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My surgeon is supposed to be doing a peer to peer review by next week with BCBSNC. Him and the nurse, Helen, don't think we should appeal. They don't feel we'll get an approval that way, so they want to go straight to the p2p. I'm so nervous :/

I am definitely feeling a bit discouraged right now. I've had the gastric band since January 2011. Since the very beginning, I've had the throwing up/regurgitating. It doesn't matter what I eat, can be chicken, tuna, green Beans, raw veggies, bread, even Water sometimes. I've been compliant and have doctors records. I've had fills and un-fills, I've been on exercise plans, and made good food choices. When I have my band tighter and have any restriction at all, I'm throwing up 2-3+ times per day. My current surgeon (not the one who did the surgery) also said according to the X-ray with the barium swallow, my band is slightly higher than it should be, but not technically "out of place". They had to loosen my band about 2-2.5 months ago (again.. So I only have maybe 2cc in my band) and since then, I've gained about 15-20lbs back. My HW 300, SW 290, LW 230, and CW 270, and I'm 5'5". My surgeon said he'd do everything he can to help me get approved. I've done the nutrition class again and the psych evaluation. They submitted to insurance yesterday, and the RN said I should hear back within 2-3 weeks if I'm approved or not. But I've been reading A LOT of stories of people being denied for revision unless there is a serious complication with the band. I have BCBSNC. The insurance company that originally paid for my gastric band surgery was Tricare Prime, by Dr. William Richards in Mobile, Alabama. I just feel like the band has taken up so much of my life.. I've had it almost five very long years. I've regretted every moment I've had it. It's been hell and I wished I'd have went with the bypass from the beginning

Omg! Seriously?! That is ridiculous. They'll find any reason not to approve us.

Thank you!! and thank you for following up with me. It's definitely nice to have support and know you aren't alone in all of this.

That's amazing!! I'm so happy for you! I haven't heard anything yet. Helen told me this past Wednesday that I should hear from her by Monday or Tuesday as to what they're going to do. She said she'll keep me posted. It's so hard just waiting.. And waiting.. :/

Thank you. I will keep fighting, even though I don't really know what I'm doing!! lol luckily my surgeons office is helping me with the next steps and didn't just give up with the denial.

I am frustrated because I totally want to be obsessive right now and continuously check the status of my authorization for revision. Butttt I have BCBSNC, and I can't seem to find anywhere online where you can do this. *cue violin* hahaha

So, I called BCBS on my way to work yesterday morning. I got denied. They said the only reason was that they didn't have proof of where I've been compliant with diet and exercise after my Lapband surgery. I then called my surgeons office and the RN, Helen, that deals with insurance stuff said she is aware, she already received the denial. She said she feels I've been very compliant and is going to review my file again. Then she said she'll decide whether she will request them to reconsider, or whether to have Dr. Miles himself do a peer to peer review.. I'm bummed... But trying to stay in good spirits that it will all work out in the end. Helen told me that she's super busy this week, but that she will get to it the first of next week and will let me know what's going on. She told me that her and Dr. Miles wouldn't have submitted my case if they didn't feel I'd been compliant. So at least it seems they're going to fight for me. :/

My surgeons office also told me it could take up to two weeks, but she said if I don't hear from her within 10 days, to give her a call.

Mine was submitted October 1st, they said they received it 10/2/15. I'm still waiting. They said I should hopefully know by tomorrow. I have BCBS and they don't have anywhere online where you can view the status of your prior authorizations. It's driving me nuts!! Lol

Awesome news!! I'm so happy for you!

Fingers crossed!!

@ - What's the verdict??

Thank you for the support and encouragement!! Fingers crossed!

I just called BCBS. They received my medical file/case yesterday. The lady said it takes up to 72 hours for a decision to be made. If the nurse has any questions about it, then it'll be sent up to a medical director which could take 7 days longer. She said my doctor put Oct. 19 as the surgery date.... I was like WHAT?!!! The lady said it could be a "dummy date" but she said, or my surgeon could be shooting for that date. I'm so nervous. This is nerve-racking!! ????????

Anyone around Jacksonville-Wilmington? Dr. Miles in Wilmington is my surgeon. Still working on an approval for revision from band to bypass.

The appeal process sounds so scary to me! But my surgeon told me getting an approval for revision is very tricky. He said if I were going for an initial surgery for bypass, that he'd already have me approved. Years ago when I was trying to get approved for the band with Tricare, my surgeon sent the paperwork in on Thursday, and I had an approval Monday morning. It was easy. I didn't have to do the psych eval or any kind of 3-6 month diet program. I did the nutrition class, heart and lung testing, and that's it. I started the process in August 2010, approval at the end of October, he wanted to schedule my surgery for December 19 but I was going to be traveling 14 hours in a car 4 days after that, so it didn't make sense. So we rescheduled it to January 20, 2011.

Congratulations on your approval!! How exciting!

Agreed!! I've despised every moment of mine these (almost) five years! ???? Congrats on your approval!

Thank you! I'm trying to keep in positive spirits, but I just want this dang thing out!! Lol

Same situation here! My surgeon just submitted to insurance (BCBSNC) yesterday - so we'll see what happens. I'm very nervous I'll be denied.. I've read a lot of stories of people getting denied for a revision unless there's serious complications??

So, I am definitely feeling a bit discouraged right now. I've had the gastric band since January 2011. Since the very beginning, I've had the throwing up/regurgitating. It doesn't matter what I eat. If I have any restriction at all, I'm throwing up 2-3 times per day. My current surgeon (not the one who did the surgery) also said according to the X-ray, my band is slightly higher than it should be, but not technically "out of place". They had to loosen my band, and since then (2 months ago), I've gained about 15-20lbs back. My HW 300, SW 290, LW 220, and CW 270. My surgeon said he'd do everything he can to help me. I've done the nutrition class (again) and the psych evaluation. They submitted to insurance yesterday, and she said I should hear back within 2-3 weeks if I'm approved or not. But I've been reading A LOT of stories of people being denied for revision unless there is a serious complication with the band. I have BCBSNC. The insurance company that originally paid for my gastric band surgery was Tricare Prime, by Dr. William Richards in Mobile, Alabama.