Awaiting approval - BCBS. Feeling discouraged.

[gebbiabn 34]

I am definitely feeling a bit discouraged right now. I've had the gastric band since January 2011. Since the very beginning, I've had the throwing up/regurgitating. It doesn't matter what I eat, can be chicken, tuna, green Beans, raw veggies, bread, even Water sometimes. I've been compliant and have doctors records. I've had fills and un-fills, I've been on exercise plans, and made good food choices. When I have my band tighter and have any restriction at all, I'm throwing up 2-3+ times per day. My current surgeon (not the one who did the surgery) also said according to the X-ray with the barium swallow, my band is slightly higher than it should be, but not technically "out of place".

They had to loosen my band about 2-2.5 months ago (again.. So I only have maybe 2cc in my band) and since then, I've gained about 15-20lbs back. My HW 300, SW 290, LW 230, and CW 270, and I'm 5'5". My surgeon said he'd do everything he can to help me get approved. I've done the nutrition class again and the psych evaluation. They submitted to insurance yesterday, and the RN said I should hear back within 2-3 weeks if I'm approved or not.

But I've been reading A LOT of stories of people being denied for revision unless there is a serious complication with the band. I have BCBSNC. The insurance company that originally paid for my gastric band surgery was Tricare Prime, by Dr. William Richards in Mobile, Alabama.

I just feel like the band has taken up so much of my life.. I've had it almost five very long years. I've regretted every moment I've had it. It's been hell and I wished I'd have went with the bypass from the beginning

[TristanNicole 169]

Unfortunately I've also read alot of the same, people being approved for removal but not for revision to sleeve or bypass. But as i also have read you can't give up, if you are denied it sounds like you have a very supportive surgeons office who will be able to help you appeal and possibly even do a peer to peer review. Stay positive though, you never know, they could call you with an approval!

[gebbiabn 34]

Thank you! I'm trying to keep in positive spirits, but I just want this dang thing out!! Lol

[dancingqueene 182]

APPEAL APPEAL APPEAL.... if you are denied you have every right to appeal up to 3x w/ BCBS and most of the time they will take the appeal b/c they know you are willing to fight for it!! Get your PCP and bariatric surgeon to help w/ that process IF you are denied!! I wish you the very best I am fighting w/ BCBS now for my bypass (not a revision though) !!!

Sending positive thoughts!!

[Cupcake 801]

I agree with the above statements if they deny you appeal it have your doctor write a letter as well as you write a letter detailing your struggles as well as all the changes that you have gone through to be healthy good luck.

[gebbiabn 34]

The appeal process sounds so scary to me! But my surgeon told me getting an approval for revision is very tricky. He said if I were going for an initial surgery for bypass, that he'd already have me approved.

Years ago when I was trying to get approved for the band with Tricare, my surgeon sent the paperwork in on Thursday, and I had an approval Monday morning. It was easy. I didn't have to do the psych eval or any kind of 3-6 month diet program. I did the nutrition class, heart and lung testing, and that's it. I started the process in August 2010, approval at the end of October, he wanted to schedule my surgery for December 19 but I was going to be traveling 14 hours in a car 4 days after that, so it didn't make sense. So we rescheduled it to January 20, 2011.

[dancingqueene 182]

It may be scary but it's so worth it in the end. You don't want all the hard work and weight you have lost to go to waste or come back either. Some things are truly worth fighting hard for. I've been battling insurance for 4+ years and I will fight this time as well, as now it's a need not so much a want! Don't give up girl!!

[gebbiabn 34]

I just called BCBS. They received my medical file/case yesterday. The lady said it takes up to 72 hours for a decision to be made. If the nurse has any questions about it, then it'll be sent up to a medical director which could take 7 days longer. She said my doctor put Oct. 19 as the surgery date.... I was like WHAT?!!! The lady said it could be a "dummy date" but she said, or my surgeon could be shooting for that date. I'm so nervous. This is nerve-racking!! ????????

[dancingqueene 182]

Breathe sweetie!!!! You got this!!! And appealing isn't all bad... And it usually works !!! I'm

Pulling for you!!

[gebbiabn 34]

Thank you for the support and encouragement!! Fingers crossed!

[dancingqueene 182]

Any news yet?? I just got my approval for surgery on Friday!!

[gebbiabn 34]

That's amazing!! I'm so happy for you!

I haven't heard anything yet. Helen told me this past Wednesday that I should hear from her by Monday or Tuesday as to what they're going to do. She said she'll keep me posted. It's so hard just waiting.. And waiting.. :/

[dancingqueene 182]

I'm thinking about you!! Keep positive thoughts!!

[gebbiabn 34]

Thank you!! and thank you for following up with me. It's definitely nice to have support and know you aren't alone in all of this.

[dancingqueene 182]

Message me and let me know how you do!!