serenity55

Not too long ago I posted that I'd been denied, and was looking for support. Weeellll ... I went to see my primary care physician on Tuesday. She told me that the medical group I belonged to had been "bought out"--or words to that effect--by a larger one, so she was resubmitting my request for a consultation. I got a letter yesterday saying that I was approved for a consultation with a surgeon! I'm so jazzed! I've been trying for six months to get this far, and I don't care what I have to do now, because I feel like I'm on my way to band land!

No, as a matter of fact, I felt better after deciding not to do the gig. The music was pretty awful, and it's taken me a long time to realize that I get to choose what I want to do. I haven't always felt like that, and now that I think of it, I have turned down other gigs, because either they didn't pay, or I felt that I was being taken advantage of, meaning it was just assumed that I'd play. I think the hardest thing with this one was saying no, because the person I talked to was so nice, and it was obvious that she, (she's the librettist) knows nothing about music, vocal, instrumentation, anything, and the composer, according to her, knew nothing about writing vocal music.

Obesity law is an organization that helps people who have been denied WLS, and are appealing. (They also deal with discrimination, and probably other things, too. Anyway, their website is obesitylaw.com. I've read quite a few posts on this site from people who have been successful in getting approval for lap band surgery. (There may be someone else who can explain what they do a little better than I have.) :-)

Hi all, I think this may be the first time I've done something like this. I was approached to be musical director for something which was called "an opera with jazz influence." I agreed to listen to the music, and decided it wasn't something I was interested in, so I turned it down. I didn't hear the influence from either genre, and the melody lines for the songs that were written seemed to have no shape; no theme, none of the traditional stuff I'm used to hearing in the music I've played. Has anyone else dealt with anything like that? Or have you ever simply turned down a music job for any reason?

Missybelle, thank you. It's really easy for me to get down and ask myself why I'm fighting so hard, but when I'm in the place I am now, just waiting, it's just as easy to feel hopeful. There's part of me that simply will not give up, even though I ask myself just what I think I'm doing. Bikini Beachy, that was kind of creepy for the psych doctor to call you on your cell. My doctor was a little strange too, but my doctor read his report to me, and basically it said that I could benefit from getting the lap band. Thanks again to you both. Debbie

Bikini Beachy, thanks for asking. I had an appointment with my doctor this past Tuesday, and the first thing she said to me was that the physicians' group I was with has been sold to another group, so she's resubmitting everything. I'd contacted obesity law and they thought they might be able to help me, but when they learned I hadn't even allowed to see a surgeon, they wrote back to say that I was "caught" between my medical group and the surgeon, or something like that. But I was given the name of a doctor to contact to see if there might be a "fit" by which I guess they mean something could be worked out. I'm not giving up, but boy! this is so frustrating!!!!

I live in Van Nuys, and though I'm not banded yet, I love the idea of a group for bandsters, and if we were welcome, though of us who are waiting to be banded.

Hey there! I haven't posted here for quite a while either, as you can see, and I've been trying to think of something to keep us going. So thanks, marie! I'm still fighting with my insurance company, but my psych eval went well. 567 questions, plus the oral part! They've denied me, and the medical group I was with was sold to another one, so my doctor is submitting everything again. I also wrote to obesity law.com because I've read so much about how successful they've been. I've just been asked to be a musical director for an "opera with jazz influence." I've listened to the music and it's, um, interesting. If anyone has any ideas about how much to charge let me know, because, although I've done this kind of thing before, the fee was set, because of budgeting. It really is great when students catch on to music, isn't it? Chime in, anybody, please! Debbie

Hi Bev, It’s nice to know I’m not alone. Thank you for your post. I did contact obesity law because I’ve heard positive things about them, but I wasn’t sure if I should have my doctor appeal or just let them do it. I asked for an opinion about that, and am still waiting. But I’m thinking I’ll just let them help me. My physicians group told me they were denying me because I didn’t have six months’ proof of weight loss, and before that it was other things Let me know what happens with you. How long ago did your doctor’s office fax everything? Good luck, and thanks again!.

