Mrs Sabre

I called the appeals service center this morning. It's still under medical review; a determination has not yet been made. I'm praying!

Congratulations Vickie! Who is doing your surgery? Our thoughts and prayers go with you. Like Melissa, I hope you can join us for lunch on May 20th.

Kathy, Happy Bandiversary! Melissa, hang in there! You seem to know what you need to change? You can do it! Angie, God Bless you! Albeit hard, your approach is best for the children. Kim, you're working too hard :confused: Everyone else, you're being awfully quiet out there! I went back to my PCP over the pinched nerve. After 16 days of NSAIDS, we've now moved on to steroids. He too was disappointed at the insurance denial. I'm hoping it's standard procedure and the appeals letter takes care of it? I should know in a couple more weeks.

I'd rather give you a big slow HUG than swift kick in the tushy Maybe we can prop each other up? Between physical pain from the pinched nerve and insurance denial, I haven't been coping too well myself. Today is a new day, and I started journaling what I'm eating. I'm using www.fitday.com so I know the quality of my food too. I'm taking it one meal and one day at a time, and reminding myself that eating myself stupid isn't the answer. I'm trying to make a point of thinking about what I'm eating and why I'm eating it. If I'm not hungry, I'm going to try to refrain from eating at all. If I cannot refrian, I'm going to try to grab something very light and healthy, like fruit. I hope this helps? Hang in there lady, and God bless you!

TGIF Ladies! I hope everyone has a great weekend!

Wow! Now that's a trip! I have some killer acid reflux, but my endoscopy was completely normal.

Many or few, it doesn't matter. We're happy to hear from you!

Interestingly, Kim at Dr. V's office and I have gotten the opposite result ... they've told me more than they've told her. I know of two others here at NC LBT that have/had the same insurance through the same employer, but were within the guidelines and quickly approved. I believe I've stated my case very well with the letter I sent. (attached) Up to this point, everything has gone very well. All the doctors, shrinks, etc. thought I'm a really good candidate for Lap Band. I won't give up without a try. It's just been a very long journey already, and I'm getting tired. I too believe His will for my life will be done, and in His time. This may simply be a lesson in patience. 1stAppealLBT.doc

God bless and thank you all for the words of encouragement! I called the appeals line again today. The gal that answered regurgitated verbatim the content of my call on Friday, and then stated it had not been 20 days yet. When asked if it ever varies, she said it's always 20 days for prior approval and 30 days if the service has already been provided. I've marked my calendar for May 19th and will not call them again until that afternoon. Who knows, maybe I'll have good news when we meet for lunch again on May 20th?

I had a good extended weekend with my Mom, but the trips to and from WV made it seem shorter and wore me out! I expect work to be really busy this week; so I may be somewhat incommunicado. I'll call the appeals board every Friday until I hear something. I can't wait until May 20th; I miss you all! I know we can write, but it's not quite the same as seeing everyone's smiling faces!

Hey Kim, after talking to everyone and their brothers at UHC and the Appeals Service Center last week, the "no coverage" just means they won't cover me because I don't meet their definition of morbidly obese based upon average BMI and co-morbidities. The gal I talked to at the Appeals Service center read the underlying detail to me. I haven't received a letter yet.

OK, I just hung up with the appeals service center. They have my letter; it's logged and a case number has been assigned. I was told it could take up to another month to review and a decision made. More waiting! :Banane56:

Dianne, you really need me to be your concierge on this trip! :Banane56:

Canceling has actually worked out better for me afterall. I'm heading to WV this evening to bring my Mom down for the weekend. She wasn't able to get anyone to switch shifts with her at Lowe's, so she's working until 9 p.m. Instead of making a round trip this evening, which would have left us free for coffee in the morning, I'm staying over and we'll head back in the morning. We won't be back in time for coffee and have plans beginning around lunch time. I'd love to see you Melissa, but this weekend's plans have changed drastically for me.

