Good Luck Alexandra

[KarenB 0]

We'll all be pulling for you!

Major hugs!:myscared::girl_hug::girl_hug::girl_hug:

Karen

[2bthinagn 3]

Yes goodluck today!!

[Alexandra 55]

Oh my god, thank you!! I had a wild dream last night that I went to the hospital and everything, only to be offered a MEAL by one of the nurses in pre-op. I was totally confused until my doctor came out and it turned out to be a total miscommunication--I had been summoned to the hospital for a dinner, not lapband surgery!

This is going to be a very weird morning. I'm already hungry...

Thanks for the good thoughts, everyone!! I'll let you know as soon as I get...the call.

[susannah 2]

Hey, Good luck Alex.:clap2: You can be an AP band girl too. Susannah

[Iluvharleys 15]

Keeping my fingers crossed for you! Good Luck!

[Alexandra 55]

You're all wonderful, but I just got the call to tell me it was denied again. :myscared: :girl_hug:

No surgery for me today. :(

[susannah 2]

Hi Alex, Why was it denied? On What grounds? Bloody insurance companies. Ahhhh! Susannah

[Alexandra 55]

Not medically necessary. My BMI is in the very low 30s now, so I'm not morbidly obese. Evidently they don't care that it was a replacement.

I'm going to proceed with a second appeal, and find out what my expenses would be if I paid myself. But I'm also going to have to face the possibility of facing life unbanded. Crap.

[susannah 2]

Hi A, You are dealing with people who have no clue that obesity is a lifelong health issue that we must fight forever. You need the band to keep your BMI low. Definately go the appeal route. Is self pay in Mexico a possibility?

Susannah

[marjon9 6]

I am really sorry to hear that you have met with this bump in the road. I know it must be frustrating and upsetting.

BUT, I just have to speak up about my opinion. It's in my nature, I'm sorry.

The distance between you and a new band is about $10,000. Considering the value of the band in your life, that is a gap that can be crossed, one way or another. You and your life are well worth it. There absolutely is a way to do this. If anything in your life is worth $10,000, this is it.

It's kind of a funny feeling talking about this to a moderator of this forum, because I know that you know all these things, and you knew them for years before the lap band was even a glimmer in my eye. But I still feel compelled to speak up because you are talking about facing a life without the lap band. WRONG ANSWER. You and your life are worth the $10,000. This is a no brainer.

[Alexandra 55]

I just need a few hours or days to process this, and once I get the denial letter in the mail I will have a better handle on my next move. I've appealed insurance denials in the past and prevailed, so I am inclined to give that one more try. The last time I did that I was a trailblazer, and I know my experience helped others in this state have their bands covered. So perhaps that's my path again, to fight this and win in order to help carriers see it as a treatment for a chronic condition, not a "cure" that can be abandoned once a certain goal is reached.

Mark, you are of course absolutely right. And I will also be exploring the costs. If they truly would be limited to $10,000 that's doable, but I live in Northern New Jersey where hospital costs are astronomical. (Mexico is just not something I'd consider, since I have such good physicians so close at hand.) But I know my doctors will work with me and it is indeed possible that the cash cost would be manageable. So there's that.

Right now I'm very disappointed and trying not to show it. Most of my work colleagues know nothing about this rollercoaster, and I'd like to keep it that way. I'll spill all over you, my REAL support system.

[Alexandra 55]

Most of my work colleagues know nothing about this rollercoaster, and I'd like to keep it that way.

:myscared: This'll be hard--just now I was talking with someone about a client that has the word "landscape" in its name, and I said "lapband" instead. This is going to be a loooooong day.

[METALBAND 0]

Alexandra......I am sooo sorry to hear that you got denied! From reading your posts and seeing what kind of a person you are, I feel confident that you will be banded, one way or another!!!

Insurance companies are totally clueless....keep trying and maybe they will finally get it, if not try bribery!

Good luck from a fan of yours....

Maureen

[socalgal3 4]

I am so sorry the appeal was denied. Keep fighting! We are all sending good vibes your way that the insurance realizes this is a replacement and therefore necessary. I can only imagine the frustration and disappointment, but you really seem so strong and I know whatever happens will be for the best in the end. Maybe your dream was prophetic....you are able to have a meal instead of surgery! Hang in there!

[Iluvharleys 15]

Awwww, Alex I am so sorry. I always say "where there's a will, there's a way" and I believe you'll find one. Good Luck!