jillrn

I have been fighting to get this approved for about 15 months now. I have jumped thru all the hoops and I should get my approval sometime this month! I hope to give myself a lap band for Christmas!

My story is I was denied based on my insurance having a restriction placed ON THE SAME DAY I SENT IN MY FINAL PAPERWORK!!! WLS had always been covered and I received no notice that it was changing! I appealed twice and lost twice. Then I found out my employer changed and is now offering to cover WLS. I was so excited except I missed the sign up period b/c they didnt tell us till afterwards it was going to be covered. However I was thinking about going FT ( I am PT now) and as much as I dont want to I have decided to go FT so I can pick up the insurance. :clap2: I can get whatever WLS I want for $3500. Unless I pay for a better plan then I can pay 2500. for the surg, but the prem would cost me 2500/yr so I am going with the 3500 plan and save about 1500 dollars. I still think I want to go with the lap band vs GB though. I must admit I am still very nervous b/c of all the erosions on here. Dh is not comfortable with me getting GB either. I am hoping to be a bandster by May!!!!!! On a positive note though I have been working out at the gym very hard for the last 7 weeks almost 5-6 days per week and eating well. I have only lost 9 lbs but at least it is a start-- 102 pounds to go!!!!! Good luck to all of you! JIll

YOUR AMAZING!! I say you decide-- oprah- dr phil whomever and we will all FLOOD them with emails on your behalf asking to help you with this skin problem. WE WILL ALL DO IT RIGHT EVERYONE??????

Kelly- I was going to ask that too about how much weight loss or weight left before doing this. I see you have 28 pounds to goal. I assume a good amount of that will come off with the TT, but are their any standards?? Like you have to be within 30 lbs or something??? It would be a bummer to have to have it again for people so what are the rules???

my dr will cancel the procedure if there is weight gain between preop check and surg day. =(

It seems like everyone on here has a goal between 150-175 lbs. Are you all giants or what?? To have a healthy BMI my goal has to be around 105-110 lbs. That seems very out of reach for me as it over 100 lbs. I would be happy at 125-130 but that would put me still in the overweight catagory-- barely but still overweight. I am short (4'11") but if my goal was 150 (seems more realistic-- I would be Obese! Does anyone get to goal?? And has anyone had a low goal like 105 lbs?? My surgeon asked what my goal weight would be -- I told him wherever I feel good at. I didnt have a number goal. I hope insurance doesnt require a certain goal that must be attained

I would really need to see a differential to be able to tell much, but yes it is slightly elevated, I would try and figure it out before surg. Jill

Many of you have followed my saga trying to get this surg approved and my appeals-- THank you for your support! I was denied by Anthem for my second appeal. I am insured through my dh and they have always covered the surg until Nov 1 the same day my paperwork was submitted they excluded anyway ON TO THE GOOD NEWS!!!! I found out my work is covering it for 1000-1500 dollars!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I dont have the insurance at my work though, I am PT but they said if I go FT I can pick up the insurance then I would be covered. I have been thinking of going FT b/c we need the money right now, but I would probably want to drop down to PT again next year or maybe even next fall. Is this ethically wrong?? I can still keep the coverage PT I have to pay more (which I will keep it b/c I will need it for fills right??) I am so excited I feel hope again for the first time in a while! I need this pray it works out ANyone have WAUSAU?????? thanks again you guys have been so supportive!!!! JIlll JACK-- YOUR ARE SO COOL_THANK YOU!_ I AM GOING TO KICK SOME BUTT--I AM GOING TO KICK SOME FAT BUTT AND LOSE MINE!!!!

Many of you have followed my saga trying to get this surg approved and my appeals-- THank you for your support! I was denied by Anthem for my second appeal. I am insured through my dh and they have always covered the surg until Nov 1 the same day my paperwork was submitted they excluded anyway ON TO THE GOOD NEWS!!!! I found out my work is covering it for 1000-1500 dollars!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I dont have the insurance at my work though, I am PT but they said if I go FT I can pick up the insurance then I would be covered. I have been thinking of going FT b/c we need the money right now, but I would probably want to drop down to PT again next year or maybe even next fall. Is this ethically wrong?? I can still keep the coverage PT I have to pay more (which I will keep it b/c I will need it for fills right??) I am so excited I feel hope again for the first time in a while! I need this pray it works out ANyone have WAUSAU?????? thanks again you guys have been so supportive!!!! JIlll

