Got my denial letter from BCBS today :(

[Kami63 215]

I knew it was coming but I can't help but feel upset. I am a revision candidate from the band to sleeve. They have approved my band to come out. That is a prayer answered in itself. I have had pain and complications for almost 5 years and 2 insurances have denied taking it out. I will be doing that in June. The letter said I have to have a Nut and Psych appt. which is normal. But the letter said that I need to PROVE that I followed my diet and exercise program after my first surgery. Which part? While the band was working I lost 32 pounds. A few month after surgery I had complications and got to where I couldn't eat at all so obviously I gained weight in starvation mode. That requirement is really open for them to say anything. I am a little scared now that this is not going to work out.... Sorry to be so negative, I'm usually so positive. But I am so fed up with these insurance companies not treating me as an individual case instead of the herd. I think I need a pep talk... On the bright side I've got the psych appt Friday and the nut appt next Tues so they can submit again next week with those and whatever the docs office decides will prove that I was compliant after my first surgery... Meanwhile I'll try not to freak out :o/

[Purplrose323 32]

Hi there! Sorry you are having to deal with all the insurance bull ish! I'm also a revision candidate. I was supposed to have my band removed tomorrow with an endoscopy but I have a cold so was rescheduled to June 19th. My doctor does not do all in one revision surgery. That being said I also have BCBS of NY, not sure which BCBS you have and I'm scared to death they will deny sleeve. Apparently my insurance also treats you like you are starting at square 1 and never had a 1st surgery to begin with. My doc told me that bc my BMI is 35 and I have a comorbidity they should cover it. I lost weight with the band but have gained a lot back as I was either a forced bulimic or I felt like there was no restriction. I was banded in September of 2004. I wish you the best of luck and pray your surgery is approved!

[Naija2atl 30]

Truth can be hard sometimes, you did not gain weight due to been in " starvation mode" you gain weight due to eating too much of the wrong food, think slider food . If you are not truthful to yourself not even sleeve will help you. Good luck

[SeriouslyChange 319]

In order to prove that you followed the diet, you should keep a food diary or attend something like weight watchers. I agree with the person above me ^^ I eat about 500-800 calories a day and am constantly in starvation mode yet I've lost. Try to modify what you're eating, exercise, and track. Then, when you submit again, they have no excuse to deny because you've covered all of your bases

[catheryn3 7]

I knew it was coming but I can't help but feel upset. I am a revision candidate from the band to sleeve. They have approved my band to come out. That is a prayer answered in itself. I have had pain and complications for almost 5 years and 2 insurances have denied taking it out. I will be doing that in June. The letter said I have to have a Nut and Psych appt. which is normal. But the letter said that I need to PROVE that I followed my diet and exercise program after my first surgery. Which part? While the band was working I lost 32 pounds. A few month after surgery I had complications and got to where I couldn't eat at all so obviously I gained weight in starvation mode. That requirement is really open for them to say anything. I am a little scared now that this is not going to work out.... Sorry to be so negative, I'm usually so positive. But I am so fed up with these insurance companies not treating me as an individual case instead of the herd. I think I need a pep talk... On the bright side I've got the psych appt Friday and the nut appt next Tues so they can submit again next week with those and whatever the docs office decides will prove that I was compliant after my first surgery... Meanwhile I'll try not to freak out :o/Hi my name is Catheryn and we the sleeve famliy will be praying for you and that you will get approve for the sleeve and lose and keep off all the weight you want and God bless you and your family.

[Kami63 215]

Naija2atl: I agree with being honest with myself. I had 5 years to gain the weight back and had a bad back injury as well. I got up to 315 when I couldn't walk for 6 months. I can now walk for exercise and I do nutrisystem and I am down to 275 (40lbs gone!) which is less than my pre surgery weight. I have documentation of my back problem and after they took all of the Fluid out of the band I did not reach for those milk shakes anymore. I have documentation that I have been consistently losing since my back started getting better. I have also dealt with some of the issues that made me turn to food to begin with and can submit the notes from that as well. To be fair to me though, I did not gain weight until I had complications with the band and followed the rules to a T with no slider foods. I know the sleeve is a tool and I know that if my band had not failed that I would have been successful. Thank you for your take on my situation.

Seriouslychange: yeah my doctors office wanted to submit before I did anything to make sure of the criteria so that is why I said I knew it was coming. They have my back and know my story better than anyone so I have no doubts if it is possible they will make it happen

Purplrose323 hello! I am sorry u had to reschedule. I don't have the date yet of the removal, they want to wait until they get an answer in the sleeve. My doc does it n two surgeries so I will definitely get it out, the insurance already approved that due to the complications thank heavens. Good luck to you I hope you get approved .

Thanks Catheryn3 nice to have some blessings!

