helleva

Thank you very much I will definitely kkeep you guys posted!

positive vibes going your way with prayers! I'm waiting too.. 2nd time trying

I hope we get approved too!! it would make life so much better thank you for the positive energy! my waiting game begins once more

thank you so very much!

update: I now have to get my gallbladder removed.. my paper work was resubmitted today.. I'm hoping my insurance approves me that way I can do both things at once.. hoping and praying.. trying to keep positive and not think of it as much as last time please wish me luck! denise

Aww.. I know your situation.. I have loss weight just about 100 pounds too.. and gained it back.. loss 10-20 pounds after that and gained it all back too.. I think the sleeve is a great idea for us my kids and hubby feel the same as your wife.. but I'm sure they will stand by our sides with our final decision

wow! that's really great news glad you got approved.. you must be so excited?!

haha! like that one Chrissy! I just took a cholesterol test and it was fine. I have sleep apnea, GERD, and had gestational diabetes with my last baby who is a year old now. thank you

thank you I think I'll call my coordinator this afternoon to ask.. hopefully, it helps my situation!

hi, I was denied during my first attempt to get approved for the sleeve. My bmi was just below 40. I have been over weight most of my life and of course I lose weight (not much) & gain it right back. So, my question is.. can my surgeon update my bmi to 40 since I've gained weight before my coordinator files my appeal? If possible, will it help? thanks much, denise

sorry if you were denied. I was too. I have blue shield of california. I have a bmi of 38 & sleep apnea. do you know if our bmi reaches 40 can our surgeon office change it before they file the appeal?

p.s. thank you for keeping us updated! denise

aww.. that would have been nice.. but I'm sure you'll get approved & before you know it you'll be on your way! keep me posted.. I'm going to my doctor (wednesday) that I was going to for 10 yrs. except the past year. I'm hoping since he was the one who recommended the lapband to me that he'll write me a letter of recommendation for the sleeve. He knows my struggles.. hopefully two doctors pushing my surgery will make sense for my insurance to give me my approval for a healthier longer life

thanks again SV2

hey, yes, that sounds very reassuring of an approval I'm sure you can't wait!! I'm hanging in there. It's just so hard because I have doubts. I feel like I'm going to be denied again. wishful thinking I guess.. more of expecting the worse and hoping for the best My friend just got approved for surgery. It only took a couple of days. She has a high bmi and sleep apnea.

Hi, I really hope it works for the both of us. Lord knows how much I need it! I called my coordinator and they stated its now an open appeal and they're communicating with my insurance company so, they can get the proper paper work in. They don't want to get another denial. Thanks denise

Aww.. its so nerve wrecking to sit and wait! I hope they make it up to you by approving you thats the very least they can do.. please keep us posted I just called blue shield to check the appeal and the rep. stated there has been no appeal or even a peer to peer?! :/ I am so confused and I'm going to call my coordinator after work to explain this to me. thanks, denise

Thanks, I'm confused a bit because my denial letter states I was denied because something like "its not medical necessary due to comorbilities have not failed with medical treatment". I'm not sure what is going on. My coordinator said everything will be okay but I'm so worried that I will be denied again. thanks for sharing and I hope everything works out for you after the 6 month diet. denise

Hi, So today I called my docs office to see how the peer to peer went. They told me that the peer to peer was not approved on the spot because my insurance needed more paperwork. Now, my docs office is going through with an appeal. Can anyone please tell me your experience with the appeal? How long did it take? What was the outcome? How did you get notified? thanks, denise

Hi, Oh gosh! I had the same problem and I freaked out. The claim is not a bill. I called my insurance company and they said I did owe the amount for the 1st sleep study which was $3800. So then I called the sleep study center and they insured me I wouldn't owe that much. I was still unsure about the whole situation until I got the actual bill in the mail. I ended up owing $230 and my insurance paid about $340. It was such a relief hope this is the same situation your in. P.s. I have the cpap now and I hate it. I too always wake up to find its off my face and wonder how? And when? Lol.. just hope to get use to it because my insurance I monitoring it with a memory card in the machine.

