N E 1 been Banded at Mt. Carmel col, oh

Thinner me · December 22, 2007

Sue.... As I was reading your post, I could feel your pain as you remembered your husbands illness. Its amazing how we realize just how much we love someone when there is a chance of losing them. Thank you for your prayers, that means more than anything.

SpecialK.... Thank you so much for your kind words and your prayers. I know just how awesome God really is and I am a living testement to what he can do. I just really needed to vent alittle.

We go for a CT on Christmas eve, and then to the James on Jan. 19th. I will keep everyone posted. Once again, thank you so much for the prayers.

suecasb · December 22, 2007

BCBS turned me down again today. I guess I will have to file an appeal.

debbiek1 · December 24, 2007

Sue--BCBS is being Scrooge. BAH-HUMBUG

dont let them dampen your christmas spirit. May you and your husband have a merry christmas and a very happy new year

did they say why they rejected you? was it your BMI? If so look on the bright side--apparantly you arent as fat as you think you are!! But fight for it. it may take a while longer but remember the squeaky wheel gets the grease.

i havent lost any weight in weeks and plan on eating up a storm for the next couple days.

but i go get an adjustment on thursday.

suecasb · December 24, 2007

Merry Christmas And Happy New Year Everyone!!! :rose:

suecasb · December 24, 2007

Deb, this time they denied me because my sleep apnea is only severe during rem sleep and mild the rest of the time! The requirements in my policy just say " sleep apnea" it does not say how severe it has to be, so I think they are changing it to suit whatever they want. I am trying to find someone that knows how to write a letter of appeal as I don't have a clue about how to write one. I am not going to give up yet!

SpecialK · December 24, 2007

Sue, sorry to hear about BCBS being so picky about the sleep apnea issue. Do you use a CPAP? My Sleep Medicine doctor is Dr. Joseph Cunningham and he encouraged me to consider bariatric surgery so he was really cooperative in writing my letter saying he felt I needed the surgery and my sleep apnea would be improved or eliminated if I got surgery and lost significant weight. Good luck in writing an appeal letter.

There is a posting on this web site from a lady who went through 2 years of fighting to get her approval and she got some kind of an obesity law group involved to help her along the way. I'll see if I can find the posting and link it here later.

I'm in Arizona this Christmas and today is our big holiday meal. I am planning to be as reasonable as I can. So far I've done okay in not getting into sweets especially.

Merry Christmas!

SpecialK · December 24, 2007

Be sure you all are aware of the insurance forum thread and then you can see what others have been doing on working with BCBS, Aetna, Cigna, etc.

Here's a real testament to perseverance - this lady hung in there for 2 years and got her approval in the past week! What a blessing.

http://www.lapbandtalk.com/f8/after-2-years-i-am-approved-47405/

suecasb · December 25, 2007

Thanks, I do read this thread and have checked out the link, but it was a form for your doctor to fill out and he has already done that one. I was told that I need to write a letter stating why I disagree with their decision. I am not a great letter writer! I have been prescribed a c-pap and that doctor wrote a letter to BCBS saying that the sleep apnea is directly caused by my weight and that she highly recommended for me to have the surgery and they still denied it. I need to write a really good letter because nothing else seems to be working and I can't afford to hire a lawyer to fight for me.

Thinner me · December 27, 2007

Good morning Ladies. I hope everyone had a great Christmas.

Sue......OMG!!!!!!!!!! What are they trying to do, make you give up??? DON'T DO IT! I wish I could help you with the letter, but I am at a total loss when it comes to that kind of thing. Could someone at Mt. Carmel help you out?

I spent the day cleaning and getting my house in order yesterday. It looked like I hadn't done anything for weeks. I have to clean my bathroom and wash sheets today and I'm done...... well, the basement and the garage are a mess, but I don't think they count . I'm getting ready to hit the stores for some after Christmas shopping. You can get some great deals on decorations, wraping paper and such right now.

We went for Dh's CT scan on Monday morning. We have to carry the films and report with us to the James. They offered to give us the films right then and then send the report, but I refused. I know if we had them I would have to look (I'm a nurse), and I didn't want to even think about any of this during Christmas (ok, so its pretty much all I thought about, but I didn't want anymore bad news). I think I will pick them up the day before we go to the James.... my way of avoiding the problem I guess.

I have one more visit with the dietician (Jan. 30th) and then I can submit to the insurance company. It feels like I have been at this for years..... well almost a year. I can't wait to be banded and get on with my life.

Ok, I'm off to get the sheets in the wash and head out to shop.

Everyone have a blessed Thrusday!!

Lady Q T · December 28, 2007

Hello every one!!! I have missed you guys!! I have been so busy it is not funny!!!!!! So I have got caught up with every one so first let me start off by saying........Angie, you and your Husband is in my Prayers' please remember that we serve an Mighty Good God!! And he has control over all Things, he is a Healer just keep your faith in him, the Devil is a Liar!!!!!!!

