Band removal approved; bypass denied!

[Bobbe Schu 53]

I'm so depressed! Don't I deserve a 2nd chance? The removal of my band was approved but the bypass denied. So if I have the band removed, I'll gain a bunch of weight and then where will I be? I've already gained 11 pounds just since all of the Fluid was removed from the band. I am beside myself. I don't have the kind of money to self-pay. Should I fight this? I'm told I need 6 month weight loss documentation -- but the only thing I have are invoices from Nutrisystem where I tried them for 2 months approximately 6 months ago. Will that qualify? I just don't know what to do. Any advice?

[India928 81]

You absolutely deserve a second chance! and a third, or fourth if needed. food addiction is no joke, it is so difficult to tackle on our own. My suggestions: 1- definitely do NOT give up! 2-Talk to your primary care provider and see if he can write you a letter of support, indicating any comorbidities you may have that could be attributed to being overweight. 3- Certainly Nutrisystem documentation counts! Worth a try in any regard. 4- if you need six months of documentation, start now. Go as far back as you can. If possible see your PCP and have monthly appointments with them so they can progress note it. 5- See if you can get a therapist on board as well. They now the impact of obesity on self esteem and mental status. I am certain they too can write you a letter of support indicating the negative implications being overweight is having on you.

DO NOT GIVE UP!! YOU ARE DESERVING.

[losing_the_band 133]

If you haven't yet, have your doctor to a peer-to-peer appeal on your behalf. In many cases, especially revisions, insurance companies will try to deny revisions unless you fight for them. My band-to-bypass was denied a couple of times, even though I jumped through all of their hoops, because they said that I hadn't proved that the band had a technical malfunction (I had severe acid reflux and couldn't tolerate any Fluid in the band at all, but apparently that didn't count, lol) and couldn't prove that I had been compliant with diet and exercise (I had been, but had to switch surgeons three times when I moved to new states, so I didn't have records). I finally asked my surgeon to do a peer-to-peer appeal, and was approved the same day.

[Bobbe Schu 53]

If you haven't yet, have your doctor to a peer-to-peer appeal on your behalf. In many cases, especially revisions, insurance companies will try to deny revisions unless you fight for them. My band-to-bypass was denied a couple of times, even though I jumped through all of their hoops, because they said that I hadn't proved that the band had a technical malfunction (I had severe acid reflux and couldn't tolerate any Fluid in the band at all, but apparently that didn't count, lol) and couldn't prove that I had been compliant with diet and exercise (I had been, but had to switch surgeons three times when I moved to new states, so I didn't have records). I finally asked my surgeon to do a peer-to-peer appeal, and was approved the same day.

I did have a peer to peer which is when they approved removal of band but not the revision. So I hired an advocate and they are working on the appeal. It just seems like it's taking such a long time and I'm so very discouraged! Confident, but discouraged. I've now developed high blood pressure and feel like absolute crap! Trying so hard to be patient but just want this over with! I know in the long run the wait will be worth it, but for now I'm a mess!