jodie1961

Great topic...learned a lot thanks for sharing.

After my approval on band removal, and denial on RNY...my Doc's insurance gal said she spoke w/BCBS and I have to go thru the psych eval. and nutritional classes again. She felt that it would be approved then. Since then the Upper GI showed a hiatal hernia and a small stricture that my surgeon wanted to check out (plan is to do both removal and RNY in one surgery)...so I had an EGD last week and he said the stricture is not big enough to worry about, definitely having bad reflux, he took a biopsy to make sure no bacteria infection in stomach, and nothing too bad to make us do 2 surgeries. I see him again next week, hoping to get all scheduled and on my way soon. Congrats on your approvals! It is such a relief to know that denials can be turned around. Thanks for sharing.

Great job on quitting smoking! That in itself is quite an accomplishment....and knowing what is going on in your life (gaining the weight) and doing something now is putting you on the right track. Good luck on losing the 30lbs and kudos again for tossing the cigarettes!

That is a great idea! I will keep this list handy while I am waiting as well. Found out I have to go thru the dietary classes and psych eval again. I am revising from the band to RNY. But while I am going thru this..we found out I have a hiatal hernia and a small stricture at the top of my stomach. Going for an EGD soon. May have to have band out now and wait 6 mos for the bypass. Depends on the damage to the tissues. Hoping all goes well and I can have both at once. Don't want to have 2 surgeries to recoup from. So glad to hear others moving forward on their journey's. It has been quite an inspiration to see other's work thru struggles, and sharing their victories. Keep up the good work and don't worry too much, this will be a great thing for you.

Haven't gotten a chance to talk to him yet. Just the insurance person. I would think they could appeal it, but it the criteria needs to be met i.e. dietary classes, etc, I don't mind doing it. I just don't want to put off the removal, go thru the classes, wait 6 mos and have them deny me again. I will get thru it, just another something to go through....always something. But, I am feeling better now that the band has been un-filled. I have followed your posts as well, and have to say I hope you find some answers soon yourself. Has to be frustrating to go through all of this surgery, etc to not feel like you have any tools to help you lose the weight. And I know the weight is something we all have fought so hard. I will be 53 this coming year, and now I am thinking I wish I had not given up so easily 4 years ago....just lived w/the problems from the band and regained what little weight I ever lost. I want to be healthier before I get so old it doesn't matter anyway!!

Finally heard from my insurance company Anthem BC BS. They approved my lap band removal (out-patient) and denied my RNY bypass (in-patient). They were actually both requested as one surgery and in-patient. It has been 5 years since the lap band was put in. They said I had no current documentation of other required classes or current psych evaluation...and then it stated that the by pass was not medically needed because I had weight loss surgery before (lap band). But, because of my trouble with the lap band, they were approving the removal of the band. When I spoke w/the insurance person at the Doctors office, she said that what they meant was I have to go thru the 6 mos of dietary classes and a new psych evaluation before they will approve. Does this sound right, has anyone else gone thru this? I just wondered, will I go thru the classes again, etc and still be denied? I am feeling a bit un-nerved now. The surgeon wants to wait on the removal to do as one surgery in a few months. Won't I have to re-request the removal again with it being months later and a new year?

Hope you are feeling better and getting much needed rest. Congrats on the 8lbs off. Will probably be much more by now. My upper GI Friday went well, no stomach flap or folded over above the pouch. Just terrible reflux since the band was unfilled. I will talk to my Dr this next week about the UGI results, and should have insurance letter by then. will let you know what we find out. Keep in touch, and take care.

Good luck...hope you find out something soon. I am hoping to find out something by tomorrow's appt at the doctor's. I checked w/insurance Friday, still pending. They told me the nurse (at the insurance company) had everything they needed, but had until Monday to look over. I am getting my lapband removed and hopefully the RNY bypass done. Hang in there, we can go through together.

Congrats Dara! I can not even imagine. I have my appt at the my doctor's office tomorrow. As of Friday, no word on authorization from the insurance company for my lapband removal and RNY bypass surgery. Keeping my fingers crossed that we will here by my appt time tomorrow. They said towards the end of the year the insurance companies get backed up, so three weeks is pretty normal. Praying for a speedy recovery for you, keep us posted.

Dara... Good luck on your December surgery. I will be praying all goes well for you.

Thank you for all your advice..and experiences. I do already feel sooooo much better! I feel great, will see how all goes through the first of the year. I didn't mention that I trained and completed my first 1/2 marathon this year. 20 weeks of 3 days a week walking, usually 3 miles on weekdays and up to 10 miles on the weekend. Can't wait until next year....I wondered the whole time how much better it would feel when I weighed 50-100 lbs less. And how much faster do you think I could go??? That is my goal for next year, continue to train, and knock some minutes/hour off my time.