kkandrod

Thanks Becky, I really appreciate it!! I am having the at home Co2 test thingy done here soon to see if I have sleep apnea. If I don't, from what I'm understaning, appealing without an official co-morbidity on their list is useless. So, I would be down to self-pay and I truly don't think my husband will go for that. We have alot of things going and are about to try and build an RV park on our land that we have in the northern part of the parish to take advantage of all the oil/gas and pipeline traffic that's in the area so we can't afford to do anything right now. But, who knows, the Lord may provide in an amazing way with that and I could do it later. So, we'll just see what happens with the sleep test and go from there. It will all work out and if it doesn't then I'll know it wasn't in God's plan for me and I'll just have to suck it up and try and lose weight on my own....again, lol. But I know the Lord can help me with that too so my feelings on the whole weight loss subject are alot better now than they were yesterday, for sure. Thanks for the support y'all!!! God bless ya!! Krystal

So is the following the standard response to the question of how to get an appeal together to the insurance ppl at a surgeon's office? Here is her response to my last email asking that very question: "Well, unfortunately, we don't unless your high cholesterol gets worse or is not controlled after you start taking medication for it. Which will mean, you will have to take your medication for a month, go back and have labs drawn, have your physician adjust medication accordingly and repeat the labs in another 4 - 6 weeks and it still not be under control by then, only then can i show a "life threatening" co morbidity." If this is the norm then I won't be aggravated but I guess I just thought they would be a little more willing to help. I mean, she never even said sorry or how bout we help you with financing for cash pay or anything. Just that I was denied and why in the first email and then this when I asked about appealing. I'm a little disappointed :-(

Ok, so I got a denial today from UHC because of BMI below 40 and no life threatening co-morbidities. SO, here's what I have going on and would love some successful appeal'ers to please help me know where to start and what to do with this info: Lower back pain due to all excess weight being in front abdominal area Hip pain from the same thing Knee pain PCOS putting me at higher risk of diabetes, heart stuff and other things and the excess abdominal fat making those risks even higher Cholesteral trending higher but not on meds yet Diagnosed Reflux & Ulcer I also have symptoms of sleep apnea but no sleep study done so I guess I should ask my PCP to order that for me if he will. Ok, where do I go from here appeal'ers????? Thanks in advance!!!

Well, I got my answer this afternoon. It's denied. I'm gonna start a new thread for it. I believe in miracles and I know that He can give me favor with an appeal approval or provide the funds for me to pay to have this done. First step is appeal. Keep me in your prayers for this if ya don't mind slebme :-)

I haven't posted in awhile so I wanted to let all of you who are newly sleeved and about to get sleeved that I'm thinking of you all and praying for you. I don't feel like I have much to offer on most of the threads since I don''t know what I'm talking about yet, LOL. But, I am on here several times a day reading and learning. Anyway, point is, just wanted to let y'all know that there's someone out there praying for you and learning from you! Still no word on insurance approval for me :-( It's been a week and a day since it's all been submitted. Just trying to keep the faith and trying not to take it out of God's hands. There's a part of me that wants to say so badly "forget the insurance, just finance it and self pay" but then my spirit says "hold on, let God do His thing with this and it will all work out" so I'm going with the latter :-) But it's soooooooooo hard, lol. Anyway, y'all keep on truckin'!! I'm so excited for all of you!!! God Bless! Krystal

Hey there! You have been on my mind so I'm glad you posted an update. Bless your heart, you have been through it haven't you! I'm so glad that you are on the mend and the problem causer is now gone and you can get on with healing and life with less and less pain!! I have to go for a Hidascan on the 14th. Not looking forward to that. But, Dr. Merriman's office knows about it being ordered by my PCP so they are all over wanting me to call them if I end up having to have my gallbladder removed so he can do the surgery for me, LOL Still no word on approval from UHC. Tomorrow will be a week since it's been submitted. Say a prayer for me! I pray the Lord just places His healing hand on you and that each day you wake up you are surprised at how good you feel!! Take care of yourself!! Krystal

Thanks MlkPas and Warrior for posting that link! I think that will help a lot of us!! I didn't find anywhere in there either where the money had to be spent in the US to be deductible so hopefully that works out for Gary!! I think that deduction is awesome for those that had to self pay!!

