Feeling Let Down: My first post

[affy 0]

I had finally convinced myself to push to be banded, as some of my relatives have really done well with it. My insurance company is Blue Cross and Blue Shield of Texas. I just found their policy regarding this:

3. Nonsurgical methods of weight reduction must have been unsuccessfully attempted for at least five years under physician supervision.

Oh, I have tried to lose the weight for much longer than five years, but have never had physician supervision. Heck, my doctor is very over-weight.

There is no way I can pay for this on my own....a school teacher just does not make enough. We have just adopted twin baby boys. I am totally in love with them, but am afraid I will not see them grow up, as my dad and uncle both died at relatively early ages...and I am heavier than either of them ever were.

I feel I am at a dead-end.

[Dianechef 3]

My insurance was also Blue Cross/Blue Shield & I was turned down as well. I chose to go to Mexico where I paid $9500 for the entire procedure & that included the hotel stay & everything. (Did not include airfare, but I got a $29 ticket on southwest!) I live in AZ. I know they finance if you need that. I felt VERY, VERY well cared for in Mexico & do not regret going there for a moment. I used Dr. Ortiz at www.obesitycontrolcenter.com

Your 2 little twin boys deserve a Mommy who is at her best!! How wonderful for you to adopt them!! I have 3 kids & besides wanting to be healthy for me, I knew I had to do this for them!! They need a Mom who is able to take care of them without huffing & puffing all the time.

Don't give up hope. I've heard of others who have fought the insurance & won. However, it's a long process. There are still lots of options. Keep your chin up!!

[banded_for_life 2]

Don't give up!!!! Have you been offically turned down by your insurance company. Have you talked to your Dr. about helping out with meeting the commitments. I was under a physician's care in another city 5 years ago and it was used. I am sorry if you have already done all of this...just throwing out suggestions...but don't give up! Keep fighting for your band.

Believe me I know what you are going through. 3 years ago, I was in the middle of trying to get my approval for my band and I lost my insurance and since I could not afford it..I just kept doing what I could and the second I could I got my approval.

[affy 0]

Thank you both. (By the way, I am the Daddy---not the Mommy.)

I do not have doctor records for any weight reduction plans. There is really nothing for me to pull from.

Unfortunately, last year I was hospitalized for a week for chest pains and high blood pressure. Heart attack, stroke, and diabetes hit my family line pretty hard. Two major back surgeries keep me from exercising as I should. Sorry, I am just feeling kinda down right now, as I had built myself up to pursue this, after being afraid of it for so long.

Thanks again for your support.

[affy 0]

My insurance was also Blue Cross/Blue Shield & I was turned down as well. I chose to go to Mexico where I paid $9500 for the entire procedure & that included the hotel stay & everything. (Did not include airfare, but I got a $29 ticket on southwest!) I live in AZ. I know they finance if you need that. I felt VERY, VERY well cared for in Mexico & do not regret going there for a moment. I used Dr. Ortiz at www.obesitycontrolcenter.com

Do you have to travel to Mexico for fill adjustments?

[Jessiebear 2]

No. There are many doctors in the states that will do the adjustments for Mexico patients. Hang in there & don't give up! We're here for you!

[Anwyn 0]

Have they actually submitted the paperwork to your insurance company, or is this a quote from your policy? You never know how they will interpret your individual case. You have 2+ comorbities and a family history. Do you have a family doctor? He may be willing to write a letter stating that you and he have been working on your weight problem.

Good luck, and don't give up! It may be a long road to approval, but you have to be tenacious!

[affy 0]

This is the policy. I have not submitted to them, yet. I will talk with my doctor.

[lady in red 0]

Hey new dad, don't give up and don't forget to pray, you're never alone in anything. My insurance is Blue Cross and last year they turned me down, we have private pay and there is a total exclusion for weight loss procedures. In May I ran into an old friend who had the band 18 months ago and was down almost 100lbs. I suddenly found excess motivation and was banded on Aug.29,2005 and am down 21lbs. My doctor uses Capital One Healthcare Finance Company and we were able to choose a 3,4,or 5 year loan. To me this was a gift from God, because my family suffers from the same health risks. This company does everything over the phone and it took less than 2 hours for an answer. Please don't give up, there are options.

Best of luck,

Rose of Texas

[La_madam 20]

My insurance was also Blue Cross/Blue Shield & I was turned down as well. I chose to go to Mexico where I paid $9500 for the entire procedure & that included the hotel stay & everything.

I too went to Mexico and used Dr .Ortiz afer Blue Cross/ Blue Shield turned me down.

I was able to finance some of my surgery, I paid cash for most of it but financed 2000 of it, Do not igve up! When there is a will , there is a way.

[Bensmum1109 0]

I agree, don't give up!! Finance or borrow against your 401K if you have to. You can get filled locally and I hear there are some really good surgeons in Mexico.

Good luck!

[Guest j. lynn]

If you've seen a doctor yearly for 5 years, then you might be fine. Heck, all you can do is submit for approval and document the heck out of it and give it a whirl. Most women have seen a doctor at least once a year.

jayme

[jqpublic 1]

Im truly sorry to hear about your problem! You could try it on your own,its truly a hard road to fallow! I have three kids and a great wife. I did it on my own it is challenge every day for the past ten months I walk and drink lots of Water.

I averrage about 14 hours a week to exercising.I talked with my family and told them I no you have needs To,but dad has to make time for me to get healthy so I, can be here for you later.....I Just do it there are days I don,t want to but I just have to do it I don,t want to be fat any more and unhealthy. That is just my thought for me!

please keep me posted on how you are doing,I,ll try help any way I can. It can be done,and it will take time.

[CandySmooch 0]

Don't give up so soon!! There are ways - people are here to help. I had to self pay w/ Dr. Sanchez in Monterrey MX for $7900 - everything included except airfare. www.ready4achange.com if you care to take a gander. It was more like a vacation than surgery in a foreign country. I'm 24 y/o - went alone and it was my first surgery. There are ways for you and if its meant to be then God will find a way for you. Be patient it may take some time - start seeing a Dr. and getting it documented now even if the worst scenario is having to wait 5 years to get approval - better get on it now.

[WannaBeHealthy 0]

hi! I know exactly how you feel. I too was denied, by Healthnet. They wanted 6 months of a physican supervised diet. and although my doctor recommends me for the procedure and have two years of notes - they are not in 6 month consecutive format. I sobbed when I heard about the denial. I really thought that the band was the only way that I was going to save my life.

Since I was denied, I found an attorney who specialized in cases where insurance has denied WLS. I sent him all the notes from the doctor and surgeon and hope to hear that he is able to get the denial overturned.

No one around me truly understands how I feel. My mom is thrilled because she was scared about the procedure. ANother friend has decided to race me and is losing weight on Optifast. another friend gave me a lecture about being a survivor. Yet, no one truly understands how intense the decision is and how upsetting it can be to have insurance in the way.