Melissa, busy is good. I can use some 20/22 pants. I wear the ones from the last clothes exchange a lot! Kim, how's work? How's Curtis doing? Angie, we're praying for you! Put it in His hands and things will be as they should! Dianne, can I be your concierge? I'll take good care of you while on the cruise and sleep on the floor! :Banane56: Jennifer, you're doing great! Keep venting as needed; it helps. Wavy, how are you doing? Denika? Where are Starr, Sherrie, Magic, Geomyth, Vericks, Stacy, Oreilly76, Oh2bethin, Court, NClonghorn, skyeblu79, who else?

I voted for the 20th, but th 13th is good for me too. I need you all right now! My DH is great, but he freaks a little when I fall apart and bawl.

Thank you Kathy! You've lifted us up; now tell us, how are you doing these days?

I don't know if I should call the appeals service center and harrass them now or wait and see? I yo-yo between being optimistic and deeply depressed. John and I talked about "what if I'm not approved" months ago, and he flat out said Mexico is not an option. Even if going there for surgery were an option, I don't think I could deal with the hassle of finding a doctor to do fills. I think financially, financing is an option, but it would set our goals back about 5 years. I know that's not long in the grand scheme of things, but when you've been working on those goals for a number of years already, the thought of postponing them further makes you cringe. Emotionally, I think I'm more afraid of staying obese than going further into debt. I may not have high blood pressure, diabetes, etc., but I am falling apart with other weight related problems.

Dianne & Kim, yes, we need to do lunch! I park 1/2 mile from the office and would spend half my lunch traveling to and from my car; so if you can come downtown, that would be great. My boss is very flexible though, so I can take an extended lunch if need be to meet you somewhere. OK Melissa, I see you out there; how are you doing? Let's say a special prayer for Angie too. I hope we hear from her again soon. Jennifer, I'm glad you're opening up. Doesn't it feel great to let it all out? OBTW Dianne, can you bring back souvenirs from Cancun? Where is everyone else? I hope everyone is happy and busy, and just doesn't have time to talk?

Since I won't be drinking pina coladas with Dianne in Cancun , then I'm free for May 20th.

I faxed out the appeals letter early this afternoon. I may not have the specific co-morbidities they're looking for, but I was able to come up with 7 of my own for which weight loss would help if not cure the problem. Just listing them out, they don't sound like much. When you include the effects they have on your health and/or quality of life, they sound a lot more detrimental. I'm sincerely praying that UHC will look at the whole picture and see how much I need this!

OK, it sounds like this Saturday has officially been washed? I should still be able to make lunch on May 20th.

I'm typing an appeals letters as we speak and will fax it to them today. Kim, I'll fax a copy over to Dr. V's office too. I'm going to ask that they look beyond their predetermined list of co-morbidities and consider my total health (past, present and future) and reconsider payments of benefits. I don't see me going as far as getting a lawyer. If not approved after an appeal, I'll look into financing options. I'm not sure that John and I can swing it, but we'll see. If I have to finance, I may have to wait until John's truck is paid off in another year.

On top of being denied on Monday, I failed to mention the new puppy dog, Max, tore a big chunk out of the corner of our couch and we took him back to the animal rescue :confused: Both discoveries were made within an hour of each other. It wasn't a good day! I'm writing an appeal letter as we speak, and will fax it to them later this morning. I don't know that I'll go as far as getting a lawyer, but I will argue my case.

Bless you all for the words of encouragement! My Mom and Dad are both overweight (although not as much as I am). Both parents have high blood pressure. My Mom's cholesterol is over 400 without medication. My Dad has non-insulin dependent diabetes. My brothers are both lean and healthy so far. As of Thursday last week, I have a diagnosed pinched nerve in my lower back to add to my list. I'm sure my weight doesn't help it any, and the resulting pain is making it impossible to exercise. After a long 8 months, it's really hard to continue to be patient, but I am going to appeal.