NicoleW8ing

Hey Guys! Thanks for your kind replies... Yeah, Jean, everyone seems to LOVE Dr. Enochs. He is doing my band and scheduled me for May 9th. He got me approved and taken care of and he is a TOTAL sweetheart. Love him to death. Dr. Moran... ugh... Seriously... if anyone reads this thread that is thinking of surgery, STAY AWAY! Everyone I know that has seen him thinks he is rude and his office staff is useless. I adore the girls at Dr. Enochs.

Please let me know what your doctor says. I am getting banded May 9th. I miss roller coasters. I haven't been able to ride for a year or two because the chest harness can't close over me anymore, or if it does, it's SUPER uncomfortable. So I just avoided the humiliation and didn't ride but Lord I miss it.

Grats, Whisper. Besides soreness, you're doing alright? Good to hear that your pumped up!

Whoa.... slow down. Breathe. I have seen many people feeling similarly for the first few weeks, as the recovery time seems to be the most emotionally trying. You are doing so wonderfully! You are following your Doctor's instructions... think of obesity as a disease. You are curing yourself right now. Every step in the right direction is bringing you towards better health. Plus, how great are you going to look once the weight is gone??? Slow down. Breathe. Try a different brand of unflavored whey Protein. Sprinkly a tablespoon into everything you eat so that you do not get a concentrated hit of smell or taste. You can do this. I really believe in you.

I was going to make a thread here with the same title. .... I am going in May 9th. I am TERRIFIED... not only of the "is this the right decision?" question but just general surgery jitters. We're all there honey.

Another thing to remember is that hospitals WILL work you. They really don't care as long as you pay anything. $10 a month is still something, you know? This has been my experience, anyway. Moving on to the deductible.... I have a $1000 deductible on my insurance policy, but due to all the appointments and procedures that I have had pre-op, I have met my deductible, so no payment for surgery. Point being, those little $40 copays add up REALLY quick to a deductible, should that be your scenario.

I have Blue Cross Blue Shield of NC... they are covering 100% of the surgery. (Got approval last week).

I was May 2nd, but due to a scheduling conflict (my mom is out of town the 2nd), we moved it to May 9th. I have no pre-op diet whatsoever. (Well, day before surgery just clear liquids) I am not really pigging out but I am not dieting either... Just kind of being normal I guess. We moved this past weekend so the surgery date being set hasn't really "hit home" for me yet. 5 months after I started the process... 90% of which was fighting with the insurance company.

May 2nd, 7:15.... am I the first May bandster? Lol lol lol... I second Magnificent Mays... :redface: Yay... I can't wait to experience it all with you guys!

Hey all... After 5 MONTHS to the day of fighting with the insurance companies and Doctors, I approved for Lap Band and have a confirmed surgery date of May 2nd at 7:15AM. My first consultation was January 2nd. After filtering through two different doctors, dropping weight to get under 50 BMI, and arguing with BCBS, I am approved. I am absolutely elated. I will be one of the first May bandsters, I imagine, as the first is a holiday. :tongue: Thank you all for your support, advice, and most of all friendship for this first part of the pre-op. I can't wait to join your ranks of BIG LOSERS after I drop my weight. :redface: <3, Nicole

I have BCBS... Here's the skinny on the 5 year. They like it a lot, but it doesn't necessarily have to be 5 CONSECUTIVE YEARS. If you can get 5 weights within the last 10-15 years, you should be fine. I was in a similar situation. Instead, I had my grandmother who works at a doctor's office a few states away just manufacture some weights for me. I know, immoral, but after dealing with BCBS for 4 months on this, I am none to happy with their morality standards. My struggle with BCBS has nothing to do with that weight history though, my BMI was above 50. Anywho, suffice to say it is no longer above 50. No one.... not the insurance company, the doctor, no one batted an eye at that 5 year weight history that was fudged for me. In any case, my doctor informed me that not many people have a 5 year CONSECUTIVE history. Remember, the more data you submit to the Insurance, the better off you are... so if you have 20 years off and on, then submit everything you got. Good luck and please let me know how it works.

I'm looking forward to the exact same things... getting banded next month.

