synicalchick

HOOORAH FOR YOU TOo! V. EXCITING!

HOORAH AND CONGRATS! I AM SO EXCITED AND HAPPY FOR YOU!!!

I'm still in the fighting the insurance phase.

hugs!

Tracy/Synicalchick

Can someone out there tell me that has self paid, but kept fighting the insurance and won.. how that works? do you get reimbursed?

I got my 1st denial and we are now in the 1st appeal process. My DH is telling me that if in a week or two that haven't approved it he wants us to go ahead and self pay... keep fighting the insurance and get reimbursed. Is there anyone out there that has done this? How do they reimburse you? Does the insurance company pay you or the hosiptal???

Thanks

Viewed online 'seminar' 1/3

Appt to discuss Psych eval results 1/15

got letter from BCBSof TN that I'm not fat enough to qualify for the procedure (summerized by myself of course) 1/30 the day before my 37th bday.

Starting appeal process 1/31.. my 37th bday

Well, I got my friggin insurance letter today from BCBS of TN saying that .. and I quote " Based on the information received and teh terms of your health benefit plan, we determined that the requested service is not medically necessary." Even though I had prepared myself for this.. it's still irritating. Let's review.."not medically neccessary" shall we.

• I'll be 37 tomorrow
  
• I weigh 334
  
• BMI 54
  
• I walk down the hallway and I'm out of breath and exhausted
  
• Family medical history.. diabetes both sides. HIGH LDL both sides. Father/grandfather quadruple bypass surgeries at 51 & 58. High blood pressure both sides, gall bladder problems, cancer & obesity.
  
• chiropracter visits every two weeks for lower back pain
  
• carpal tunnel aggravated by weight.
  
• been over 200 for 15 years
  
• been over 250 for 10 years
  
• been over 300 for 5 years...Hmmm I see a pattern here folks.

Gee.. I'm starting to see what they mean.. medically necessary.. PSHHH I'm healthy as a HORSE...and the size of one two... IDIOTS.

Anywho. going to talk to my surgeon tomorrow about my options, see if they'll contact the lawyers that represent the lap band people and take it from there.

URGH.. all this waiting and not knowing if I'll be approved. sigh

My DH and I have planned my 'last steak dinner' trip for the weend following V.day in Gatlinburg, TN. One of our favorite spots. it's only about a 3 hour drive from here. Is it sad that we have planned a trip based on me eating one last large steak dinner... hmmmm

ANYwho. tick tick tick tick tick

T

I'm a nervous wreck.. Dr. Morton's office just called and they faxed all of my paperwork (over 400 pages) to BCBS. They said it would be 2-4 weeks before we know something. They also said with the food journal included (which accounts for the bulk of the pages) I would be hard to turn down, however, I'm trying REAL hard not to get my hopes up. If I can just mentally count on being denied then I'll be pleasantly surprised right? Ugh.

My old doctor FINALLY found all of my past paperwork and faxed it in. I went there 3 weeks ago to sign a release form and finally go them yetserday. I'm going to call Dr. Morton on Monday or later this afternoon to see if they have everything now. My current dr is supposed to send in a 4 page form for BCBS and she is fixing to go on maternity leave so I'm hoping she got it done before she left.

I'm feeling pretty good right now. My session down town went REALLY well(psyche eval). He was very impressed with my research and in fact said that I was by far one of the most educated about the lap band procedure before and post surgery that he had tested and talked to. He feels that I am an extremely good candidate. the tests summary was basically "Tracy is a very warm and friendly person who tends to bend over backwards for others and likes for everyone to get along. She also has a good head on her shoulders. Im' pegged as suffering with very mild depression brought on strictly by my weight and not feeling well.

So.. NOW, he writes up a report and a letter of recommendation, faxes that in to Dr. Morton, then assuming they have all the paper they need, they will fax to BCBS of TN then we sit and wait, then wait some more.. then.. well, wait some more.

heeheeheeheehee

{{{hugs}}}

The pre surg liquid diet is the part I'm the most worried about. don't know how I'm going to do it.

