Prwk submitted for insurance approval - Send me all the positive energy you can spare

[Candle 11]

Please cross your fingers for me and send me all the positive energy you can spare.

My doctor's office submitted to the insurance company today and assigned me a surgery date of 8/27/07.

I started this process in Jan and found out I had an exclusion on my policy. I switched insurance companies to a policy that supposedly covers WLS. (All they will say is: they will approve if medically necessary)

I figure I've spent about $1,900.00 in co-pays and pre-op testing. ($30 co-pay each visit + $250 each for shrink & nutrition + $500 co-pay for the endoscopy) I've been to about 23 doctor appointments in the last 6 months. (with the 2 sleep studies + 6 month diet + etc )

I'm prepared to self pay if I have to but I'll probably go off the deep end before then. - lol. I'm still blow away by all the TIME and MONEY I have had to invest in this so far. I’m kind of wishing I’d just done self pay back in Jan. *sigh*

Please wish me luck!

[sharon2u 0]

wow I cannot believe you had to pay out all that money so far. I ahve paid out let me see 200.00 these are co payments only everything else is included in with the surgery, the pre op, etc. My surgery will run around 17,000 oh plus I have to pay the 150.00 co pay for the hospital but all very well worth it

[Candle 11]

YOU can't believe it - I can't believe it - lol

The $500 co-pay for the endoscopy really blind sided me. I was not told I would have to pay that. I guess it's my insurance company's co-pay for out-patient surgical proceedure - ugh!

It sucks my co-pay is $30.00 per visit too!

I also wasn't expecting $100.00 for the CPAP machine - which I'll never use.

[juliegeraci 7]

Candle, I am sending my positive thoughts your way. Everything will be okay. Good luck.

[sharon2u 0]

Ouch is right you poor gal you. I don't have to worry about the apnea thing but I might have to have that nasty upper gi GI sure hope not but it could be worse I guess. The Doc asked me if I ever had to have a tube down my throat well I said no but the only tube I remember is the one they stick down you during surgery called a breathing tube. Who is your Insurnce company? I have firstcare it is a federal employee plan and generally they approve all federal employee plans from what I was told.

[Walter 0]

Good luck! But if you're denied, be sure to have the doc submit you for an Application into the Allergan appeals program....it costs you ZERO and we can help you get approved if GHI (as they sometimes are) is a "jerk."

[Candle 11]

What is the Allergan appeals program??

[Walter 0]

For the past couple of years our office has been contracted by the manufacturer to handle certain types of LAP-BAND denials. Pretty much any kind of denial other than a direct contract exclusion is eligible. An application is obtained by your surgeon, filled out by you and submitted to us. There is no fee to you. We've gotten hundreds of LAP-BANDs approved through this and encourage you to consider that option before shelling out your hard earned money on a cash pay or financing alternative. Just a thought.

Good luck!

[Candle 11]

Thanks Walter - I'll drop you a note if I have any problems. (let's hope I don't have to send that message - lol)

[valzie 0]

Good luck to you Candle. I am in the same situation you are so I can relate. My Dr. sent everything to the insurance company on Friday and I have a date of Aug. 13th as long as approved. I will say a prayer for you. I'll let you know if I hear anything. Please do the same when you get word.

Walter thank you for the heads up. Like Candle I hope it wont have to come to that.

[pmmegm 0]

Candle.....Don't sweat the paperwork........I had to stay on top of both my insurance company and my doctor's office. I kept notes of everyone I talked to, what they said and the date of our conversation. Took me a few weeks to realize I should have heard SOMETHING! Once I started making calls it was AMAZING how fast I had a result. (mine was positive, surgery is scheduled for Aug 23) The fact you have a surgery date could be positive.....your doctor must feel confident about it?

About the cpap.....why not wear it? I have one and wanted to encourage you to try to get iyours on. It isn't the funnest thing I've ever worn, but it sure does make a difference in my moods & engery level. I thought I was depressed for the last 5 yrs....found out I just wasn't getting any REM sleep and it was killing me.

[Candle 11]

Thanks for the words of encouragement.

re CPAP: I've had it for almost a week and I've tried to use it every night. I use the ramp button but I always wake up within an hour or two all wrapped up in the hose, with the mask off my face.

I'm a stomach sleeper and I think I just toss around and rip it off.

If for nothing else, I was hoping it would help condition me to sleep on my back. I know after surgery, sleeping on my stomach won't be an option for a long time.

I think it really bothers me too because I have to read or watch TV to fall asleep and I can't do either of those without my glasses … which I can’t wear because of the stupid mask.

This CPAP thing has kind of put me into this weird depression the past few days. I know I didn’t get this heavy over night but the reality of the state of my health and the size of my body and all the related problems is freaking me out. I’m really disgusted with myself. How did I let myself get to this point?

[pmmegm 0]

okay.........wearing the cpap with glasses can be a challenge, I need them to watch tv as well. Being that you're a stomach sleeper doesn't help, but don't give up! It really will make a difference in your life! I had to change masks after about a month....I didn't even know I could do that. There were never any options given to me at the time that I was "fitted" for my machine. Perhaps you could try another mask? I can wear my glasses with my new mask (I've now had it for about 9 mos) Let the CPAP work for you......and perhaps after surgery you can say good bye to it forever!.....I'm hoping I can.

[valzie 0]

Good advise Pmmegm! Candle I dont have a CPAP but I can imagine how difficult it would be to get used to. Hang in there. As far as the shape and the condition of your body...Well we are all with you and understand. It is depressing but you are doing something about it and that is what you need to focus on right now. My thoughts and prayers are with you...chin up!

Val

[Candle 11]

I'm approved!!! I'm approved!!! I'm approved!!!

:whoo::whoo::whoo::whoo::whoo::whoo: