j_war06

My insurance denied my claim about 2 weeks ago, and we are going through appeals and I was just wanting to know if anyone else went through the same thing, and how did they win?:Bunny

I do not have arthritis, I have already been tested for EVERYTHING! I have had an MRI, CT Scan, Bloodwork, X-Rays out of my ears, and all the advance technology systems of detection. We do not have any more PCPs that I could go to. Everything else in town is owned by Christus, and if I change then I kinda have to stick because of the insurance. Christus does not believe in BC and I have to have BC to regulate my body. The problem is every joint in my body hurts except for my shoulders and back until you get to my lower back (that does hurt). Mom's company has always had that exclusion, the lady was dismissed because the company had a huge budget cut because they lost their business in Brazil, and she was the obvious to "let go" because of all the time off she had taken due to her mental health state. The lady literally had horrible break downs, she is the reason I decided I needed to see a psychiatrist, it was like looking into the future. But anyways, she had another bad breakdown and had to leave work for another month to undergo "treatment" and they used the excuse of budget cut to get rid of her, but it was really because they could not fire her based on her mental state since she was not a threat to others. I just do not understand, how can there be this much pain with no explanation, therefore the only obvious reason for my problem would be weight. Makes since to me, that my weight causes my problems, my bones really are very small, you can tell in the X-Rays and MRIs how small they are compared to the amount of fat around them.

Its bad im so emotional about it. I see a psychiatrist every 2 weeks because of the problems my weight has caused. I see a doctor for my knees probably one a week (different doctors to get medicine), I have a low immune system from my knee pain, and cannot do ANYTHING! My whole body hurts all the time, I cant even curl my hair anymore! My hands hurt too bad. I ache and cramp all over my body, and all that is wrong is im fat. WHY ME! I have to work hard for everything I get, nothing ever comes easy, and on occassion that it does, it always has some horrible consequence. I think I am cursed. There is one lady who did have it done under mom insurance that worked for mom's company, mom she was dismissed for controversial reasons and now she cannot talk to anyone affiliated with moms company.

My doctor is extremely caring, she just lost a lot of weight naturally and not through surgery, but she is going to write me a letter anyway. I have been to every doctor from here to Houston and even in San Antonio (5 hours from here). I have done physical therapy about 3-4 times and it just makes them worse every time. We can not afford a surgery like this, at all. It is way out of budget and if my parents came up with the money I refuse to bankrupt them anymore than I already have. I have tried everything to make my knees quit hurting, I was even addicted to pain medicines at one time because of the pain. I hope this can happen soon, I just do not know what all is supposed to go in an appeal?

How can you people afford to pay cash?

My mom's company is self-insured and they have decided not to cover morbid obesity as a disease. We can not get weight-loss anything because the insurance will not cover it, so we have to list another problem that can be solved by the weight-loss products. The doctor says that because of all the fat around the muscles and bones and stuff all over my body that it is extremely hard to read any of the test results. He does not think that there is a disease in there though anyway. He says that because my knees hyperextend and my bones are too small to support my weight. You probably do not hyperextend, that is why you may have never have had knee problems.

We cannot afford to self-pay, period. My BMI is 41, but their problem is that I do not have co-morbid conditions (that are listed on those forms). I have serious knee and muscle issues. My primary care physician does not agree with the surgery, and will not write me a letter. My Lap-band surgeon already wrote a letter to them the first time to file the claim. I think the problem is the amount of filings they have had for this surgery, and because I am only 17. If I do not have this surgery, I may never be able walk any further than out my door into my car. I cannot even drive it when my knees hurt. I am so depressed.

All I know is that my mom's company is self-insured and United Healthcare is their insurance provider. Basically they are telling me that the surgery is for cosmetic purposes only. We are preparing a case right now by going back to when all my problems with my knees and other problems developed and are adding up all the money that they have spent on doctors bills, tests, and medicines. I am having problems getting a letter from the orthopedic surgeon who actually recommended this surgery to me as a form of weight-loss, his receptionist has no idea what lap-band surgery is and is entirely rude everytime we call his office, and we never get to talk to him. I have a letter coming from my psychiatrist, TMJ specialist, and other orthopedic surgeons that I have visited. Basically if I do not have this surgery, and lose weight (quickly), my entire knees are going to collapse! I do not know what to do, I am so discouraged! I do not know how to go about an appeal, and am scared that I will have to live with this unbearable pain forever.

I was denied under UHC, claiming that it was purely cosmetic, but lemme tell you BoxerLuv, I weigh a little more than you, I am at 225, and all I wear is Old Navy, you just gotta find your fit. And guess what, I do not wear plus sizes either!! But I do hope everything goes well.

