Approved.. I think

[june09bandit 0]

Hi all! I've been reading all ya'lls words of wisdom, and I've learned a lot. I figured it was time to introduce myself and give some background.

I screwed up my knee last year, and it's not much better after one surgery. The ortho keeps telling me it's arthritis and it won't get any better. I'm only 44. The only thing that will help me (until eventual knee replacement) is to lose weight. I found myself angry with the ortho, so I scheduled an appt with my PCP to get referred to another ortho. I had to wait a few days to get in with PCP, but while I was waiting, I did some soul searching and decided that I should try to lose weight first.

Sounds good until you know that I can't exercise much because of the knee. So my weight just kept going up. I decided to discuss lap band with my PCP (3/2). He agreed that it was worth a shot and gave me a referral to a bariatric surgeon.

Got in to see the surgeon a couple of weeks later (3/19). He looked at my stats - declared that I'm not heavy enough - BMI was not 40. Dammit. Lucky for me I took my insurance papers with me (along with 5 years of medical records), so I showed him insurance allows for BMI of 35 with co-morbity (knee is comorbidity). He didn't think it was going to work, but he was willing to try. He told me the rest of the requirements and sent me on my way. He billed insurance for over $900 for this 5 minute consult.

Scheduled myself to see the psychologist the following week (3/23). She agreed that I was ideal candidate, so I checked off another block. Now I just needed the letter of medical necessity from PCP. I called them, they whipped out a letter and sent it to the bariatric guy. Now they have everything they need to submit it (4/6). I had been in constant contact with insurance company (Heath Net) and knew they processed stuff quickly. I called the doc's office to find out submittal date. ARGH - they don't submit to the insurance company, they submit to another company that prepares the submittal (4/13)(with a 6-8 week lead time).

Depressed now, because knee hurts and walking is getting harder every day - and now they expect me to wait another 6 weeks?:sad:. Eat more, gain more weight, knee hurts worse. You get the picture. I was totally deflated inside.

Today, the doc's office calls me and tells me that the third party company has made the submittal to insurance. Right away, I called insurance and she said she has an authorization with an admit date of 5/13.

Now to me, this felt like at least a year's wait. Now that I'm typing it, I realize it was less than one month from consult to approval. Now I have to get that admit date changed, hopefully sooner. I leave for Mexico on 5/16 and I'm sure it's a bad idea to leave the country 3 days after surgery.

That's my story up till now! Hopefully I can move to the post-op forum soon! Good luck to you all in your journey!

[OnTheWay to Thin 0]

Dont get discouraged, I am 48 and my knees are the reason why I have looked into and will do the lap band. I have arthritis in both, but my right one is especially bad, I now have to have 3 synvisc shots in my knee every 6 mos (1 week apart) or so and the last ones were terrible, could not walk for a couple of days after each one. I am in the process of this too and you actually did remarkably well for time frame, many people have to go through a 6-9 mos process. I would love to know how you do so keep me posted.

[K8_MA 0]

I def can relate to you with the knee problem. I am 23 y.o and had 2 knee surgeries 5 yrs ago from a field hockey accident in highschool. I have arthritis in my right knee at the age of 23! It can get depressing not being able to do much cardio at the gym or walk long distances without my knee throbbing. The ortho and my PCP told me that losing weight will help my knee. So I am hoping that the Lap band will allow me to walk and run again. Good luck with every thing and congratulations!!

[june09bandit 0]

Thank you for your replies. We all have more in common than we ever realize. I was just starting to look into the synivisc injections. Maybe I'll reconsider based on this new information.

I injured my knee in Jan 08 when one my horses (the goober that he is) tripped and fell and the two of together landed on my knee - this represents about 1500 pounds. My knee didn't take it very well. It's been hurting almost all the time since then.

Do either of you have your dates yet? Thanks again for the support! I needed it!

[OnTheWay to Thin 0]

I dont have a date yet, I see the surgeon next week. On the synvisc shots they really do help, once you get past the trauma of the shots that is. I have been having them for 3 years and only twice have they flared up after the shots. A flare up is when there is so much swelling that the nerves get compressed that is what caused me all the issue this time. But as time goes on the knee continues to deteriorate, I will need a full knee replacement eventually but they cannot do that if you weigh over 200lbs, so I am stuck between a rock and hard spot as I am definately over that. So I dont want to be cripple some day so here I am, pretty strong motivation to find a way to lose weight, let me tell you. If you decide to go with the shots I do have some words of advice, have them late in the day when you can go home and put your leg up. If you can have the day after off so that you can ice them and take it easy if you do have swelling. I have had this done 6 times or so and 2 times had issues, the other 4 were pretty ok. However, it relieves the pain and makes walking much easier for several months. You still have to watch what you do and not over do but it is a big help. Let me know how you do and hopefully I will be having sg soon too.

[june09bandit 0]

I finally got the call from the surgeon's office. The insurance DID approve the surgery. Now I have the pre-op appointment scheduled for tomorrow! I guess it's easy to see I'm very impatient. I'm so happy!:thumbup:

[june09bandit 0]

And now I have a surgery date - June 2!!! I can't wait!