Hey folks-- I finally will have a surgery date by the end of the week for sometime in April. Here is my honest to God, unbias opinion of the Doctors and Specialists I have seen. First up, Bariatric Surgeon #1.... Dr. Moran. http://www.alasurgery.com/ The Short: $250 "administrative fee." Unsupportive Staff. Reputable and experienced Surgeon. Bad Bed side manner. Very much to the point. The Long: His office staff was rude, unhelpful, and unsupportive to my needs. They gave me a hassle about faxing my documentating to another doctor when I decided to change. I was denied by insurance because my BMI was > 50. They knew this on the first visit/consultation. Dr. Moran told me all he would have to do is call the insurance company and the denial would be overturned. After I plunked down the cash, the copays, etc, I was told by his office staff that Dr. Moran was far too busy to call me or my insurance company. They referred me to a financing company to pay for my surgery, even though I am fully 100% insured. They offered no assistance in the way of the appeals. Pharrah (office manager), Iris(receptionist), and Ann(bariatric coordinator) are the office staff that I had the displeasure of dealing with. I had to call their office constantly to receive updates on my case. It seemed as if without me calling and asking constantly, nothing got done. Dr. Moran himself was alright, though a bit cold and curt. The office staff motivated me to move to a new Doctor and never look back. Tammi Moore-- Psychiatrist: She is a wonderful woman and knows all about the bariatric surgeries. I really enjoyed working with her and talking with her. I am considering seeing her again after my surgery. Dr. Earnhardt - Cardiologist: This man was probably my favorite of all the specialists I have seen. So kind, attentive, and informative. Loved this visit. Ashley Miles - Nutritionist at Rex Wellness SHe was a total sweetheart as well. It was a joy to see her. Highly recommended. Baratric Surgeon #2.... Dr. Enochs. http://www.surgerync.com/ Angelica at Dr. Enochs is my angel. She was VERY helpful over the phone far before I paid them a single dime. She is the bariatric coordinator over there. She talked me through my issues and got me in to see Dr. Enochs as soon as possible. Luckily, in between visits, I lost the weight I needed for the BMI factor, so that will no longer be an issue. Dr. Enochs himself is a sweetheart and took the time to answer all of my questions. However, there is a $500 administrative fee here. BUT, since I had already paid Dr. Moran $250 and was so frustrated by the process, Dr. Enochs only charged me $250. Yay! It was somewhat of a lengthy wait once I got to the office (30 minutes after my scheduled appointment) and his office in Cary is a bit of a haul from my home in NorthWest Raleigh, but I think it was well worth it. Dr. Enochs also has a FANTASTIC support staff who saw me and spent time with me. I met with 5 employees while there, all guiding me through their area of expertise. Highly recommended. Please PM or reply with any questions at all.

I also have a lump on my breast right on my breastplate. My ob gyn said it's just a cyst. But, go get checked out anyway. YOU CAN NEVER BE TOO SAFE!!!!!

Congratulations to you!!!

:wink2:I look forward to the weight loss from the band so that I can have my formerly insatiable sex drive back. Now... I'm so blase about sex. I could take it or leave it. My fiance... well, let's just say his hard drive is filling up rapidly as a result. *shrug* When I am in the mood, he doesn't care whether I am drunk, frizzy-haired, or in my "fat clothes." Lol. Takes it when he can get it. But, I can definitely handle a 2-4 week wait after op :thumbup:

Truth be told, I don't want to deal with those people. I have another doctor lined up for my follow-ups. My mom works has worked in the hospital where he operates for a very long time. She prefers me to go under his knife than anyone else's. I am deathly afraid of doctors, surgeries, the whole deal. She trusts his slicing and dicing abilities more than the other doctor, though the other doctor has a MUCH better bed side manner and friendly support staff. I'll be switching after the operation. GAH! The idea of dealing with them for a lifetime after my surgery makes me cringe.

Hey guys-- Again, thank you for your warm wishes, your sharing, your experience, your time, and your support. I love this forum so much. Once I know everything for sure, I am going to create a thread in the larger weight loss forum so those of you with higher BMI and BCBS know what to do... Here's my log of this morning: Calling BCBSNC's Utilization Management team (the people who do the denials and approvals) revealed that I did have all my paperwork correct and the only basis I was denied on was the BMI. Good to know... they also said that I probably would not need to appeal, that a call from the doctor to the insurance company's doctor (they call it a peer to peer review) would be all I needed to get it most likely approved. It seems that my problem is not with my doctor specifically OR the insurance company. It is my doctor's support staff. Unfortunately, my doctor's support staff was BEYOND unhelpful this morning. They simply told me that I could contact Capital One for financing. I considered this obscene. They told me my doctor was too busy to deal with the insurance company. Considering my surgery is being billed for $23,700, I find it hard to believe he's far too busy for 15 minutes of my time. I emailed him. He called me within 45 minutes and told me he would be contacting the Medical Review Coordinator and BCBS today. This is a step in the right direction and it keeps me out of the appeals process so I do not have to lose my March 19th surgery date. I'll keep y'all posted. As soon as I finish everything, whatever method I have to take to get this surgery approved, I'll be posting a guide so the next person does not have to deal with this. I've had 3 panic attacks in the last 48 hours, nursed through by Xanax and rest. Undue and completely unneeded stress. Love ya guys! Nicole