Not necessarily, Warrior. If he went to Mexico, that could be a whole different ballgame. Not knocking the Mexico surgeons because I don't have any knowledge on them so this is just a question....Have they ever turned someone away from surgery because it wasn't "medically necessary"? If they have certain criteria that have to be met before they'll consider doing surgery on you then, it might be ok. But, then you still have the whole "out of country" issue to figure out on if that's allowable or not. When I called my mom to ask her, I got the number details but then she had to run out before she had a chance to dig around and find out about having medical procedures out of the country and if they still counted or not. And remember, you can't take medical expenses alone. You have to have the other deductions to qualify you to itemize period, only then do you get to take the amount of the medical expenses that are over the 7.5% of your AGI. But, mileage is in there too somewhere. I'll have to ask about that, if medical mileage can only be taken if you are able to take medical expenses or if you get to take that regardless if you are filing long form. I know one year we had a tremendous amount of out of pocket medical expenses that we took and just the mileage alone got us hundreds of $$$'s in deductions because all of our doctors were 2 hours away with many, many visits that year. That was a rough year in itself so getting to take those deductions helped our feelings in a major way.

Gary, my mom does taxes/bookeeping and for medical expenses, doctor ordered, you can take whatever the amount of the expenses are that are above 7.5% of your Adjusted Gross Income. And you have to be able to itemize, which means you have to have enough other deductions that amount to more than your standard deductions you are given on a 1040 form. So if you have that, and the surgery is doctor ordered and your medical expenses are more than 7.5% than your adjusted gross income, then you can take it. For instance, you earn $100,000 AGI this year. 7.5% of that would be $7,500. Whatever your cost for medical expenses alone are ABOVE the $7,500 is the deduction you get to take. Hope that makes sense, LOL

Hey girl. Just wanted you to know that I'm praying for your healing and thinking of you! Keep faith, rest and take care of yourself. You know your body better than anyone so when you don't feel right you keep speaking up. Keep us updated, I know all of us here are waiting anxiously for your next post letting us know you are good to go!

Well, she informed me today that my cholesteral had to be life threatening and it be shown in medical records were I was put on medication so either she isn't willing to go the extra mile for me or UHC is great about approving but has a very short list of accepted co-morbitities.

Cool Carla, thanks for that info! Do you know if UHC told you anything about joint pain stuff? I'm keeping faith!! My God is a God of miracles! Watched my little boy be healed of meningitis last school year in the hospital right in front of me with no meds in him (I say that so ppl know that it wasn't anything he was given that made his neck loosen up, made him sit up and color and eat and laugh and know what he was saying), had just got in his quarantined ICU room! He can make me approved for surgery without any co-morbitities if it's His will Speaking of shorter, I've thought all my life I was like 5'7 or 5'7 & 1/2 but nope, turns out I'm 5'6, LOL So, that's already happening, heehee

I have lower back and hip probs and pain in my right knee but she said that couldn't count as a co-morbidity for me with UHC. Crazy huh.

@ the ankle weights thing. LOL! I would have to put 30 lbs of weights on my feet to do that, I could see myself weeble wobbling into that office, they'd be like "get her surgery STAT! She's got some major stuff goin' on!" lol

So, I just got an email from the insurance lady and she asked me where I got that I had to be on meds for high cholesterol for it to be counted as a co morbidity, LOL So, I emailed her back and told her that's what I had understood her to say and that I sure was hoping that I completely misunderstood her, LOL There may be hope yet!! :-)

And the only thing wrong with me that would help toward surgery is my bad cholesterol is 151 and she said it should be 100 or below and no meds needed. Just diet and exercise...hmmmmm. So yeah, not looking good on the co-morbidity front for insurance approval. But, I am thankful and praising God that I am healthy as far as that goes. It just aggravates me that according to the surgeon's insurance girl, some of the stuff I've seen other companies approve as co-morbitities won't fly with UHC. But, I absolutely refuse to purposely gain weight to get my BMI up 4 points. If it doesn't happen, I may hang out with y'all still and be a wanna be sleever and try and take some things from y'alls way of eating and such and try once again to do it without surgical help. Cuz I just plain ole like y'all!!

