Eroded band to sleeve - I won my appeal!

[FXDF2008 14]

For those who haven't been following my story...............

I was diagnosed with an eroded band in November of 2011 and had it removed in March of 2012. I had to wait for six months before revising to the gastric sleeve as my surgeon wanted to wait for me to heal completely and do medical tests before confirming that I would be a good candidate for the sleeve. I have complete those tests and he was satisfied that I could have the sleeve. We also found that I had developed another hiatal hernia (the first one was repaired when I had my lap band surgery).

My predetermination request for the sleeve surgery was denied. They stated that I needed to complete a six month weight loss program in order for them to consider my request. I asked my surgeon's insurance coordinator to appeal based on the reasoning that this was a repeat surgery for a lap band that had medically failed me and that I shouldn't have to complete the six month medically supervised weight loss program. She filed an appeal but no where in the letter did it address the six month weight loss program so of course they denied me again stating that we still hadn't submitted the records they had requested.

Frustrated beyond belief, I took the initiative to write my own appeal letter. I used language from the BCBS-AL bariatric policy regarding repeat surgeries and their rationale for requiring the six month weight loss program and explained how I had met that rationale just by having a lap band for four years and that my waiting for six months before revising to another surgery was not conducive to improving my health.

I just got off the phone with BCBS-AL and they have approved my surgery!!!!!! I am actually shocked that I succeeded in my appeal. I fully expected them to deny me and had already started the medically supervised six month weight loss program in preparation for that denial (and have lost 10 lbs over a six week period which is nice).

I'm excited, relieved and nervous! I've been through this before so I don't know why but I am. I was very successful with my lap band (losing 94 lbs). I remember how wonderful it felt to be thin and feel good about myself and how I looked and not to be in pain anymore from carrying around all this extra weight (yes I packed the pounds back on after my band was removed). I can't wait to be there again!

Yeah me!!!!!!!!!!!!!!!!

[JerseyGirl68 1,172]

Yeah you indeed!! Congratulations!!