Welcome Nurse Niki!!!!!

Sue You need to keep fighting BCBS, maybe you should call your H.R dept. to see how they have it writen in the policy, alot of time we want to fault the ins. company when in reality it is the employer that is blocking us from having the surgery!!!!!!

Debbie, I haven't lost any either:think,and I too have been eating alot of forbidden foods (I know, Bad bander, Bad bander). What time was your appt. Thursday the 20? I was there at 1:15p I think we must keep missing each other. I also saw Dr. Choban in the ad, I told her that she is a Star now!!!

As for the food question, I was able to tolerate broccoli, pop corn, prime rib (very tendered Yummy) in small amount, but let me say this every one is different, and I suggest every one follow what your Dr. tells you to do, don't buck the system like some of us do because it is not fun when your food gets stuck it is down right painful!!!!!!!

AnyWho, I am back to doing the right thing starting next week, really starting tomorrow (since I messed today up:embarassed:) But to be honset it has been very hard this Christmas without my DBIL, I was just at his house tonight and had to leave because of his stocking holder that did not bear his stocking!!!!!!!!!!!!!!!!!!!!!!!!!!

Okay I am going to bed now, I will try not to be away for so long any more!!!!

I will try to get some thing together for all of us to meet after the New Years, with people coming from Heath would Pickerton or Reynoldsburgh be a better meeting place? Just trying to get ideas. Please let me know.

SpecialK · December 31, 2007

My sister and I used to always some up with a New Year's slogan and she shared hers yesterday with me: 2008 - Its going to be Great!

I was thinking Lose Weight in 2008! and Get Healthy in 2008 will be my theme. I can remember one year we had a slogan of "Lose Weight, Get a Date, Find a Mate in 1988!" Too bad it didn't work for me. Looking forward to getting my lap band in 2008!

Any others want to chime in with their New Year slogan or resolution?

Happy New Year! :clap2::clap2:

SpecialK · December 31, 2007

I was able to get my new psychologist appt set up for Nov 29 by being flexible and taking a 2pm appt which is no problem for me because I can work from home that day and go the appointment and then come home and keep on working through the beauty of the internet.
That will be one busy week for me. Cardiologist Nov 28, Psychologist Nov 29 and the Mt. Carmel Support Group mtg Dec 3rd!

Since we've been saying meet at Polaris, how about if I throw out a specific day and time day and everyone can chime in if they can make it.? So here goes...

Meet January 8, 2008 at Polaris Mall in the food Court area - That's the 2nd level of the mall. Let's say 6:30 to let everyone get off work and get there. We can find a nook or spot where we can sit together and the food court will offer alot of choices of what to get to eat or you can just get a beverage. Whatever is best for you.

Wear PINK and I'll get a helium balloon to mark where the meeting spot is. Shouldn't be too hard to spot a group of us that are losing substantial weight and wearing pink!

I have received some responses that people are interested in this meeting and also that we should try to schedule one on the East side of Columbus on a Saturday for those who can't make a weekday.

Let's still do this one for those who can make it and I'll chat with Debbie from Heath and see what we can work out for the east side group to get together.

SpecialK · December 31, 2007

Here it is coming up on the New Year already - 3 months since I started my lapband journey - and I'm still jumping through hoops. I thought I'd recap here for my own record as well as share with others who may be considering lap band surgery how long things do take even if you are working at it and staying on top of it. They don't make it easy to do.

