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?

[armywife79 123]

YES!! I had the SAME exact thing happen! I hired an AMAZING obesity advocate group who is nationally known by all insurance carriers. They operate out of CA and the main advocate in a post op patient himself who not only fights our legal battles but travels the country educating the doctors and staff about how to best get us approved the first go round or how to fight if not! Don't worry about money, they will work any payments you can afford. for me, they worked almost six months and it only cost 600.00 and they broke that up over all six months! They spoke to me weekly just about, and they WON MY CASE! We went up against Tri care on a second denial! I am now 68 lbs off since pre op and so greatful! They are called LIndstrom Obesity Advocates, # 877-992-7732. I had to live without my band for over a YEAR! DON'T GIVE UP HOPE! Call them and let them help you, they win tons of cases every year for people like us, help is out there, don't let the insurance companies win without a good fight! Let me know if you ever want to talk, I know just how you feel right now but, believe me, with them, you have a great shot! GOOD LUCK!

[Bobbe Schu 53]

OMG OMG OMG -- I'VE JUST BEEN RESEARCHING THEM ON THE INTERNET!!!!!!!!!!!!!! You are wonderful -- your advice is just what I needed to help me make my decision. Thank you armywife79 for the advice. You're an angel in diguise.

[armywife79 123]

I'm so glad I could share my experience with you and that it may help you with yours! These people not only help us but, are actively working to change insurance legislation to end the discrimination that makes it so very hard for the obese to be treated medically. If you or I had a heart valve that needed replacement would they hesitate??? NO! However, obesity IS a recognized disease and yet, these insurance companies are allowed to exclude coverage, deny procedures or revisions based on almost no medical evidence! Most of the time they don't even have doctors reviewing our cases! That is why we need to fight back and stop taking no for an answer. We pay our premiums in good faith and shouldn't be denied life saving surgical intervention! Tell Lindstrom You were referred by Heather Budd, and I wish you all the luck in the world! You are in a much better spot than I was since your band is still in place, it's easier to get a revision at that point. I feel good about your chances! Keep in touch!

[TristanNicole 169]

Can you do a 6 month supervised weight loss and be approved? That is what I'm currently doing right now, if thats all you need to do I think it would be worth it. And nutrisystem invoices don't count, I was on nutrisystem for probably 7-8 months and I asked about it and they said I had to have formal "weigh ins" like what they do at weight watchers.

[Bobbe Schu 53]

I contacted Lindstrom Obesity Advocates and we're good to go!!! I feel like I have a chance after speaking with Kelly!!!! So much I didn't know!! When I email my info in the morning, I will definitely mention your name!!!!

Edited May 21, 2015 by Mrs. Schu

[Bobbe Schu 53]

Oh Heather--I feel like I've made a new friend!!!! AND that I have an excellent chance of getting my revision paid for now that I have a knowledgable advocate! I'm so glad this forum was available so I could locate this help! I will keep you informed.

[richie0927 1]

I just went through the same thing with blue cross. My Dr. Appealed the denial 3x and I just got approved. My Dr worked real hard for me and it work. I'm having my bypass on July 13 2015.

[richie0927 1]

Does anyone know if my pain meds will work with my bypass surgery? I have had 5 back surgeries and must take pain meds to live my life. If anyone can give me a answer that would be great.

[gz345ski 3]

I was on pain meds in the hospital and I was sent home with a prescription for pain meds with one refill so it shouldn't be a problem.

[Pinkpeonies1 87]

I wish I had the advocates info sooner. I was denied 3 times last year after having my band removed. The doctors office didn't do much, they just claimed the insurance co has the last word. I had to do all appeals on my own without any luck. Finally changed medical groups, not insurance and got approved. Only thing is I had to start from scratch with classes, documentation, doctors visits etc. Took me 6 months but I'm in, having bypass August 4th.

[betrthnever 107]

This post is a real inspiration!! I see my Dr on 8/18 about a revision (again) and I fealty they won't fight for me. Pink you just changed drs and it worked?

[Pinkpeonies1 87]

I changed medical group (therefore yes, dr too). I still have blue cross but switched my medical plan from St Jude to Bright.

I did have to start from scratch though, dr visits, documented nutrition classes, everything!

[Pinkgirl1234 761]

Bobbe what is the update did you appeal

???

[betrthnever 107]

Bobbe what is the update did you appeal

???

Been wondering the same thing!!