Michee, thank you for the encouragement. I’m going to try everything I can. I’d thought about self pay, but that’s just not an option for me, or at least, I didn’t think so. I believe my insurance will pay for it, and if they don’t they’re going to give me a good reason why. Skinipete, as you live in Florida, you have no idea how bad the transportation is, nor how difficult it might be for me, because I am blind and don’t drive. I don’t use my blindness to get pity; I’m simply stating a fact. Even if I were to get to a doctor closer to me I’d still have to travel for whatever classes or groups that were required, not to mention post operative appointments. I wouldn’t ask any of my sighted friends to drive me that far, not with the price of gas, and the time it would take. When I said it was an hour away, that’s in a car, directly from my house to the doctor’s office, not sharing a ride with others, which is what I’d be doing. Yes, I want to get a lap band, and I want it badly, and I also know that my insurance company has sent people to doctors closer to home. All I’m asking is that they do the same for me. I think that’s my right.

Yes, I’m definitely going to appeal. I think the fault lies with the insurance company. My doctor told me to be prepared for a fight. I’ve written to obesity law.com to ask if I should let my doctor appeal first or just go with them. I just learned I might only have one chance to do that.

I guess because she didn't think she could send me to one without authorization from the insurance company?

Beth, I know it's very confusing. My insurance company has different plans, and the one my employer has chosen makes me start with my primary care doctor. I couldn't even get a referral to a surgeon, but in talking with the support person, I was told that bariatric surgery isn't excluded. I'm confused because most people on this site have been sent to a surgeon, but I can't even get that far, so I've just done what they've told me they needed, the psych eval, the cardiology exam, whatever. I'm not giving up, but it's very frustrating because I feel like I'm not being given the same treatment as most people here seem to get, i.e. going to a surgeon and doing all the pre op testing and nutritional guidance under that person's guidance. I've made an appointment to see my doctor, but that's not for another week and a half. I have six months to appeal, according to the letter I got yesterday, but I want things to happen now, and I hate waiting for another week. I was also told that the insurance company would appeal for me, too, but it was suggested that I first go to my primary care physician. If I had my way, I'd go to her, the insurance company, and obesity law. Can you tell that patience isn't a virtue? I'm just going to try to keep searching and learning, as my signature says.

Thank you both. Karen-Karen, I've never heard of the body bug. Interesting. I'm really intent on making my insurance company pay for the surgery. I spoke to the liaison, or support person that deals with my employer, and she suggested that i have my doctor appeal for me, or call the member number on my insurance card and have them appeal. I've also read about obesity law.com on this site, and am seriously considering applying to them for help. I went on their web site last night and liked what I read. Veronica, I wish you lived closer to me. You said you'd be calling every day, or writing letters every week. I really think that's how you get things done, and it's not something I'm good at, but i guess I'm learning. that's great that you didn't have any trouble with your insurance company. anyway, I feel better knowing that I have options--not that I didn't knowthat last night, but I was just so bummed everything seemed hopeless, and i thought, why am i trying so hard? Debbie

Thank you, BikiniBeachy. I called the insurance company, well, actually, i think the woman I talk to is sort of a liaison between my employer and Pacificare. Anyway, she gave me some options: 1. Call my doctor and have her appeal, because, she says, that might carry more weight--no pun intended. 2. Call the member number for Pacificare and have them do the appeal. and 3. I told her about obesity law.com, which she thinks is wonderful. So I'll leave a message for my doctor, maybe go to see her, or maybe I'll just contact obesity law. Like you, I've been doing this since March, and while I know that many people deal with this crap for much longer, I don't want to if I don't have to. Debbie

Hey Beth, thank you for the words of encouragement. I know that some insurance companies just don't want to pay for weight loss surgeries; in fact, my best friend was saying that this evening. It really makes me mad, because, like you, I take medication that i'm sure I wouldn't have to, if I lost weight. I might even be able to lose my CPAP machine, which I know cost them a pretty penny. It all adds up. Thanks again. I needed to read what you had to say. Debbie

Thank you adamsmom and April. I know I'll keep fighting, my best friend tells me I'm a true Capricorn, stubborn, and a climber, whatever that means. I'm just not used to going for something like this that I really want. But I must really want to be banded, otherwise why would I be so upset? Thanks again, to both of you.

