My Story, As I Wait.......

[Jbright 10]

Hi ALL,

I have been following this board for a couple months because I've been considering Lap Band. I honestly feel like I know some of the people here personally especially after reading about their journey.

About me lets see..... I'm 33 and have been overweight for years. After having my first child in 1998, I started taking Metabolife. I managed to loss 45lbs or so. When I took metabolife, I watched my what I ate and exercised four times a week, I was in the best shape of my life. Then I became pregnant with my son. I managed to continue exercising while I was pregnant. Although I gained 48lbs while being pregnant, I lost all but 10 pounds after I delivered my son, in 2001.

In 2003 and at 170 pounds, I began taking Phentermine diet pills to maintain my weight probably for the past 9 years (off and on). While I didn't lose much weight while taking the pills I noticed when I went off of them, 10 pounds or so would creep on. I workout and try to eat right but the weight would never come off. So, I decided to kick the phentermine to the curb once more and since July 2012, now Im 15 additional pounds heavier(instead of the normal 10). I am now tipping the scale at 243 (my highest weight). Being overweight is genetic (well at least I believe it is). My mom had gastric bypass in 2002 she was almost 400 pounds she has lost and managed to maintain her weight at about 220. My mom's weight issues has always scared me thats why I would workout and try to eat right. I have Aetna POS II and I have been awaiting their approval since September 21st. I am remaining hopeful about this whole process and pray I am approved! I can't not continue to take phentermine pills as they no longer work for me.

I have been calling Aetna everyday asking for a status since September 24. Everyday, the status has remained as pending. I am wanting this surgery to be approved so that I can go on with my life. I have completed the 3 nutritionist visits (as insurance instructed me to do so) psychological test, sleep apnea (which I found out I have a case of and was issued a CPAP machine. Does anyone think calling the insurance company everyday is considered being too pushy?

Also, my two years of weight history happen to all be through the dietary programs (which I paid for) that prescribed me the phentermine so I am hoping and praying Aetna will recognize my attempts when they are reviewing my file. BTW, beside the sleep apnea I do not have anymore co-morbids. My BMI is 42. Anyone else has any similar stories they would like to share about two years supervised weight history?

Best of luck to everyone!!!

Jbright

[kvr1977 28]

Hi, I have Aetna too. They required the 2 years history for me also. I had documentation from my pcp and that was sufficient. What you provided them is probably even better since it shows you were making an attempt to lose weight. I think as long as its documented somewhere. I got denied because I gained a few pounds during my 4 month nutrition visits. I gained 5 pounds in 4 months. So I started the process over again. Hopefully this time will be better. Good luck to you on your life changing journey.

-Kelly

[Sarah75 67]

I also have Aenta Pos ll...my 2 year history was from PCP..and I gained 15 during the 6 month wait and was approved in less then a week after my last weight in..sounds like u have everything in order..I know the waiting process is stressful..hang in there sending you positive thought for approval

242..surgery 9/5...now 218

[Mandylove 32]

Hi,

I as well have Aetna but sadly got denied in August. I used documentation from when I did Jenny Craig in 2010 but since I had lost weight my BMI at that time was too low for approval even though I gained it all back and then some. From what it looks like you have, you have a much better chance of approval than I did. I am in the appeal process and hope the get my denial overturned in the next few months. You should be hearing something any day now! It took a little less than 2 weeks for me. Good luck on your journey.

[Jbright 10]

Thanks everyone for the replies..Sadly to say I found out this morning I was denied as well because they stated my BMI hasnt been 40+ for 2 years. My surgeon and the medical director (at Aetna) is supposed to have a peer-to-peer review. I am praying this is approved. If not then I will be consulting the Lindstrom group as well for assistance. I am really kicking myself for attempting to lose weight with a supervised medical professional and not just letting the weight creep on up maybe I would have been approved. I am so upset about the whole process!

[kittylove32 90]

Hi, my name is Jen. I was lucky because my insurance wanted a 5 yr weight history. My dr office didn't have any diet records and neither did I. Thankfully my dr just wrote a letter and that was good enough. I also was on diet pills for many yrs. Too many yrs. Not anymore. I also weigh 243. I am only 5'1 so I feel horrible and am in pain every day. All my life I maintained 125-130 lbs. Then 9 yrs ago I started gaining weight due to depression. Then I had my son, that was 30 lbs there. The icing on the cake was I quit smoking and that put on 40 lbs! My small frame can't handle this weight. I just went for my last visit. Got my 2 week supply of shakes. I start those on the 10 th then surgery on the 25th! I am pretty nervous. I feel like I will die from hunger on the pre op diet but I HAVE to lose the weight. Good luck to you and I hope you find something out soon! Oh, and I called the insurance all the time too, LOL I only had to wait a week though

[kittylove32 90]

Oh no! I just saw your post that you were denied. I am so sorry I hope you will still be able to get it somehow. Good luck hun

[Jbright 10]

Hi, my name is Jen. I was lucky because my insurance wanted a 5 yr weight history. My dr office didn't have any diet records and neither did I. Thankfully my dr just wrote a letter and that was good enough. I also was on diet pills for many yrs. Too many yrs. Not anymore. I also weigh 243. I am only 5'1 so I feel horrible and am in pain every day. All my life I maintained 125-130 lbs. Then 9 yrs ago I started gaining weight due to depression. Then I had my son, that was 30 lbs there. The icing on the cake was I quit smoking and that put on 40 lbs! My small frame can't handle this weight. I just went for my last visit. Got my 2 week supply of shakes. I start those on the 10 th then surgery on the 25th! I am pretty nervous. I feel like I will die from hunger on the pre op diet but I HAVE to lose the weight. Good luck to you and I hope you find something out soon! Oh, and I called the insurance all the time too, LOL I only had to wait a week though

HI Jen

I kinda feel I gave them too much information. Oh well everything happens for a reason..I am awaiting the results of the peer to peer review if that doesn't grant an approval for me I plan to contact the Lindstrom Obsesity Advocacy group (well I have already put in a call to them) As you can see I am a very persistent individual. Congratulations and Good Luck with your surgery, I am sure everything will go well