Hey all... So it happened. Blue Cross denied me. Through some careful manipulation, I got an appeal meeting for Monday morning. I am digging out everything I have, writing up an argument, etc. (see my thread here: http://www.lapbandtalk.com/f84/devastated-blue-cross-blue-shield-52974/ for the full story). Anywho, I am begging you all for a bit of help, as you all have had unique experiences in this area. I need data, studies, testimonials, ANYTHING, expressing the following: Risks of Gastric Bypass vs. Lap Band Success of Lap Band vs. Gastric Bypass (short term and long term) BMI restrictions and Lap Band Benefits of Lap Band in BMI's over 50. I am researching my own data and coming up with charts and such, but anything you guys could add so I can get approved by BCBSNC would be sooooo helpful. I plan to BOMBARD them with information. Thanks guys. Keep lookin hot!!!!!

Check on Blue Cross's requirements in your states for pre-op. If you don't have all the i's dotted and t's crossed, they'll deny you. Just go over it thoroughly and make sure you have everything, and I don't see why you shouldn't submit it on Day 1. For me, BCBS required a 5 year CONSECUTIVE weight history.

We simply can't afford it without insurance. I'm young, as is my fiance, we have 0 established credit. We both work full time and are in school school full time. Unfortunately, there's not enough money to go around, you know? Thank you for your kind words. Your thought process makes a lot of sense and it is good to hear that you and your husband decided to go with the healthy route. It's one thing that really irritates me about this country... how the health insurance companies rule the roost. If my doctor and I agree on a procedure being healthy and extremely beneficial for me, I don't understand at all why an insurance company has any right to deny it, whether you're underweight, overweight, whatever... C'est la vie. Thank you again!

Lol! Thanks Kat! BTW, looking at your weight ticker is very inspiring. Awesome job!

Hey Guys-- Just a quick update. I called Blue Cross/Blue Shield and they just received my pre-certification claim today. I will know whether I am declined or not for sure by Monday. I'm praying my lil heart out that by some grace I don't get declined at all and won't have to deal with the appeal. If they approve me, I am on track for a March 19th band date. *sigh* Here's hoping!

You guys have really pulled me out my slump, by the way, thank you. I was just distraught this morning. Here's the situation as of close of business today: Losing weight is not an option. Not because I can't but because BCBSNC calculates my BMI for the surgery out of the AVERAGE of my last 5 years weight. I am the heaviest I have been, but not by much. My average is at 50.9%. Sooooo close. I wish I could just drop the extra weight and be done with it and get it approved. I'd have no problem doing that if it were an option at this point. Things aren't so bleak though I guess, just delaying my surgery date of March 19 till ?? when my appeal goes through. Truth be told, I haven't been denied yet, so God could smile on me for a moment. I'll have an update from the insurance of whether it is covered or denied by the end of next week. If it is denied, it is off to appeals I go. You know.... insurance shouldn't be able to decide what is appropriate for me if a Doctor says otherwise. But that's just this liberal's decision. Lol. Thanks people. By the way, all you banders are lookin HOOOOOOOOOOT!!!!! Keep it up!

Well, my coordinator at the Doctor's office said it, the one who does my pre-surgery work up. Here's the link to BCBSNC's documentation on morbid obesity. https://www.bcbsnc.com/services/medical-policy/pdf/surgery_for_morbid_obesity.pdf Notice page 5, number 3, where they "frown" on banding for people with a BMI > 50. I am more than frustrated with the insurance company demanding which surgery is appropriate for me, especially considering that LAP BAND is LESS EXPENSIVE than gastric bypass. Also, I have seen data showing that while gastric bypass does have a great UP FRONT weight loss, lap band equals out to the amount of weight loss over an 18 month period.