Denied <BMI 40 - has anyone gained weight for approval??

[em1125 0]

Iulizbug,

If by chance I would have to self-pay, what happens if I have a medical emergency regarding the band. What if it slips or erodes? Would I also have to selfpay that. What would happen if the patient needs to have an extended hospital stay due to complications? What has been your experience?

That's the one thing I'm truly nervous about.

Let me know.

Em

[shackdog 1]

This is weird that a person would want to gain weight to have surgery, Life change is just what it says, Life change. Go see a Doctor who knows what they are doing, work the plan that they give you, join support groups and things like weight watchers or another group, but to gain weight so you can have the band is NUTS..................................

Also for people to say things to help you cheat the system, I would be very careful listiening to any of their ideas, where is the INTEGRITY people. Sounds to me there is NONE.

[em1125 0]

I wouldn't be so quick to judge whomever decides to cheat the system. No one should be judging anyone. For some people it takes desperate measures. And if there's someone lacking integrity, you need to look at the people in the insurance companies making life decisions for patients who are in great need of WLS.

I am in full agreement about not gaining weight for surgery. That's purley self-sabotage. However, I'm not going to call these people weird or nuts. If Weight Watchers, supervised MD diets, or other support groups were successful, three quarters of the people on this site would not have had WLS. FYI, only 5% out of 60% of Americans who are obese will lose their weight and maintain it for many years. The rest will continue to gain weight, lose some and gain more back or just maintain their dangerous levels of weight.

Instead of critizing people, it would be more beneficial to this post to come up with ideas to help people in need. There's no need for any kind of name calling. We would all appreciate good advice and ideas. We are all here to help one another not be judgemental in any way.

My advice to all - if your in the process of an insurance denial, fight it. Don't be discouraged.

Em

[wantlapband 0]

Oh that is sad. That is what I am afraid of....I went yesterday, I'm going to brigham and womens in Boston...I have BCBS of MA. The doctor told me that I shouldn't have a problem. He circled all the co-morbities..the big one is heart disease. With me everything is documented....my insurance approved xenical for 3 months but it did not work. Everything kind of surgery, angioplasty, ultrasounds, MRI's, catscans I have had over the course of 6 years is documented. I have had SVC syndrome, which I get from lying down flat...so he is using that as heart disease..i have other things going on, DVT's, chronic venus insufficiency (Which I am able to be on disablity for.)

But its heartbreaking..i hope I don't be disappointed.

[wantlapband 0]

oh yeah...the PA i met with yesterday told me that she tells people with no health issues with a low BMI to actually gane weight..and that is coming from a doctors office!

[RLittman 4]

Until yesterday, I felt so down about the insurance denial. I have been overweight (50-90 lbs) 31 out of 46 years. It is the only thing I know. I have lost and gained, lost and gained great amounts. I still remember the fear each time when the weight slipped back on. With my bad back, now I don't even have exercise to help me lose, and I have never lost weight without a very aggressive exercise plan.

Then last night my husband surpised me with the news that he was planning to self pay if I was turned down for insurance. This week I will complete the paperwork and schedule the procedure for the first week in August. I am still in shock and feel a sense of hope I have never known. Wish me luck!!

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[wantlapband 0]

oh that is wonderful! What a great husband.

[em1125 0]

That's great news! Good luck. If everything goes well with my insurance I will have the surgery around the same time.

[Iulizbug 0]

em1125,

Sorry it took me so long to reply--been away from the board busy with work. You have hit on the EXACT reason on why I tried so hard and stuck through the tedious process with the insurance co. to get approved. WHAT IF there is a complication that arises the needs immediate attention?? Well I guess at that point I will have to bite the bullet and take care of it even if it is financially devastating to me. I have discussed this with my doc, Dr.Ortiz, and he implied that financial discounts would be arranged at that time if necessary BUT I am just trying to stay positive and hope that I am not in that 1-3% of people wilth problems down the road. IF there was any way that I could have had this procedure covered by UHC I would of fought it and stuck it out just for that reason--the possibility of other surgery down the road. That thought still scares the *hit out of me. I guess we must all do what is right for us at the time....For me it was surgery NOW b/c I was gaining weight at an alarming 1-2 lbs a week and would of been well over 300 lbs if I waited it out and jumped thru the insurance hoops for another 2 years trying to prove to them that I medically needed surgery. Good luck on your upcoming surgery.

~liz~

03/10/06

241/192/150

5'7''

[em1125 0]

Thanks so much. I'm with you as far as getting it done as soon as possible. I told my husband that I will fight up until the end of July and then I'm done. I will self-pay. I work in a school district and I'm off for the summer. I chose not to tell anyone about the procedure except for my husband and mom so I need to have it done before I go back to work at the end of August.

Thanks. I'll let you know what happens. I should know something by the end of next week.

Em

[Iulizbug 0]

Good luck Em!! Keep me posted....

~Liz~

[pbrown 0]

I have been denied by Aetna as my weight loss history is 8 years old. I have a BMI of 38.5. I also have a bad disk which I have had physical therapy for and suffer from migrains. Even though I had documented the phen phen phase of my journey 8 years ago that wasn't good enough. I am not going to do another 6 month adventure only to loose and gain it back as has been my pattern over many years. So I am going to self pay $11,000 as I do not want to go down the same road my mother has traveled at 83, diabetic, two knee surgeries and two back surgeries, last summer. I am at my all time high and want to get rid of the extra weight before it creates problems for me as I am 51 years old. I have been exercising walking two miles 3-4 times a week for 40 minutes. I will continue to do this. My surgery is scheduled for August 17th. I already had a surgery date back in June, and had had all the blood work done. Nowthe blood work is out dated so I have to do it again at the end of this month. We had to do all of the blood work and chest x ray before submitting records etc. to the insurance. I am finally seeing my way clear to a "for sure "surgery date!! Anyone lese being banded in August?

[em1125 0]

pbrown,

Good luck to you. I should be having the surgery arounde the same time as you in August. I'm waiting for my appeall to be reversed. I should know something in the next week or two. If I don't get approved, I am hiring an attorney (i think). I just don't know if I could wait more than a month. I'm getting very impatient. If I have to, I will pay. However, I'm nervous about self paying. I want to use the surgeon in NYC and he's very expensive. We'll see what happens.

I am very happy for you and wish you only the best.

Emily

[wantlapband 0]

When do you think I should start calling the insurance company to see if they have any paperwork on my surgery? Should I bug them? It's only been 2 weeks (I think) since I first met with the surgeon. I already have my pre-op visits arranged and my surgery date on Sept. 20th..

[em1125 0]

Absolutely call them. I call my insurance company once a day to follow up on my appeal. They underdstand that we're anxious. My insurance company told me that it could take up to 60 business days on an appeal.

For the pre-authorization it shouldn't take longer than 20 business days. I would definetely call every day until you get an answer.