Tracy/Synicalchick

Man.. worn out today. Went to work then left to go to my general dr. to get her letter of recommendation. Dr. Morton is v. convienantly across the hall from my general Dr. so i stopped by there to give them my food/exercise journal for 2006 and my personal letter to the insurance company. She gave me the phone number to the RN that I will be dealing with the most. I gave her a call and she went over the stuff I provided. She said that BCBS is VERY persnickety:huytsao and she wants me to have every single little thing before we turn anything in. She likes the letter I got from my therapist but knows that they will want an actual Psych test done and gave me a couple of numbers. I called one, drove down town, and took the test. Two different paper test at least 20 pages each. True/False, then False SomewhatTrue, Mostly True and Very true. HOLY MOLY :omg: FOLKS. the questions on there. do you hear voices.. do you see people no one else sees, headaches? is the world against you? have you ever dreamed of writing a good bye letter to your friends if you were going to die, do you feel as though you are more than one person? WOW:guess ANYwho.... I finished turned them in, then scheduled an appointment for 1/15 to see if I'm crazy :der:or not so everything is on hold until then.:ermm I was just really glad to be out of there:bolt:

:faint: Holy freakin crap. Had my consultation today. My BMI is......54 how the geebbies am I even walking around???:omg: ANYwho... I'm hitting them with TONS of paper. I have been food journaling on caloriesperhour.com since jan of 06/ I have printed up every freakin' page and put it in a note book, have the three pages from my therapist recommending the procedure, a typed up page of my family Medical history ( THAT my friends.. was a HUGE Eye opener:eek: ) My company considers any and everything to do with Weight loss to be.... are you ready... COSMETIC:kiss2: That's right folks... the fact that I'm 329 isn't a health matter... gosh no.. it's a matter of just wanting to look spankin hot in a tootoo I guess.:flame:

this site is, to put it mildly.. FANTASTIC:clap2: I have learned more in the past two nights sitting in front of my computer :typing: reading post for about four hours a night Than I have in the four years I have been wanting to have this procedure done.

Please, if there is anyone out there that is about my height and that started about my weight and you are almost at goal.... What happens to your skin. I feel kind of vain asking.. but I am really SCARED of the floppy skin thing. I'm going to be 37 at the end of the month so I am no spring chicken here.:flypig: em em.. cough... yes folks.. I do realize that this is a flying horse and NOT in fact... a spring chicken.. but well, i didn't feel like searching for one. The second and possibly the MOST important question I have is... uh.. well some string of post mentioned bbq tongs... WTH? WHY? What? What this a joke? Can someone explain?:cry

Peace out,

Apple crisp aka Synicalchick(Tracy)

My 1st consult was today. Went pretty well. Oddly enough, the Dr. I'm using is two doors down from my regular Dr. I have to have a letter of recommendation from my reg Dr. so I'm going to see her tomorrow. I have been Fjournaling for 2006 on www.caloriesperhour.com and I have printed up all of it and will be turning that in as well.

:help:

Well, I'm gearing up for the fight of my life. I'm 36, will be 37 Jan 31st. for the past 15 years I've been over 200. The past 10 years I've been over 250 and the past 5 over 300. I think I need to get of this ride.

I love food. I love to eat. I don't eat as much junk as one would assume a person of my size would eat, but what I do eat.. I eat a lot of. I consider myself a quantity eater... even if it's salad. I've been following this procedure for about 4 years now but my insurance at work excluded anything to do with weight loss specifically. Last year they added another company as an option. 7 other woman in the company went with the new one offered (BCBS of TN) and even thought the procedure is still excluded by the company, they went in, were denied once, fought it and won.

I'm scared and nervous all at once. Of course going through my head is, what if they decide that they aren't going to accept any in '07? I am prepared to fight them tooth and nail this time. I went in for it 3 yrs ago, was denied and just cried for 3 weeks instead of fighting.

In preperation for it, I have gone to a therapist and gotten a recommendation from them, I am requesting my maternal and paternal medical history, going to my doctor to get my past 5 year medical history and I've been food journaling for the 1st 9 months of 2006. My numbers are great when I have a physical ever year which means I'm going to have to fight extra hard.

I have an appointment with my regular Dr. to start the process on Jan 3rd. She will have to refer me to the Lap Band Doctor I will be using.

wish me luck

Tracy:messenger3: