Very Discouraged (graphic in a spot, might not want to read)

ready_2_live · November 12, 2008

First off I would like to apologize for writing in a sad tone. I don't really have people around me I can talk to, so I guess I'm venting a little here.

I haven't come here in a long time because it looks like my surgery won't be approved. I have a sleep study to do and my husband, who has apnea, says he knows I don't have apnea.

I really do understand that Medicare wants one comorbidity, and it isn't like I want to "wish" a comorbidity on myself, but there is so much shortness of breath, knee pain, and fatigue with me and I know it is due to the weight. I know something is going on with my breathing. I hurt on my left side at the heart every single day, so I guess I should ask them to go into more detail checking it, but isn't that like I'm wanting or asking for a comorbidity?

Maybe God doesn't want me to have this surgery and maybe I am trying to push it on myself or "make" it seem like He wants me to have it. I know I "really" want the surgery so much.

Ever since I realized I was probably not going to be qualified, I started trying again to lose. I lost 4 pounds then gained 5 back then lost 4 more and am steady at over 250 lbs...SO discouraged.

Please don't worry or think I'm being stupid, because I won't do anything like this, but I have dreams that I just stop eating or that I cut off my stomach fat. I know it sounds gross, and I'm so sorry - it's funny because you "want" to be healthy, I mean it isn't like I want to walk in to the doctor's office and hear anything about me having a comorbitidy, but I know in my heart I have at least one because this weight is getting out of control.

Okay I think I have spouted off too much and repeated too much. I know I sound like a baby right now. I'm just at a crossroads and sick of being this big. I'm sick of hurting when I get up, sit down, roll over in bed, try to be active..etc....

Okay I'll hush up now. I just ask for prayers. I know there are more important things than some fat redheaded woman who wants to be thin. I'm sorry to waste anyone's time. God bless, and please just pray.

-Donna

lapbandtalker · November 12, 2008

Getting someone else to pay for the band is often a discouraging process. Many have smooth sailing while others feel like they are jumping through flaming hoops over and over.

Keep this between your doctor and you. Your hubby and others are there for support ONLY. Let your doctor guide you through the process.

If, and that's an if, you hit a brick wall and get a 'no' from your insurance, appeal it.

But remember, you can always select a doctor on your own and just find some way to pay for it yourself. Many of us have to do that. We wouldn't let an insurance company (or lack thereof) stop us.

Hang in and hang on! Keep us posted on how things are going for you in this process.

MellyB · November 12, 2008

I was denied twice. Both times it was because all of the info wasn't sent in. Finally on the 3rd try I sent it in myself, very explicitly explaining how and why I met the criteria. I got my approval within 2 weeks, and that was only because the person handling my appeal was on vacation the first week.

Don't give up. Take every test they want you to take, do everything that you are able to do to make it happen. Write the insurance company a letter, a personal letter explaining to them why this is so important. Go to your primary care physician and get a letter from them. Back up you claims with written proof. Send in things that they aren't even asking for, anything that could possibly help your cause.

Good luck to you!

aubrie · November 12, 2008

I got denied initially as well. It took me 11 months to get an approval. BUT I didn't give up. I went to my heart doctor ( I have a little valve that doesn't close all the way and leaks) and had him do tests. Explained what I wanted to do, and he said he would be HAPPY to write me a letter in support of what I was doing becuasue the excess weight put a strain on my heart and it was already stressed from the valve. I went to my rhuemetologist and told her what I wanted to do. She supported it to and also wrote a letter. I had arthritis in my knees and the weight was agravating the condition. I had the sleep study, and although I didn't have apenea, I did snore so loudly that I woke myself up and interrupted my sleep cycles. They felt that weight loss would improve that. It was written in the report at my request. So..... don't give up. Meet with your doctors and have them help you. Mine were more than happy to help.

tapshoes · November 12, 2008

You have received excellent advice from the other posters. Take each and every test, document everything you can think of, check and double check and triple check on each and every document that all the info is there (trust me, someone wasn't approved because the full name wasn't on 1 of the zillion forms). Your doc does not want you to be overweight, so he/she will (or should be willing to ) help you identify each possible condition of which you are borderline or have or are heading to.

Do not let your husbands opinion dissuade you, do not give up until the final ultimate appeal to the last insurance company says no, and then, find the money and do it self-pay if you have to.

We have been there. We understand