khelm32

I got the call today from the Benefit Director for my employer, they are approving my appeal, woot, woot! The only thing is they want me to have it done before the end of the year, because our insurance is changing. Waiting to hear back from the nurse coordinator to see how soon it can be scheduled.

It has been a long process for me as well. I started my supervised weightloss plan with my doc dec 2012. I'm still waiting after submitting everything to the ins 7 months ago. Of course I had to go through the appeals process with ins and now my employer, who is self insured. If they still won't approve it, I'll have to look into self pay options. I really thought by this time this year I would be on my new journey.

I was denied by the insurance 3 times, after completing everything they required each time. My employer is self insured, so I have now appealed with my employer. I've been waiting another month and still haven't received an answer yet, just that they are still reviewing it....I started this process in December 2012. It's coming up on a year now. I've been getting really discouraged here lately thinking I've wasted all this time and energy on something that isn't going to happen. For now, I decided to continue to eat healthy and exercise and hope for the best. I've thought about paying out of pocket, but that really isn't feasible right now. It is disappointing because it took me a long time to come to the conclusion that the lapband may be the only way for me to lose the weight i have been trying to lose for a good five years now with not much progress. I thought this would be the year that I finally had something that would help me get over that big hump and really be able to make some progress. It seems like that isn't going to happen, but I'm trying to hold out hope that my employer will approve and maybe this will happen this year.

So over the last 10 months I've been going through the process to get approved for the lapband. I've done the 6 month supervised weight loss plan, had a sleep study, completed all paperwork and checkups needed for the procedure and what the insurance is stating is required. I received my 3rd denial from the insurance last week. Yes, I said 3rd. I have exhausted all appeals with the insurance. Everything they've said was required for the approval, I have done. The first denial said it was a cosmetic procedure and it was not covered. The second denial said because my BMI was at 37.5 at the time the paperwork was submitted, I would need to have a co-morbidity of either diabetes or sleep apnea to qualify. I had the sleep study done and was diagnosed with mild sleep apnea with a recommendation of weight loss. I received the 3rd denial stating that the co-morbidity had to be moderate to severe. My employer is self insured so the insurance company only coordinates the benefits according to the contract set forth by my employer. My last step is to appeal through my employer, which I have done. I am now waiting for their decision. I'm feeling discouraged and don't really know where to go from here. If the insurance won't cover this, then I will have to let go of that option for weight loss, which I've been seeing as my last resort. I've literally tried everything and all my doctors recommended this procedure for weight loss. Since I have tried everything, read every book, etc, I'm feeling lost as to where to even start or what to do next to lose weight. I'm hoping my employer will come through and overturn the decision, but considering they aren't going to want to fork out the money, I have little faith that will happen, so then what?

I just got off the phone with the insurance and they have denied for the third time. I'm not sure what else to do at this point. I'm waiting to hear back from the nurse coordinator I have been working with. I literally have met all the criteria that they have asked for or asked me to do, and still no approval. Why do they have to make it so hard for people to get healthy.

Yes. I started my 6 month supervised plan, Dec. 2012. I have yet to be approved. I am on my 3rd appeal now, awaiting the insurances response. I ended up having to have a sleep study done as well in hopes that this would get the approval. I meet all of the criteria, but they keep giving more and more hoops to jump through.

I understand how you feel. I have a friend now that has always struggled with her weight but has made comments that she would never get the Lapband as if that is any more ridiculous than all things she's tried to lose weight. I'm still waiting on insurance, but I haven't told her I'm getting done yet. I have recently heard her comment about someone else who had it done and said she really would be too scared to do something like that... I still haven't told her. The thing is that many people are against things they don't understand or they're afraid of. If the really want to be your friend though they can't judge you for your decision just because its not something they would so. That's not really fair to you.

I'm on my 3rd appeal with my insurance. I'm so frustrated with this process. I started back in December of last year with the 6 month supervised weightloss with my physician. I was first denied early July. I appealed, and was denied again. My BMI has been between 35 & 40 for the last 10 years, but the insurance was denying me saying that because I hadn't been at 40 BMI with diabetes or sleep apnea I didn't qualify. After last denial, I had a sleep test done and was diagnosed with mild sleep apnea. The nurse coordinator I have been working with has now submitted for a 3rd appeal with the sleep apnea diagnosis. I am hoping this will work, but it's hard for me to stay positive considering how frustrating this has all been. I don't understand why the insurance companies don't take into consideration what would be best for your health and well being or take into consideration your past history which mine clearly shows I have literally tried everything to lose weight. I'm not one looking for a quick fix or else I would have tried to get this done years ago. If I am denied again, I will have to consider the self pay option which really isn't ideal, but I really don't know what else to do...