Formely fluffy, Good looking out I am surely going to look in the foundation! You never know they might just be able to help me thanks so much for the link!

ValdostaGA, Thanks for understanding my pain and frustration. I will be on top of my coordinator and insurance. A foundation would be awesome. Good idea <3 I see that our friend has found a link to one. If my insurance fails me I will look into it as well. I will fight to the end. Thanks for your prayer because in the end it is in gods hands <3

thanks mmoral, that's a great idea. but my only problem is that I've been walking everyday because i thought i was gonna get approved. i read that losing some weight before surgey is a great idea to shrink the liver and so forth. If i am weighed again i will be even less (about 8 pounds) I'm so stressed! haha! maybe i should sew some weights into my waist band?! jk. i just wish my insurance would see the benefits of granting me the sleeve. better, longer life for me & less money for them to spend later!

thank you Formely FLuffy, I will definitely look into the info you gave me. THanks Bubbaloo10, I hope that it was my coordinators fault. I was working with this one lady the whole time and just before my paperwork submission she left to have surgery and was out for two weeks. She left the paperwork to be submitted by another lady. I'm hoping my original coordinator will be back this week so that she can over look it and re-submit to my insurance. Thanks Minat, I was reading about GERD and how it can be linked to obesity. I asked my coordinator if I was diagnosed with GERD could it possibly help my chances of getting approved. She did state that anything at this point will help. I thought it would be an easy decision because of all of the above ^^ but my insurance company seems to think differently. I'm assuming they believe I don't have cormorbidities that my father has yet.. and when I do get them (which i am at my weight) that i will no longer be their problem and another insurance company's problem. thanks Likesulema, oh do i hear you! I am so frustrated. I really thought i'd be approved first time around. I just like I'm sure many have struggled my whole life with obesity. I don't care to wear a bikini and look like a model. I just want to live a healthy life and live long enough to raise my 1 year old and possibly see my grandkids one day. I hope and pray that my insurance will approve my surgery with the peer to peer or the appeal. Thank you for the compliment of donating my kidney to my dad. but it wasn't a choice.. it was a must.. I NEED him I greatly appreciate all of your responses and information in trying to help my situation all you great folks really help ME and you give me so much hope reading your success stories from insurance to your new life after the sleeve! Denise

I have received my letter of denial today. It states the a Medical director has reviewed my request and has denied it because "The documentation does not demonstrate significant obesity-related complications (comorbidities) which have failed to be controlled with medical management." I am really disappointed. My coordinator swore i would be approved because I had gestational diabetes, i have one kidney due to donating it to my father who has diabetes, kidney failure, rhinoplasty (spelled wrong but he can go blind from diabetes), high blood pressure, quadruple bypass, and some, and I was diagnosed with sleep apnea. I am so scared because all diets have failed even though i try so hard. I have three beautiful little girls, ages 14, 11, and 1 and i fear that i am following my dads footsteps. I talked to the coordinator and she states i should have been approved. She states although the sleep study was included in the paperwork that my doctor did not note it in his letter. He did not state that i had Sleep Apnea and now use the CPAP machine. I hope this is why i didn't get approved. My coordinator is going to try and set up a peer to peer review. If this does not work she is going to try an appeal. I have made a doctor's appointment this Tuesday with primary because i believe that I also have GERD (have all the symptoms).. Do you know if GERD can help me get approved if i do have it? What if I ask my primary to write me a letter of recommendation? or ask my last doctor who I went to for ten years to write me a letter of my struggles of weight? I am looking at Obesity all my life (bmi just under 40), gestational diabetes, mild case of sleep apnea, possibly GERD, one kidney, and family history of diabetes, arthritis, high blood pressure, kidney failure. thanks fpr your help and support, Denise