16. wash

    Hi Katie,

     

    I have another update dated today on my Bandster.

     

    Priscilla

  17. wash
    Hi Mrs Plimpy (love that id), I have an update on my bandster. Go to Golferette's story at the bottom and see the 5/3 update. Priscilla
  18. wash
    I still think you could win if you had the help of your DR's atty. I'd give it a shot but I can understand where you now have a date you just want to get it behind you. Good luck! Priscilla
  19. wash
    [QUOTE=Mrs. Plumpy;1445514]On 6/18/2009 I called my insurance and was told that the LAP-BAND® was covered, she even walked me through finding the papers to print out about it. I went through all the hoops of a six month diet and everything, had all my papers filled out and was ready for my surgery. The LAP-BAND® doctor turned in all my papers to the insurance for approval and it came back denied and said that they didn't cover it. I called up my insurance again today and the lady looked back through my files and said that it was never covered and she could see when I made the phone call on 6/18/2009 and she could see that the lady told me that I was covered. But all she said that I could do was make an appeal and she didn't sound like my chances were good. This is so unfair, I was so close, should I get a lawyer to write the appeal or what else can I do? Please help. Hi Mrs Plumpy, I have a very similar situation. My ins is Anthem bc/bs of Ohio who has a contract with Verizon. Verizon has overridden some of the Anthem benefits so it's not exactly the same. I'm a verizon retiree. I called the member # on the back of my ID card 4 times giving them all my info to verify I'm covered w/ a 36 BMI. Each time I was told yes. I also sent an E-mail and received a positive reply again. My ID # automatically identifies me as a Verizon retiree subscriber. Allergan also has info on the benefits of a lot of ins co's and their website showed it was covered w/ 36 BMI and one co-morbidity and even includes Verizon. Anthem says that info is no good because it comes from a 3rd party. The mistakes that Anthem kept making with me is that their reps never checked the Verizon contract to make sure VZ's policy was the same. I went through all the necessay steps required by my surgeon and was given a pre-op date (5/12) and surgery date (5/20) by my DR pending ins approval. No problems were anticipated since we checked in advance and I met the guidelines. Well, this past thurs, Anthem called me and said I did not qualify because VZ's contract overrode Anthem's policy (ok for 36 BMI) on Bariatric surgery - VZ required a BMI of at least 40. Anthem's stance was that VZ makes their own rules and they have to abide by them so they were going to send me a denial letter. I have since provided them the E-mail stating I qualified (w/36 BMI) from one of their cust svc reps. Their Medical Director is now reviewing my E-mail. They said if they gave me incorrect info, they would approve the surgery anyway to make things right. Allergan will help to appeal if necessary and I'll have an atty which might cost a very small fee. Let me know how you make out and I'll do the same. Priscilla
  20. wash

    Looking for May Bandsters

    wash replied to ms.rhonda's topic in LAP-BAND Surgery Forums

    [QUOTE=acp1974;1455220]Just wanted to join the parade. My date is May 19th. I'm getting banded at Beth Israel in Boston, MA by Dr. Schneider. Any other Massachusetts folks with a May date out there? I'm excited for everyone, and also a bit anxious for myself. Which I suppose is normal. The reality really hits you once you have a date, eh? Good luck all and keep updating this thread so we can see how those of you with early May dates are doing post-surgery. Also any tips/encouragement on sticking to the pre-op diet are always welcome as well. Mine starts May 4th.... Al My date is May 20th at Norwood Hosp by Dr Adam Glasgow. I live in NH but after investigating 3 places, this one is the best fit for me. However, I got a call 2 days ago from my ins co saying they were going to send me a denial letter because my BMI is only 36, and you had to have at least a 40. I had an E-mail showing that they answered me in writing that 35-40 is ok if you have at least 1 co-morbidity which I do. So their medical director is looking over that E-mail and hopefully will get back to me by the middle of next week. They did tell me if they made a mistake, they would make it right and approve the surgery anyway. I think I'm safe in presenting the E-mail. Otherwise, if they deny me Allergan said they will help me with the appeal process with an attorney. My dr's office is so great, the scheduling coordinator is going to keep my dates until we hear back from the ins co. It's very aggravating because I called 4 times just to make sure I would qualify. My mistake was never getting the names and dates when I got those confirmations. There is a name in the E-mail though. Thanks for letting me rant! Priscilla
  21. wash

    Looking for May Bandsters

    wash replied to ms.rhonda's topic in LAP-BAND Surgery Forums

    Welcome and remember April showers bring May flowers! Priscilla
  22. wash
    I know I'm so excited too and thankful to "know" you so it doesn't feel like I'm going it alone. Check my update on my bandster for my visit w/Dr Newman. Priscilla
  23. wash
    Hi Sue, Yup, then I know who you are. Do you remember me? I'm not sure how many group meetings I'll make because I live in NH but I wish I could go every week! Priscilla
  24. wash
    Congratulations Katie! Can you believe it...we have our dates already! And just 2 days apart! Now we just have to keep our fingers crossed that we get our approvals from the ins co.(I have Anthem BC/BS). Start thinking pre-op diet! Were you able to find my update ok on my bandster? Tomorrow is my day for the psychologist...hope he doesn't make me cry. Priscilla
  25. wash

    Looking for May Bandsters

    wash replied to ms.rhonda's topic in LAP-BAND Surgery Forums

    Hi, I just got my surgery date of May 20th! My pre-op is scheduled for May 12th. This is all pending insurance approval...I hope I get approved but I'm worried since my BMI is only 36. I have co-morbidities though. Everything went pretty quickly for me. Consult with surgeon was on April 16th and I have a surgical date already. I didn't need a sleep study because I just had one in 2007. Glad to be here on this forum! Priscilla

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