[Brenda0928 145]

I knew it was coming but I can't help but feel upset. I am a revision candidate from the band to sleeve. They have approved my band to come out. That is a prayer answered in itself. I have had pain and complications for almost 5 years and 2 insurances have denied taking it out. I will be doing that in June. The letter said I have to have a Nut and Psych appt. which is normal. But the letter said that I need to PROVE that I followed my diet and exercise program after my first surgery. Which part? While the band was working I lost 32 pounds. A few month after surgery I had complications and got to where I couldn't eat at all so obviously I gained weight in starvation mode. That requirement is really open for them to say anything. I am a little scared now that this is not going to work out.... Sorry to be so negative' date=' I'm usually so positive. But I am so fed up with these insurance companies not treating me as an individual case instead of the herd. I think I need a pep talk... On the bright side I've got the psych appt Friday and the nut appt next Tues so they can submit again next week with those and whatever the docs office decides will prove that I was compliant after my first surgery... Meanwhile I'll try not to freak out :o/[/quote']

Hang in there and good luck!!

[Kami63 215]

Thanks bscott92863! I am really close to my psych appt Friday. Supposed to be 2 and a half hours... Seems long but I think that is with completing all of the paperwork.

[Brenda0928 145]

Thanks bscott92863! I am really close to my psych appt Friday. Supposed to be 2 and a half hours... Seems long but I think that is with completing all of the paperwork.

Good luck tomorrow.....just be honest with him/her and enjoy the conversation and potentially awesome future when you finally get approved!!!

[Kami63 215]

Thanks bscott92863 all went well today with psych! There are two parts the interview with te Dr. And the test that was 370 questions (whew!) Dr. Told me that I passed the interview portion and he will have the results of the test on Monday. Hope I passed he test

[Naija2atl 30]

I am glad things are progressing, get your sleeve so you could join us here on the loser's bench. I am sorry if I came a lil too brash with my initial comment I have a days .

[mggonzal 54]

I knew it was coming but I can't help but feel upset. I am a revision candidate from the band to sleeve. They have approved my band to come out. That is a prayer answered in itself. I have had pain and complications for almost 5 years and 2 insurances have denied taking it out. I will be doing that in June. The letter said I have to have a Nut and Psych appt. which is normal. But the letter said that I need to PROVE that I followed my diet and exercise program after my first surgery. Which part? While the band was working I lost 32 pounds. A few month after surgery I had complications and got to where I couldn't eat at all so obviously I gained weight in starvation mode. That requirement is really open for them to say anything. I am a little scared now that this is not going to work out.... Sorry to be so negative' date=' I'm usually so positive. But I am so fed up with these insurance companies not treating me as an individual case instead of the herd. I think I need a pep talk... On the bright side I've got the psych appt Friday and the nut appt next Tues so they can submit again next week with those and whatever the docs office decides will prove that I was compliant after my first surgery... Meanwhile I'll try not to freak out :o/[/quote']

They gave me a denial too... I was son angry.. They told. That I didnt need it sinc I had no high pressure or diabetes... I was weighting 333 pounds!!!! They asked 6 mo to follow up with my dietician but i did refuse to wait so long time... I went ro mexicali with dr Aceves and 2 weeks later I had my sleeve... Excellent option i couldnt have a better experience... The best sevice and attention plus excellent results... I wasted 3000 dlls on deductibles to get a denial from BSBC

[Brenda0928 145]

I knew it was coming but I can't help but feel upset. I am a revision candidate from the band to sleeve. They have approved my band to come out. That is a prayer answered in itself. I have had pain and complications for almost 5 years and 2 insurances have denied taking it out. I will be doing that in June. The letter said I have to have a Nut and Psych appt. which is normal. But the letter said that I need to PROVE that I followed my diet and exercise program after my first surgery. Which part? While the band was working I lost 32 pounds. A few month after surgery I had complications and got to where I couldn't eat at all so obviously I gained weight in starvation mode. That requirement is really open for them to say anything. I am a little scared now that this is not going to work out.... Sorry to be so negative' date=' I'm usually so positive. But I am so fed up with these insurance companies not treating me as an individual case instead of the herd. I think I need a pep talk... On the bright side I've got the psych appt Friday and the nut appt next Tues so they can submit again next week with those and whatever the docs office decides will prove that I was compliant after my first surgery... Meanwhile I'll try not to freak out :o/[/quote']

I got a denial from my insurance today after 2 months (today) of waiting and being told it is in review.....they said we did not provide the"clinicals"....Dr notes stating it is medically necessary and showing I have been doing the weight loss programs and follow up appts, and what the post surgery plan will be,etc.....We already submitted all of that, and my surgeon has copies of all of it so they submitted an appeal with all of it attached AGAIN.....now or could be ANOTHER 30 days!!! Someone is dropping the ball somewhere and it isn't ME!!! Arrrggghhh....so frustrating!!,

[Kami63 215]

Oh no! I am do sorry. I had that problem with Cigna. Hang in there! Maybe the appeal will be quick.

[Bellanthin 112]

same exact thing happened to me today w atena they said they had no proof of my high blood pressure high colestrasl which was all stated in my clinicals