jodie1961

It has been a long journey....approval for removal of my lap band was done December 13, 2013. They originally denied the revision to RNY. But after many months, dropped ball, etc..a peer to peer review was scheduled week before last. The day after my doc called and rescheduled my appointment because of unforeseen circumstances he was going to be off a week. I had put in my mind the review wouldn't happen until this week when he returned, but today I got the letter from my insurance company!!! Bless his heart, he must have spoken to them before he left. And I don't have to go thru the appeal process. Peer to Peer review process worked. Thanks to this site for all the support ..... really helped during the waiting time.

I trained last year with the YMCA for the 1/2 marathon. They had a couple of stores they suggested. Go to a sporting specialty store. They have someone watch you walk w/no shoes, to see how you walk, and if you roll your feet in or out when you walk, etc. They watch your knees and hips too. After that they chose a shoe that was made for that type gait. Mine in particular are Brooks. I walk on the insides of my feet. These have a very sturdy heel and force me to walk the correct way. They are pricey, about $120, but I am asking them to carry a lot of weight (mine) and go a lot of miles. All together with the training and the 1/2 marathon, I probably had about 200+ miles on them. I have new ones for this year. Spend the money, get professionally fitted, it will be worth it...because YOU are worth it! Keep up the good work.

Debbie (receptionist) called today and said she has the peer to peer meeting scheduled with my doctor and Anthem. I really don't understand exactly if this can reverse the original denial, or if it makes the appeal process have a better outcome? Has anyone else ever had a peer to peer meeting done on their case before being approved?

I think it is great that you have so many experiences to hear about on this site. I personally chose the Lap-Band originally because it was less invasive and had a much quicker recovery time. I just was one of the unlucky few that had problems. After one revision surgery on the band, and 2 years of trying to get the fill just right, I pretty much gave up. I have been seeing my doctor again since November, hoping to get a revision to RNY bypass. I lost approximately 80 lbs the first year, but after the problems, and second surgery, have gained nearly all back. So glad I still have options. That being said, many, many people have good luck w/the band and are still doing well years later. You really should listen to your doctor the most though, he/she knows your personal health history and will be the most unbiased about what you need to attain your goals. Good luck with your surgery, and here is to the new healthier you!

Well, today I spoke w/doc's receptionist. Bless her heart, she was swamped the insurance clerk is no longer with them. I believe I am not the only issue with problems stemming from her work/lack of work. The receptionist has all the details and was going to call the insurance company herself and get Doc scheduled to do the peer to peer meeting with Anthem. Hopefully, this will help them to reverse their original denial decision. I see him next Monday either way. Praying this works. Thanks for being a forum I can vent to, share with and get through this whole process with.

I called this morning and got my Doctor's insurance clerk's voicemail. Left a short message, basically that I had spoken to an insurance service rep's supervisor and I needed to talk to her as soon as I could, left my number. After lunch, no call, so I called the main office, got an answer machine again, left a message for the receptionist to contact me and no call. Tomorrow, I will call in the morning again, and if I don't hear back, I well take a late lunch and go to their office. I don't believe there is an office manager there. They are short handed, one girl left at the first of the year. Am I expecting too much? I have been waiting since February 7th for an answer, and really should have had a peer to peer meeting scheduled after my December letter of request was denied. Any ideas?

I don't know why these things happen and seem to pull us down, but if you have already confronted those feelings and issues (which I can only imagine are some of the hardest things you have been through), then you are one STRONG woman! You can get through this too. Prayers your way. Keep us posted.

I'm so sorry this is happening-- it's funny that they make us see a psychologist, but half of my problem is the stress about the process! :-)

My surgeon told our group that if we get declined at first to not panic yet--- that about half the time he has to get on the phone and "chat" with the insurance to push it.

Good luck to you! I'll wish for the best!

Thank you Melanie36 for telling me that. I haven't seen too many discuss the denial and appeal process. I pray the "chat" will do it. And I agree the stress of waiting and not knowing is killing me. Trying to keep my chin up, but just such a blow yesterday, it was almost a knock out....but, not quite I will succeed.

Long story short...denied for revision from band to rny in December 2013. Insurance girl at Doc's office said we needed to re-do classes, psych eval, etc. Did this and got approval letter from NUT, Psych Dr, and Doc 2/7/13. Insurance girl didn't send in new clinical info to insurance until 2/26...after 10 business days I called Anthem and they said they had no new request on file. Called Doc office, insurance girl called me back and assured me they had everything. Still no word as of today...so I called Anthem again: a supervisor finally got on the phone and said there is no case pending. New clinical info doesn't do anything. the original request was denied -not medically necessary and now the only option is to have my Doctor call and have a peer to peer meeting to discuss, and/or file an appeal. (neither have been done.) Sooooooo in other words I have been waiting for NOTHING for nearly 2 months. I have to call my Doc's office Monday and talk to the insurance girl about scheduling a peer to peer meeting now. What is going on? Why would she not know this was needed? Why would Anthem continually tell me the case was pending when I called to check? I am soooooooooooo frustrated and depressed. Has anyone else ever been thru this?