I agree with you. The nurse that has been helping me said there are attorneys that work for Lapband and will step in and try to assist. The problem she ran into with my insurance is that my employer is self insured, so that means they write the contract of what they will and won't cover and the insurance company is simply just administering the contract for them.... My other option if the sleep apnea diagnosis doesn't come through will be to get on my husband's insurance, but we will have to see what their coverage is for this procedure before we do that. Self pay is the last option and not one I really want to do.

Perhaps you should get a second opinion. All of my doctors encouraged the lapband over the other procedures. My surgeon mentioned the sleeve, but he said with it being a newer procedure there isn't as much data on it. The other thing about the sleeve is your stomach can stretch back out after the procedure and you would have to have another procedure to correct that. That was told to me by another surgeon I met with before I decided on the lapband. Do as much research on your own because regardless of what the doctor's opinion is, you are the one that has to live with it.....I visited a couple different hospitals and surgeons before I made my decision to do the band. I'm not banded yet, but am in the process.

I had my appt with the sleep doctor last night. I'm scheduled for the sleep apnea test next Friday. I have United Healthcare. They are telling me if I have sleep apnea or diabetes I would qualify even though my BMI is over 40 now. I've been tested for diabetes and do not have that. Otherwise they are saying I would have to have a BMI of 40 for 2 years. If I don't have sleep apnea then I will try getting on my husbands insurance and go from there.

My mom and a friend both have the Lapband and still have some drinks. My mom has said that she can't drink alcohol and eat, you have to do one or the other. My dietician said that carbonated beverages aren't good for the band. She suggested wine as the go to drink which is primarily what drink when I do drink. The thing with Lapband is you have to be willing to adjust your life and habits to it. It won't adjust to yours, so if you aren't willing to do that you will have really think about things before adopting the banded lifestyle.

I went to my primary on Tuesday. I have an appointment with the neurologist on Tuesday regarding the sleep apnea test. So we'll see how that goes.

They appealed it once. I'm going to go to my doc and see if I have sleep apnea. I've never been tested for it and that is one of the qualifying comorbidities. If I don't have that, I think I will be out of luck.

After all this time and an appeal, I have been denied. My BMI is 40 and I have asthma. After all this preparation the ins is telling me it is because my employer is self insured so they dictate their own policies. I am now being told that I do not qualify because I would have to have had a BMI of 40 for two years prior. They are not counting my asthma as a comorbity because they have a specific list of those. These qualifications are new to me. None of that is in my policy paperwork or was discussed when I called to get the qualifications prior to beginning this process. I'm kind of at a loss right now because the nurse coordinator is telling me that at this point there isn't anything I can do except to self pay, which I can't afford. Has anyone else out there had this experience?

I went ahead and submitted the paper work for the appeal process. I'm hoping I will hear something soon....all this waiting makes me feel like I'm in limbo.

Thanks for encouragement!

Well we heard back after a month on Tuesday and it was denied because my BMI wad 39.8 instead of 40. My nurse said she has never had an ins deny because of that especially since I also have asthma. She has already appealed it and is supposed to be talking to the medical director at the ins. I am trying to stay positive but am feeling discouraged.

Well we heard back after a month yesterday and it was denied because my BMI wad 39.8 instead of 40. My nurse said she has never had an ins deny because of that especially since I also have asthma. She has already appealed it and is supposed to be talking to the medical director at the ins. I am trying to stay positive but am feeling discouraged.

Yes that is the name. It does have a website but you can't purchase from there. It does show a list of retailers. I got a can of the double chocolate today. I'll let you know how it tastes.

I've been checking out the designer whey powders. The have similar nutritional info as the unjury but use stevia instead for the sweetener. They are also a lot cheaper. Has anyone tried this brand?

So far I like the vanilla & chocolate splendor.

I met with my surgeon the first week of June and am still waiting for the insurance approval. I have united healthcare too. I'm guessing they are ones to drag their feet. I'm going to follow up again on Monday! I'm ready to do this, but can't w/o the ins. approval.

I have been wondering the same thing. I look forward to others insights.