#1 Worry-Stop Thinking Just DO IT

[Bright 9]

Oh christina, that's awful - I really hope you fight it and get your band!!

Thinking of you xx

[I'llsucceed 1]

The Blue Cross/Bull S*** network denied me, too. The wouldn't pay 15 grand for the band but they paid over 30 grand for my port removal. Brilliant.

I also asked what if I pay for it on my own? If I have a complication will I be covered or will it be considered a pre-existing condition. The lady said that I have a NO- pre-existing phase in my coverage & that sure I would be covered.LOLOLO Just not for the initial surgery>> Oh MY Gosh.. that really is just mixed up- so I understand Delarla.

Thanks Zoe for the tips & thnks everyone else-Patty,Betty,Sharon,Jamie(you lucky gal you)Marie, Bright & anyone else I forgot!

I'm sticken to this liquid phase no matter what-Also just got off the phone w/my Mom(I love my mommy;0) & she said fight like heck but in the end keep my date & somehow we would work it out! She is the GREATEST! But OUI!! the pressure. she really can pack it on... saying-"well you made your decision & as long as you'll go through with it & do it & follow the rules-we will figure out how to pay for it" I'm not ungrateful don't get me wrong, just she can pack on the pressure in a manner that stiffels me(always could). But maybe she is the drill sergeant that I need;0) Good thing I don't have your guys phone #s-you all would have taking them off the hooks by now! Thanks for listening.

[paula 4]

Christina, Im with Marie... FIGHT it! They gave you specifics for denial, thats a good thing. How about your diet pills? Who prescribed those to you? Get that MD to write or fax something to them.

My PCP wrote a letter to my ins. stating that he 'assisted' me on several failed diets (which was a lie).

You have a good chance of winning this. Honestly, you do!

[coyotegirl 3]

FIGHT GIRL FIGHT!!!!!! I will pray for you. Keep your chin up (your fist also). My Mom is a drill sergeant also. When I am eating around her she always ask " are you taking small bites are you chewing it good?" Jeez mom I am 41. Moms, gotta love um!!

[HarleyNana 10]

I don't know what's worse knowing from the get go that the band is not even a consideration as far as insurance goes as was my case or getting your hopes up and finding out you're denied.

My mom has been told she'd probably be covered, then she was told she wouldn't be, then she was told there was a chance they might cover part, then she was told she was denied, now they're back to the maybe again. She doesn't have bc/bs, she has mailhanlrs and medicare. Good luck

[coyotegirl 3]

Pat, I have medicare and had no problems at all.

[HarleyNana 10]

Terri, I may have said the wrong one, I always get medicare and medicaid mixed up, which one's for the retirees? Thanks

[coyotegirl 3]

Medicare is for retirees. I have Medicare because I have a physical disability not because I'm old.

[Alexandra 55]

Christina, I so can relate to your rollercoaster. I went around and around with my insurer for 9 months before winning on external appeal. But I won, and you will too.

You have three specific reasons for denial and have already addressed one of them. The BMI thing will just take another letter from your doctor, maybe mentioning two or three co-morbidities that you have and maybe just weren't included in the first letter. And the other thing is just a matter of time, if you can't put together notes from the last two years detailing a physician-supervised plan. Start it now and re-apply in six months, and you'll have it.

I know six months sounds like a very long time, but if insurance is the only way it can be done it's well worth the wait. But I think a couple of well-worded letters from your PCP, your surgeon, and maybe an OB/GYN that you may have seen in the last couple of years could turn the tables on you. This sounds like a routine appeal they are likely to overturn themselves if pushed a little.

You were NOT told it wasn't covered, so you're in great shape there. This is just a small obstacle to be gotten around, and you will do it I'm sure. I know we don't have to say don't give up.

[I'llsucceed 1]

Christina, Im with Marie... FIGHT it! They gave you specifics for denial, thats a good thing. How about your diet pills? Who prescribed those to you? Get that MD to write or fax something to them.

My PCP wrote a letter to my ins. stating that he 'assisted' me on several failed diets (which was a lie).

You have a good chance of winning this. Honestly, you do!