I would like to start out my membership on this discussion board to tell everyone my history. I am 17 years old and am awaiting approval from my insurance this week in order to have lap-band surgery in the beginning of May. All my life I have been way way overweight and my mother had me on my first diet when I was probably 2 or 3. My mother has always been heavy-set and so was the rest of my family, basically I thought I was normal until I started daycare. I soon realized that the other kids were thin and had absolutely nothing in common with me. I liked to watch t.v. and suprisingly I did not eat very much, but when I did it was always something very unhealthy and fried, since my parents were not pulling in very much money, it was just easier to eat fried hamburger meat, mac and cheese, and beans for supper. When I began private school as a pre-schooler I realized that all the kids had a lot more energy than me and always ate way more than I did. They started calling me fattie and lazy and whatever else a 4 year old's vocabulary can expand to. At private school they made you eat every meal, which is not good for an already large child with the metabolism of a snail. It is true that I did not like to play outside, or even with other children, I have always preferred to do everything on my own. I became severely depressed by the time I was in Kindergarten, having no friends that came over to play. When I was in second grade I plunged deeper in depression when one small kid exclaimed to me, "Your the fattest white girl I've ever seen." That was truly heart-breaking, from then on every two-three nights I would get in the bathtub and just cry and cry until my mother would have to come and sooth me and tell me that yes I was different than the other kids, but that doesn't mean I can't try to be friends. My depression continued to deepen, as I made friends I plunged into a life of anorexia in the 6th grade at 12 years old. I did not eat breakfast, two-three bites and two sips of something for lunch, walk 2-3 miles in P.E., then come in and eat half a plate to nothing for supper. I dropped about 50lbs within 5-6 months and when I was still fat even after that, plus I had had 3 nervous breakdowns and passed out twice in P.E. I realized all this effort wasnt working. I was in with the "popular" crowd, yes, but wasn't happy. When they began to date and have boyfriends and even begin to kiss a little, I was hung back and gradually withdrew myself from them. At Jr. High you could eat whatever, whenever, and I did, and becoming increasingly depressed with everyday, I never had boyfriends, I think I had a total of 3 or 4 that would not even hold my hand. I became best friends with a guy, eventually, we became best best friends and started doing everything together the only problem is that he is very good-looking and I have never felt very pretty and have continued to eat, and go on diets, and eat and so on.... I am dating the guy now and I now see a psychiatrist to treat my severe depression, which is fading off well, but I still have times like today, when I feel like I do not deserve my boyfriend or my few friends who love me no matter what I look like. I have severe knee problems, because I was supposed to be skinny, my small bones can no longer hold the weight. I have never had life, and up until probably November or December I felt like the living dead, and wanted to die everyday. I am finally starting to live. I have withdrawn from public school because of the severity of my knees and cannot wait till I get my surgery so that I can go and celebrate my senior year with everyone. I am ready for my life to finally begin! I cry everytime I think about getting the band, I am so happy. I look forward to all your advice on here.

well, I got a note from the insurance Wednesday, and they said no and that we have to appeal it, so please pray for me

Thanks for the welcome, I can't wait to share my experiences with you all

I cannot do hardly any physical activity, I have an unknown disease in my legs, and it is spreading throughout the rest of my body into my arms and torso. When I lose the weight, it will take a little over a year, it will allow me to begin exercising, if I can, and will allow the doctors a clearer look into my body, which is completely clouded with fat right now. My entire body hurts all the time. That is why I am no longer in school. Right now I am 5'2'' and 234lbs. I have literally gained 15lbs in one month or less. I have also put on about 30lbs since January, in which I have been eating healthy. I do eat right, just sometimes I have to splurge a little when I am with my bf (only sometimes), since he orders the food and picks it up. I want to stress to all of you that I do not eat unhealthy because I can't, I have bad acid reflux and other gastro-intestinal problems (which will be fixed by having the surgery). It just seems like all I do is gain weight, just overnight, and then I will lose 15lbs all at once then gain it back. No change to diet or anything. Once I lose the weight then the doctors can check my thyroid acurately and can check for other diseases also

The doctor that I am using said that overeating will cause erosion of the band, although it has to be done constantly.

you probably are due for a fill. You see even though the band is on you can still over eat. If you do this enough it will put a lot of tension on the band and will cause it to erode into your stomach (which is not a good thing). You should not try to push what you eat to the point that you can eat no more, eat what you know you can eat (portion and healthily). Remember you did not have gastric bypass, you had lapband so you can still eat anything you want, as far as digestion goes, but remember the less calories you put in the less you have to burn to lose weight. The lap-band can only work as well as you do. If I were you I would go see my doctor for a fill and ask him if this is normal.

See the problem is that I do not eat unhealthy, yes I splurge a little, but I can eat healthy and exercise and never lose a pound, but let me eat a hamburger, I will gain 5 lbs just from that. So I already eat well, now I have to lose a considerable amount of weight to be able to exercise since I am almost bed ridden. BTW, I wanted to get it out, I forgot to mention it in my long story, that I am 235lbs. I am supposed to be about 110-120, my bones are so teeny tiny that I have to lose this weight fast. I can't wait until I can live!