Congratulations!!! I talked with a doc in OK day before yesterday and he said that your doc and his partner were the best and most experienced in the state, that he was aware of. Sounds like you were in good hands!!! I've actually thought about contacting them myself if nothing happens with insurance with the doc I've chosen in Shreveport. Do you know if your docs down there will fight for you with the insurance companies? Take care of yourself! It's so great to hear you newly sleeved peeps doing so well right after!! God Bless! Krystal

So, I've been reading and was just reading the thread about the lady who thought her stomach was made too large because she could eat a whole sandwich. (I'm so sorry I've blanked on your name or I would have given you a proper shout out Anyway, in there someone made mention of the lady (another name I can't remember, I'm so sorry) who wound up having a pouch off to the side where food was just sitting there. So, that got me thinking about what the surgeon said yesterday about how he does the surgery and doesn't remove the stomach right up at the end/side of the esophagus. Instead he angles it out from the bottom of the stomach up so that the top of the staple line is still in stomach tissue out to the side at the top instead of into the esophagus. He said he does this to lessen the risk of leaks and strictures because there are only 2 layers of esophageal tissue and there are 3 layers of stomach tissue for the staples to hold onto. ANYWAY, I loved that idea, made me feel safer. But now I'm wondering if that would create that "pocket" type thing that the other lady suffered from. Because if you look at the anatomy pics of a stomach, the way this doc does it, there is a little area that goes up and out from the esophagus and that is what he leaves part of. Any input would be appreciated :-)

Praying for you 3/25 ladies!! Can't wait to hear updates!!

Thanks Lee! Grateful, ok, thanks. I'll ask next time I talk with them. I know there are conflicting opinions on that subject between doctors anyway and that there are pros and cons to oversewing same as not oversewing. How ya feelin'??? Hope you're doing lots better!!!

Wouldn't that be awesome Carla? I would love to have a sleeve twin!! LOL I was thinking on the 2 hour drive home from the doc, "wouldn't it be cool to walk in and have a message saying they've already approved me and to call them back so we can set up a date?" LOL But, that message was not waiting on me. Wonder how long it usually takes insurances to approve or deny something like this?

Thanks y'all!! Grateful Heart, do you know if Dr. Merriman oversews the staple line or not?

and boy is he secure in his abilities, LOL He's only done 100 sleeves, no leaks. He's done 1100 gastric bypass surgeries and 1300 lap bands. He uses a 34 or 36 bougie and he does not staple up to the esophagus. He angles the staple line off to the side so that no staples are in the esophageal tissue. I COMPLETELY forgot about asking if he oversewed the staple line or not. He does a leak test during surgery but not before you leave the hospital, not sure if I like that one. He keeps you 2 nights in regular care, not ICU and he's had no one need ICU in the last 17 years. He's not a "if tight is good, then tighter is better" type doc when it comes to the sleeve size and band tightness which did make me feel good. So, unless the bloodwork comes back today with something up on the TSH or Lipid profile I have no co-morbidities with a BMI of 36. Insurance gal said that she didn't think they would care about my infertility, PCOS, joint pain, back pain or stress incontinence. But, she was submitting it anyway with those things mentioned and we will appeal if it's denied. She said that I don't have to worry about the insurance company anymore, she's got it taken care of. So, now it's a waiting game and seeing what hoops have to be jumped through. Y'all have a blessed day! Krystal

I am a rep for a company that has 2 products that have been hugely beneficial for WLS with skin tightening and inch loss. But, I don't want to "advertise" here because that's not why I'm a member of this site so please feel free to PM me if you'd like info and my website. I was sooooo glad to see your post about being on the other side of your complications! Congratulations!!!

SOOO glad to hear you are doing better!!! Will I still be seeing you Wed. morning??? I'm super excited about finding out everything that day. Just praying that nothing happens with my insurance policy on the employer side before everything goes through for approval since the healthcare "reform" passed on Sunday.