joyaskins34

No I have jut changed the way I am eating and hitting the gym hard everyday...I just am @ a point where I don't know what to do ..I'm just so discouraged ...thank u ladies for checking;-)

I had to submit 3 times and it finally went through...took them almost a YEAR!!!! I had every piece of paper from my doctor/hospital to send to them plus my C-PAP documentation....NEVER GIVE UP!!! By any chance is it Tricare? Good luck' date=' and God Bless You![/quote']

No I have blue cross blue shield alabama

The problem is that my bmi was 38.something for 3 years prior..no other comorbids besides sleep apnea which has to be a score of 50 mine was 25 something...but required Cpap?..so blue cross is saying there is NO way to get it approved..

Unless someone knows a way around this they won't approve....and from what I have been told there is no way :/

How exciting about the date;-) girl I know about the knots I still have them:/ praying that u get great news Monday!

Thank u mami

Hey Joy' date=' have you considered self pay? I am in a similar situation and have opted to go to costa rica. I have been there for other surgeries in the past. The doctors are fantastic. And the price is 8500. financing is also available. I am going this august for my GBP.

Just something to consider.[/quote']

The prob with that is the hubby& to be honest I would b scared to do that... Hubby would flip @ that thought of me going out of the country for surgeryt!!if insurance paid for it he was semi ok with the thought because he had no say really but to just pay out right no.. All tho he did say he would pay for any nips tucks I wanted... He is not a huge fan of RNY!!

I am going to call & write ... Let me know what she says..when I called I a Strong sense of dread so I can relate!! Lemme know!!

Joy our hearts go out to you but I would encourage you to not give up. Have you discussed options with both your surgeon and your primary care physician? Insurance companies follow a protocol which is really nothing more than a checklist. A lot of folks have been denied only to be approved after some fine tuning in the information submitted to the insurance company. Most insurance companies will approve rny for folks with a BMI of 35 or greater and two co-morbidities. You mentioned sleep apnea. Hypertension' date=' type 2 diabetes, cardiac, some forms of arthritis and/or osteoporosis are just some of the possibilities. Keep trying! Never give up! If they want a fight, give 'em one! You will find the "right formula" and once you're approved, it's illegal for the insurance company to back out. We all can appreciate your frustration but tough situations never last. Tough people do![/quote']

Thank u DL I am overall healthy despite needing to loose 100 pounds.. So there for I have no other comorbids.. for that I am thankful .my sleep apnea score was moderate to severe but not scored high enough ..it needed to be 50 or greater...so now I am pondering calling them ..as far as doc is concerned I am a tall 5'8 if only I was 5'7 there would be no concerns I'd been approved :/ I suppose they wanna wait til I have another issue heck I don't know lol! I'm just frustrated and let down ..but all of your kind words sure are uplifting!

Prayers to you! Good luck on what the future holds. I know this is probably going to seem silly' date=' but I wouldn't give up! I would keep appealing. Sometimes insurance co.'s just want to see if you give up. What do you have to lose? Right? I would write a letter indicating the struggles and impact the weight puts on your life, anything! I've seen people get denied more than once then get approval the third time. Good luck hun.

Surgery date: May 14, 2013[/quote']

Thank u;-) I def.am thinking about writing an appeal myself. I just am trying to process everything in my mind ..and figure out where to go from here ..thank u again!

Well Margaret mentioned on fri he would talk to medical director but I guess since she received the reason for the denial he won't now? ..I said to her "so is this it? Nothing else I can do" and she said" no I am so sorry I know it disheartening" she was very sweet but at the time nothing was comforting

Yes was denied yesterday again because my sleep apnea wasn't scored high enough even tho its moderate to severe..my bmi was not consistently 40 for 3 years( it was 38-40)

So this forum will no longer apply to me..I am devasted heartsick and just hurt .I just want to say thanks for all the sweet words and good luck to everyone!

I will say a prayer for you. I sure hope Dr P can work his magic.

Earlier in the day' date=' I got a call from miss Margaret and I am in a bit of a pickle too. Tricare wants 2 months of Physician supervised diet. Five different Tricare Reps told me there is no such requirement anymore.

Well, now I don't have that, because none of my PCM's ever offered me such an option. I would just get the regular diet and exercise speech.

It starting to hit me hard, right now.[/quote']

Well I was denied a second time yesterday because my bmi was not consistently 40 for 3 (was like 38 -40)years..even tho I have sleep apnea which is moderate to severe..it wasn't scored high enough to be considered a comorbid...so I guess I will no longer need this forum..I am to say the least devasted...they assured me I would qualify ..so 6 months and a lot of money paid outta pocket to get to where I thought I needed to be I am back to square one and deeply saddened , and just sick! Good luck to u girls in your journey to health and happiness in your own skin!!