Thanks Paula- but they already have all those letters. They were in the orginal documents. Plus receipts from gyms & other diet centers. All 27 attempts fully documented except for diets like cabbage Soup & slim fast ext...

I'll keep trying for a bit but thanI don't think I will wait long & will have to be self-pay. Its to tough emotionally to be on hold for me.

[Feel2Young2B40 0]

Hi Christina! Is your company self-insured? I know mine is and the process seemed to go rather quickly. I wonder if you are self-insured if going to the HR department would help and speaking to a manager. I've read many people have been successful in reversing the decision when this is the case. Just a thought....

Also, I'm in mourning about food. You touched a nerve when I read your post and I felt compelled to say I HEAR YA! You couldn't have said it better or closer to how I feel. It's funny how much of our life growing up revolved around food. I remember all family get togethers and food being the binding ingredient. You begin to associate love (for your family) with food. I gained all my weight back after moving down to Texas and I believe it's mostly because I miss my family in Illinois.

Very few people in my family are overweight (and thank goodness my kids aren't!). My sister is a size 2 and a recovered bulimic and exercise fanatic. Funny how we are both so very different but suffer the same obstacle - FOOD. Bottom line, I love food, the taste, the smell, the time spent cooking and eating that I'm going to miss - to some extent. However, I know in the end all will be for the best - going ahead with the band. Of that I am sure.

The other thing I am confident of is you. From what I've seen of your postings I know you will succeed in the approval process. You're name says it all! You are a confident, successful and motivated lady. Take care and the best to you. Laura

[DeniseG 3]

Although I wouldn't recommend it, my husband gained weight on purpose to get his BMI from 39 to 40, where it would be for approval. You may not be approved for 6 months, but, start keeping a log with your psychian now as to diets tried. My insurance at the time John Deere, didn't need psychian approval diets, although, I had been on Nutri-System 5 years prior. Try to get your psychian to right a letter about other health issues as to why you need the band ex....sleep apnea, high blood pressure, high cholesterol, high history of family heart disease/diabetes, arthritis, joint issues, skin rashes due to excess skin etc. The more things the better.

[PFernandez 0]

I understand your anguish after a denial. but you have already made the decision to be banded and become healthy so keep fighting...If at first you don't succeed try and try again.... we will be here to support you 100%.........

Alwyas here if you need to talk...

Pat

[princess_n_thep 2]

Christina,

SOOOOOOO sorry to hear about the denial! I know you were really counting on it and all the "signs" were going so well! Just know that everything happens for a reason and what doesn't kill ya makes you STRONGERRRRRR! Fight them!

I am also a "cusp BMI" at 5'8 1/2" and 221 with a 35 BMI (and rising also). I went throught the process but was denied quickly and swiftly and told to re submit when I gain 40 more pounds or so. HUHHHHH??? I was like... heck with it, I am going to Mexico, paying myself (about the cost of a used car) and be done with it. no more headaches, no more worries, no more stress. For me it was worth it.

But I would LOVEEEEEE to see someone fight and win against the insurance companies that are constantly screwing us over anyways! So, YOU GO GIRL... FIGHT FIGHT FIGHT!

(but just in case, is paying yourself an option? if so, you may want to start doing your research on self pay docs now!)

GOOD LUCK GIRLIE! I know everything will come out well for you!

Maybe is this a "sign" to go with the TV show???

Jenna

[I'llsucceed 1]

joint issues, skin rashes due to excess skin etc. The more things the better.

Good one Denise & Alex!! I forgot that I do have documented stuff over several yrs on rashes & diets from my GYN. I will be driving there tomorrow & have her write a letter. Thank you.

The BMI thing I just don't get - but ask My PCP tomorrow. It was 39 when the paperwork went in & is 40 now so??? Jenna- thanks for the encouragement as well- I will try my best "sales pitch" this next week w/no stone unturned. I just won't let the fight go more than a month or so. I would rather self-pay & deal with it later. I need to get moving on with my life-social & work wise.

LAURA- good suggestion but unfrotuately I am self-employeed & wear all the hats, but I'll have a talk with myself just in case I come up w/something-LOL:0)

Thanks everyone & good nite- Tomorrow is another day & one never knows.