Congrats, praying for you all. Let us know how you are doing.

Sounds funny to say, but I am looking so forward to starting my liquid diet....means my surgery will be scheduled. But, I can definitely feel your pain too. This will be a revision, so I have done it before. Try doing something to take your mind off the hunger....word puzzles, Sudoku, etc. I cant seem to eat and read or do puzzles or be on the computer. So keep those hands busy, and I will be praying for your time to pass quickly! Stay strong, you CAN do it!

So bummed out...everything signed off and ready to send to insurance 2/11th....called 2/24th and the Dr.s office was behind and still had not sent in my request letter. They said they would do right then. 2/26th they finally sent letter. Insurance says could be up to 10 business days...so today was the 10th day and no word. Called the insurance company and they say they don't have any requests in for me. Called my Dr.s office and the girl says she did send. She will call them and get back with me. Of course no word back today.. They are closed now. I have 6 days of vacation left to use before 4/13/14...and in February my Dr was sure we would have scheduled before then, not so sure now. Please, pray for patience and an answer for me. Thanks.

I know Deaconess has a support group for their own patients but if you are ever interested in getting together after surgery let me know. There are a few of us in town that did not go to local surgeons but still need support from others. Deaconess will not extend their group to "non" deaconess patients.

mommashari...I would love to get together, it is a shame there is not just a wls group period. No matter where you went. You can learn so much from others. Do you have a set time and place? I am getting anxious now, tomorrow will be the 10th business day for my insurance to have my request. Hoping to hear something this week.

Jodie1961, where will u be having surgery? I will having mine in Carmel with Dr Evanson. I have Cigna insurance so hoping they approve fast!!

Sorry still learning how to use this...I am having mine in Evansville at Downtown Deaconess Hospital. Dr. Chris Haughn is my surgeon.

I am from Evansville. Had my bypass in Indy this past Oct. where is your surgery?

I will have mine in Evansville at Downtown Deaconess. Dr Haughn is my surgeon.

Yay you!!! So exciting! Keep up the good work, and spend this time learning from many experienced WLS people here - they are sooo supportive.

Yes, Newburgh Indiana-awaiting insurance approval, then surgeon meeting w/surgery date....can't wait!

Congrats to both of you! Wishing you both a smooth recovery. I am awaiting my insurance approval. Crossing my fingers. keep up the good work,

Glad you are here. Hope you find the support you are looking for. I am having a revision from a band to RNY. No problem getting approved for the removal....awaiting approval on the RNY now (denied the first request). Had to re-do classes, psych eval, etc. But, my letter was just sent to the insurance company again yesterday. Hang in there and know you are doing the right thing to have a healthier you!

That is great msfitn2014! Make sure to check back in...maybe we will be scheduled close to the same time.

Well, I called to check in with my Doctor's insurance girl today. She said she has been so backed up and they have been short handed, so she hasn't gotten to my file yet....it will be 2 weeks tomorrow. Anyway, she promised to pull it out of the pile and do it today. She said she would mail a letter to me also, so I have the date to keep track of. I guess it could be the middle of March before I hear. Bummer, I really wanted to get scheduled before the middle of April, so I can use the end of my vacation from last year.

Thank you for your encouragement. Keep us all posted.

I have not told all yet. Of course my husband and grown children know. They all are supportive. I have 1 friend and one co-worker/friend that I nearly had to tell, as she is who I report to for time off, and the many doctor appts I have been to. My hesitation is that I had the lap band several years ago (which I will have taken out, then revision to RNY) and it didn't work. Even had a revision surgery on it. After the first surgery, I did tell all, and nearly all were supportive. But, now I am afraid some will judge me because it did not work, and this is even more intrusive surgery (and the easy way out as I have heard some of them say about others). So, I haven't even told my mother this time. I guess they will find out at some time, but would like to learn my new way of eating and dealing with food/emotions/situations without the eyes of the world on me.

Rearaes..that is great to know. I got a letter telling me when the doc office sent request the first time, but no letter so far this time. I will call them Monday. It will be 2 weeks Tuesday that I was cleared for the surgery from the NUT and Psych Eval...Hopefully soon. Thanks for the info.

Good for you! You will prevail. It is great that you have been recording your info on my fitness pal....it is a great tool. And I agree you will/would have much of this done before surgery anyway.

Keep on keeping on...and let us know how you are doing.