2007 Oct 3 - Attended the Mt. Carmel Bariatric Program Information session held at Mt. Carmel East Hospital on the first week of the month. See their website for info.
2007 Oct 10 - Confirmed my insurance (Aetna PPO) does have bariatric surgery as an option they will cover if you meet the required conditions.
2007 - Oct 22 Mailed the application packet I received on Oct 3 into Mt. Carmel and this is quite a bit of info to complete on health history so you can be considered as a candidate for their bariatric program.
2007 Nov 10 - Received acceptance for Mt. Carmel Bariatric program from Mid Ohio Surgical Associates with all the info I need to gather and medical clearances I have to complete before it can be submitted to my insurance. Paid a $300 program administrative fee out of pocket - not covered by insurance.
2007 Nov 15 - Dr. Cunningham at Mid Ohio sleep Medicine gives me clearance letter required for sleep apnea based on prior sleep study info. Don't have to repeat this to get clearance! No Cost $$ Yea!
2007 Nov 28 - Dr. Chawla appointment to begin cardiology clearance - basic exam and EKG and fortunately he's on my In Network doctors list so all I have is a $25 co-pay out of pocket. Requires me to have a chemical stress test and echocardiogram before he can write cardiac clearance letter for lap band surgery.
2007 Nov 29 - Dr. Brenner appointment to begin psychology clearance required. Basic 1st appointment but identifies that she cannot write clearance letter for surgery without a written 200 question psychological test given, graded or evaluated by her then her recomendatioons from that test shared with me. $20 co-pay only out of pocket.
2007 Nov 30 - Dr. Phil Price - my Mid Ohio Surgical Assoc/Mt. Carmel bariatric surgeon - initial appointment to discuss weight loss surgery options - agrees to perform lap band surgery and write letter to insurance for approval as soon as I can complete the clearances I am required to do. $25 co-pay only out of pocket.
2007 Dec 3 - Attend required minimum 1 Mt. Carmel Bariatric Support Program Monthly meeting at Mt. Carmel West. Free!
2007 Dec 5 - Primary Care Physician (PCP) requires $50 out of pocket administrative fee to pull 5 years of medical records from a remote storage and copy it to provide a required history of 5 years of morbid obesity BMI info for Aetna insurance clearance.
2007 Dec 14 - Chemical Stress Test done on my heart as one of two special tests for cardiology clearance.
2007 Dec 19 - Echocardiogram test done on my heart as 2nd of special tests required for cardiology clearance. Now need to find out results of tests and see if Dr. Chawla will write clearance letter first week of January or what is next. $$ out of pocket for 2 tests unknown. Will be submitted to insurance and we'll see.
2007 Dec 18 - Initial Mt. Carmel Bariatric Nutritionist appointment with Michelle Strakowski, RD for nutriotion counseling diet history, etc. $200 cost out of pocket. Will try to submit to insurance but don't know if nutrition counseling covered.
2007 Dec 21 - Psychological test cancelled 2nd time because of insurance pre-cert delays. Will now have to try for January and likely pay for the psychological test out of pocket.
2008 - Jan 11 - 2nd Nutritionist appointment - believe I have either 3 total or 6 total still not sure how many minimum! $100 out of pocket per appt. but will try to submit for insurance to see if they will cover any of it.
2008 - Jan 16 - 2nd PCP doctor appointment to document weight loss efforts and document BMI. $20 co-pay only out of pocket.
2008 - Jan 18 - Psychological test (200 question written test) - Likely to have to pay out of pocket on this. $$ unknown

To Do: 2008 - Feb - 3rd Nutritionist appt
To Do: 2008 - Feb - 3rd PCP appt
Goal: 2008 - March 1 - Submit for Insurance approval!

debbiek1 · January 2, 2008

hi, all.

after my last band adjustment i have noticed much more restriction. this is good. before i was as loose as a goose. now i can only eat half a bowl of oatmeal. meat is a lot tougher to get down. if it is in some kind of sauce it goes down much better.

but this is all good. i dont want to be able to eat "mass quantities". i am not a "conehead". anyone rembember the coneheads?

i did lose a pound and a half. finally. seems like i have been stuck for ages.

I am going crazy at the thrift stores!!! i was in the ohio thrift yesterday for three hours and spent 55 dollars. but if i hadnt kept putting stuff back it would have been 150 dollars

and not to brag or anything BUT i found a cool, gold necklace that i am going to use as a BELT!!!! and i found another gold necklace that does not have a clasp, but if i put it over my head and put one arm thru it at a time, i can get it down to my waist to use it as a belt too!!! Golly, I am so impressed with myself!!

my friend and i found a gorgeous size 12 coat and my she kept telling me to try it on. i kept telling her no way could i fit in a 12. and a bystander said that she thought i could fit in a 12!!!

it helps to be tall. but i still aint fitting in a 12!!

nurse niki · January 2, 2008

I hope everyone had a wonderful holiday! Christmas time (with a 3 and 4 year old) was very busy and very exciting! Taking down the tree yesterday was hard for the children to understand...they keep asking if tomorrow is Christmas morning again.

Debbi, congrats on the new fill. I am sure the scales will be smiling at you soon. I also wanted to share that Mt Carmels insurance does cover the band if it is medically necessary...we will see what they say. I am just finishing up my second 6 month diet history and plan to call Charlote today and see about sending it in for approval. I am a little scared at this point...I am having deja vu' with last year. I don't know what I will do if this falls through!

Sue, don't give up! If there is not specific settings on a cpap machine stated, I would think you could fight it! I wish there was a place on here where people would post copies of the letters they have used to win appeals--heck, we are all in this together!

Special K, looks like we are about on the same schedule! I hope to be banded around March 8th or so....We are taking the kids to Disney for Feb 25-March6, what better way to celebrate!

TM, I have thought about you and your family several times this holiday. I know the road ahead is full a bunch of questions...and that can be scary...know that we are here! Let this be the place for you to let your guard down; save your strength for the family!

My husband asked me last night about any resolutions for the year...I just giggled. I told him that I have made the same resolution to lose weight and get healthy since I was 12 years old! This year will be it, ladies...one way or another I will have my surgery!