For 6 long months I have stalked this forum and have messaged back and forth to several sweet ppl.Friday I was denied approval for surgery ..yesterday denied again because they said my Bmi wasn't consistently @ least 40 for past 3 years.. it was like 38 ..even tho I have severe to moderate sleep apnea my "score " was not a 50 on sleep study.so my hopes and dreams of having this surgery, changing my life& trying to love the skin I am in were washed.so to all the sweet supportive ppl on this forum thank u! Unfortunately this forum will no longer apply to this girl ..sad sad but happy for all of u who will have and have had the surgery to get your life back.

Well I have sleep apnea... They said that they didn't need my medication list that if I had sleep apnea it would automatically approve for surgery.

That's basically what bcbs requirements say but still had to send them in..they just wanna make it hard for ppl in hopes of giving up

Yes I had to have 3 years worth of med records..and when Margaret submitted mine they denied me on Friday because they said that wasn't included in what she submitted ..her response was yes it was...they said my bmi was not high enough during 3 years..she said she has sleep apnea!!! They said mail in hard copies..they would re-review so now I wait! She said if they deny again DrP will talk to medical director and hopefully that wil get approval..but hoping the approve second appeal! ..so hoping praying they will approve this time! I'm stressing OUT!!!i Ha!! Never been told I'm not "fat"enough! :/

Me too. :hi5

How close are u 2 surgery?

Mine gives a decision within minutes of the cooridnator filing I have Bc/Bs alabama

Music I def am letting them do their jobs;-) I just was extremely disappointed.as far as the life style change I have been walking /running for the past 2 weeks and have lost 12 pounds...my problem is I have trouble keeping it off..however I already feel better & that is a great motivator in itself..I can't wait til the mornings for my walk&run...don't exactly love it while I'm doing it but afterwards I feel great...

Also thank u for the encouraging words

I would look at it another way - you said your coordinator and surgeon will take care of things. Trust in their office because it sounds like the doc believes this is right for you. So keep the faith and let them do their jobs. In the meantime focus on eating right and exercise. Start making the life style changes now.

Oh and prayers will be said for you! I know it is hard and frustrating to hurry up and wait' date=' but we have ALL been there![/quote']

Music I def am letting them do their jobs;-) I just was extremely disappointed.as far as the life style change I have been walking /running for the past 2 weeks and have lost 12 pounds...my problem is I have trouble keeping it off..however I already feel better & that is a great motivator in itself..I can't wait til the mornings for my walk&run...don't exactly love it while I'm doing it but afterwards I feel great...

Thanks ladies I'm not giving up ????

Sometimes this happens it will all work out there's little Angel watching over and knows what needs to be done and just pray cause you have lots of prayer behind you on this site

Thank u I have prayed thru this whole journey that His will be done in my life .The selfish part of me just hopes this is part of His plan for my life

You are right this site is full of wonderfully supportive folks! Ty!

Thank u Debbie! I somewhat expected it I don't know why ..I guess I figured this process wouldn't be easy for approval ...but I am praying it will get approved..I just want so badly to be happy with myself & healthy!!!

I know I probably shouldn't be asking this but Anyone who is a believer& prays .. I need it ! Today I spoke with my surgery coordinator she submitted all my info for surgery approval and minutes later they denied!! Because they said I didn't meet qualifications from last 3 years bmi

She said she had no idea why they did this because that wasn't true I did! Also I have sleep apnea that requires Cpap ..they told her to mail in my paperwork and they would review it...she said if they deny again the surgeon would speak to medical director on my behalf..I need for then to approve this request this time..I so have my hopes up and want this so badly! I feel selfish for whining about this but I am so broken hearted and depressed! :...(

Thank you so much' date=' I'm getting anxious and nervous.[/quote']

Good luck!!!!

I've met the mental health lady and love her! She has a great sense of humor. Unfortunately my insurance is requiring a licensed psychologist to do a full psych eval and she said she can't do it. So I have an appointment with someone I don't know. This is only requirement my insurance has so I can't really complain too much!

Looks like when you go in I'll be a week or two out. Can't wait to know my date for sure though!

Boo on the full psych but yay on that being only requirement!!! Keep me posted!

Got so excited by your other reply that I didn't see this one! Pennington did the seminar that I went to and I loved him.. he seemed so sweet! The pysch eval is the last thing my insurance is requiring and Margaret told me that my insurance doesn't take long for approval either. Yay for a surgery buddy!

Haha I just did the same thing!! Lol yay I'm excited also ..6 months I've searched for someone in my area!! Can't wait to hear how things go for u..u must let me know when u et a date!!