mama angela

The company I work for just got bought and they are looking at layoffs .. so right now they are saying I should not take the time off work..especially. since I just did that for the last 6 months....

Well...I am filing an expedited appeal. The initial guidelines do not state that I have to meet with a doc. So..I have a letter to insurance..the initial guidelines ....the referral from my doc to the medically supervised wls program....a letter from my doc mid way staring that she was informed of my progress...the notes from 6 month program....a copy of my sleep apnea report and the severness of lit with notes that I am obese and need to lose weight and that it would be helpful....a file notes from my orthopedic surgeon..last Oct when he specifically recommended that I get also. Hopefully that will all help

Thanks. The nutritionist and physical therapist are on contract with the doctors office. I work a lot of 12 hour days...5 days a week. Right now I can't juggle my job around taking time off every month for another 6 months to go to doc/nutritionist meetings... It was hard to get that approval the first time from work.....

I am so mad at the weight loss team! grrrr....I kept asking "are you sure I don't need to meet with my doctor too?" and they saying no, since she referred me and that this is how they have done it in the past.... 8-( Man....I so wanted to have this done by now...

thanks....I just received all the weight management teams notes, the doctors referral.... It looks like insurance is saying that I had to meet with the doctor everyone of those 6 months. I met with her initially and she referred me to the weight management team - whom I met with. I just got off the phone with my doctors office and they are saying that insurance will not budge - that I will have to start over and meet with my doc each month and the weight management team.

Thanks! The nurse here at work wants me to file and expideted (Sp?!) appeal. She said I need to get hold of the doctor and the team (nurse, nutritionist and physical therapist) and have a copy of all their files and then resubmit with the appeal. I'm going to see if I can get all that paperwork together and try that. I'm told we have an insurance liasion - so if the appeal doesn't work I can try that. I can't believe what a hassle this is. I am WAY overweight...have been for years. I've tried Weight Watchers, Atkins, South Beach, Diet pills, Medifast, HCG...you name it. I also have high blood pressure, sleep apnea, high cholesterol, and type 2 diabetics.....arthritis in my knees...etc. You would think insurance would do anything possible to help me get this weight off.

Okay...so an update. My doc had to go out of town for 2 weeks for an emergency...but she called the insurance yesterday...and they are still denying! The nurse (I am in a program - the surgeon, nurse, nutritionist, physical therapist and my doc)...anyways, the nurse just emailed me this morning saying the insurance will not budge. They are saying I can start over and meet iwth my doc once a month and the nutrionist and physical therapist!!!!! I already did that - except meeting with my doc because the nurse was giving her the notes from my meetings. UGGHHHH... i feel sick to my stomach. The nurse here at work wants me to get the denial letter and she wants to send it to our insurance liasion...so I will try that...but I'm so discouraged. I had wanted to have this done by mid May.

Congrats!!!! You can do it!!!

Thanks Steph04. I didn't go back into my doc every month after my meetings with the others. I asked if I should and they reassured me that I didn't need to that they were filling in the doc on appointments. My doctor has said she will appeal it - the insurance agreed to do a peer to peer review with her. I'm not sure what that means...but it sounds like that will be another 2 weeks out. I've debated on calling the insurance company and asking them...but I don't want to mess up my doctors chances. ughhhh....and I'm so NOT a patient person.

That is so true!!! I have a friend...who is thin/normal. I keep remembering from one time when we were talking. She said she didn't understand how people could eat a whole bag of chips or cookies or.... She said it is meant to be a SNACK and the servicing size says ">>>"...why would people eat more? Hmmm...never dawned on me to eat the serving size. I asked her if it filled her up...she said no...but it's enough. Goes to show how my thinking has been off...

I'm sad ...my nurse coordinator just emailed me that my insurance is denying your claim because my Dr did not see me monthly during the weight loss visits. (I met with the nurse, physical therapist and a nutrionist). My Dr signed giving her consent and knowledge of these visits, but the insurance is saying that is not good enough. They have, however, consented to a peer-to-peer review with my Dr. Has anyone else had something similar? I'm so upset about this...I was hoping to have surgery on the 30th....

Thank you! It just really caught me off guard as I thought we had all my "ducks in a row".

Thank you! I will be checking this out tonight! I have seen some YouTube success stories that have been very helpful.

Bandashoop! I love that idea!! A place with the tips compiled... I know...first off to call my doc...but it would help to have a general guideline of tips. I love the "drinking a glass of water" for head hunger. That is always so hard for me to remember.

Congrats to both of you!!! How exciting!!!! I'm waiting to hear for my approval...I have my throat scope next wedneday...

Hang in there....I've heard that the 3rd - 5th day starts getting better - in that the hunger isn't as bad. When I start mine - I have to do 2 weeks of 800 calorie days...but they have mine being food - protein, veggies and a dairy a day...

I use Syntrax Nectar Whey protein shakes - they come in a lot of flavors... and I use Natural Factory Whey Factors Natural Vanilla and Double Chocolate... I get mine online through vitacost.com

You look great! I bet you feel so different!!! Thanks for sharing - that is so encouraging!

How exciting!!! Good luck!! I meet my surgeons tomorrow afternoon! I've done the 6 month dr supervised diet, psych eval and stuff...so after tomorrow...it is my understanding that it could be up to 60 days for insurance to approve. I'm hoping for with in 30!! I went ahead and ordered my shakes - strawberry/kiwi, vanilla and a fuzzy navel! Hang in there!!!

I use vitacost.com for a lot of items

I have Idaho BCBS and I had to do the 6 month supervised diet. I finished that yesterday. I meet the surgeons next thursday and have heard it should be within the next 60 days that I can have my surgery!! I'm so tempted to start my pre-op diet now...so that when it is approved I can just scehduled it done...alshtough...looking at my7 work schedule...the soonest I could would be the first week in May....but that is only 3 weeks away... On my pre-op diet - it is 8 calories a day, made up of lean Protein, veggies and 1 dairy each day.

I love the Syntrax Nectar Whey protein mixes. They mix great in water and have 23 grams of protein. So far I have tried: Fuzzy Navel, Wild Cherry and Strawberry Kiwi. I also like Natural Factory Whey French Vanilla and Double Chocolate - these I mix in light soy milk.

Good Luck! I'm right behind you! I have my last appointment this thursday - mine has been a 6 month dr supervised time frame. Congrads on losing 12 lbs!!! that is awesome!

I have blue cross blue shield in Idaho

My insurance required the 6 months supervised diet, sleep apnea test, psych eval, and 2 years of medical records. I have my last of the 6 months appoinments on the 11th!! the rest is done. So, from my understanding after that appointmnet I will then meet the surgeons and they will submit everything to my insurance company. Then I wait for an approval. I've been told that can be 7 to 60 days.... ughh....but it is getting there!