It looks really bad-- everyone was great except this lawyer they had there she had every reason under the sun why they shouldnt have to cover it. Some of them were just plain untrue--- she tried to say that the band and the high number of complications related to the band is more expense the the cost of obiesity! She has no clue- I am a nurse- I see people with heart attacks, stroke, cancer and diabetes everyday run up hundreds of thousands of dollars in one hospitalization. It really seems like their mind is totally made up before you even appeal. I should know their answer with in a week but I am sure it in NO WAY, So I have to figure out what the next step is. I am going to look into Indiana's Dept of Insurance and see what I need to do to file a formal complaint and get an independant appeal board to look at the case. I could just cry..... I dont know what to do to lose this weight-- I have tried everything

You go girl-- I hope to be joining ya!

ok I have been trying to post all day hope this works. Wednesday I am going to stand before the appeal board and I am just curious if anyone has done this and what they will ask me, or any advice to improve my chances?? Jill

wish me good luck! I did find out that my dh boss really cant do anything to change the policy b/c Anthem controls the plan and they do not "self pay". So this appeal is my only hope then if I want to go further I have to sue them. I cant go before a independant appeal board b/c it has to be that they are denying me due to medical necessity and that is not why they are denying me. I really really hope I can get this approved! Jill

When I asked my surgeon about this he made it sound so rare and obviously it is not. He said he hadnt had an erosions but some that he heard about some on the people are doing just fine without any complications and are keeping their band. This seems dangerous to keep the band-- it seems like it could open you up to serious infection, any one know about this??? Jill

Dh talked with the president of his co. today about the fact that the insurance denied me, and the whole saga. His boss said he will do whatever it takes to get it approved for me!!!!!!!!!!!! YEAH!

Dh talked with the president of his co. today about the fact that the insurance denied me, and the whole saga. His boss said he will do whatever it takes to get it approved for me!!!!!!!!!!!! YEAH!

Do not open the prilosec capsules and try and put them in anything. I am sure you will get plugged. We use this stuff all the time at the hospital and it clogges our G tubes quicker than anything. They do have a liquid prilosec out now I am not sure you can get it without a script though. Jill

My first appeal was denied before they even got my paper work or appeal letter. It was denied based on me saying "I want to appeal, send me the forms" They sent then but sent me the denial before they really even received the forms based on the new "exclusion" they inacted the day my surgeon requested the procedure. hmmm these people are really shady-- so now I am going to stand before their board of appeals with their Dr's RN's and lawyer and such. I am not a bit intimadated at all-- this is probably a good thing b/c they wont realize what is coming at them is a strong, determined, and educated person. I think my Dr is going to join via conference and I may have a lawyer present if I can find an affordable one. Anyone have experience with this????

yes I am going to go before a panel of Dr, RN's and such at a appeal hearing I wish I knew where I could find some legal info about min coverage in Indiana law. Anyone know? Anyone know and use a lawyer specializing in Bari stuff???? thanxs Jill

Well I faxed my stuff in the 1st in the afternoon and I sent in certified mail too. I got a letter dated the 2nd denying the appeal for the same reasons. I want to know how they could have got my letter read it and denied that quickly they cant do anything overnight and this was less than 12 hours ????

Well I sent it-- actually I faxed it and I sent in certified mail too. My dh talked with his HR person at work and she wasnt even aware the coverage was dropped on November 1!!! ( the same day I filed my paperwork to be approved) Err anyway we will see from here. I have to wait 20 business days to hear the answer and then I will contact a lawyer if need be. I really hope we dont have to go there! Jill

Thank you-- I am just wanting to know the facts whether I want to hear it or not! =) Jill

I agree with alex-- I am a nurse and I have seen lots of GB pt's with severe complications and although annoying slippage and erosion is nothing compared to some of the complications from GB I really hope yours works out without surg! Good luck Jill

Thank you ReneBean-- I am just here looking for help and support from those who know this all best--the ones that have been here. To describe my letter as "very controversial" is a bit extreme. I know Johnnyreno you have had some problems on here but I was not involved nor do I wish to be. Please can anyone give me some helpful comments?--thank you to those few people that already did. Emily thank you I agree I hadnt caught that I have corrected it on my main draft thanks Jill

NO I am not I am privately insured but this does not indicate it is for public employees at the top it even says "to amend Indiana code concerning insurance"