I posted this on the insurance thread, but I guess I really want encouragement and support. I’ve been dealing with insurance for months now. First they told me that I wasn’t elegible to get a lap band because they didn’t have office notes from my doctor. Then it was because they didn’t have a psychological evaluation. Then it was because they didn’t have five years proof that I’d tried other weight loss methods. (Or maybe the weight loss thing was first.) Anyway, my doctor sent office notes, I wrote a letter explaining why I couldn’t show proof that I’ve been trying to lose weight, not just for five years, but for over twenty. Oh, my insurance company also wanted to send me a very long distance from where I live. I don’t drive, I use public transportation, and I explained that it wouldn’t be good for a post operative patient to travel such a long distance. So I’ve been denied, and I’m so depressed I just want to crawl in to a hole, or in to bed, and stay there, eating myself to death, because that’s the one way I know I won’t feel anything. But I am feeling, because I’m upset. I think, Well, maybe I just don’t want the band, but then why the hell am I fighting, and why am I so upset? Answer: Because some part of me does want it. I will probably feel better tomorrow, and hopefully I’ll find the strength to do what needs to be done. I guess I just need some encouragement, support, or a good talking to? But be gentle, please?!

Well, it’s official, I was denied, because I didn’t have the six months’ attempt at losing weight. Before that it was that I didn’t have five years’ proof, or the psych eval. I’m really depressed and feeling like there’s no one to help me. Pacificare, or at least the physicians’ group I deal with, gives me reasons, one at a time. I know that if I really want this I’ll have to keep fighting, but right now it really sucks! I know that I can appeal, and I know that I will, but I’m just so sad right now.

Sooner, that's fantastic. I'm still fighting with insurance, so I think I'll check out their web site. I hope they're nationwide! good luck! Let us know how everything goes! Debbie

Thank you HeatherO. I've been playing phone tag with the woman who does authorizations today, but I'm hopeful. thank you for the encouragement.

OK I did the psych eval and my primary care doctor hadn’t received anything, so I called the psychiatrist back, making sure he had the fax number so he could send the results. I called again last Thursday to find out if my doctor had received anything. Yesterday I got a letter from the physicians’ group saying that they want office notes from my doctor, dealing with my attempts to lose weight. I’ve talked to her about the things I’ve done, but I’m not sure how much she’s documented. I’m going to call her tomorrow to find out, but I’m wondering if anyone has any suggestions as to what I can do if she doesn’t have anything on paper. I was feeling very hopeful because they didn’t mention the fact that they were waiting for the evaluation, so maybe they got it. If that’s all they want now, maybe, just maybe they’ll approve my band! Thoughts and opinions, please?!

Yes, Debbie, hang in there! We're all with you!

Debbie, I was a little nervous about the psych eval, but it wasn’t bad. There were some rather strange questions,--well strange to me, though I suppose some people might have answered yes to them. There was nothing related to weight, but there were questions about childhood. The one I remember was--and I should say that they weren’t actually questions, but true and false--My Mother and later father, was a very good man/woman. And then later still, I loved my father/mother. I’m not sure I understand the purpose of the psych eval, even though the doctor explained it. Old age, I guess. Hahahaha!

I had my psychological evaluation today, well the second part, which was all true and false--567 questions! A friend from work read the test to me, and it took the better part of three hours. I talked to the psychiatrist last Monday, and he was very nice. He seemed impressed with me, though I have to wonder how much of that was because I was blind. People sometimes think that what a sighted person would be expected to do is admirable in someone who is blind. Anyway, I’m glad I read a lot on this board about the evaluation, because I was aware that many of the questions were phrased in such a way as to make one think they should have different answers, but they were the same as some I had already given. And nothing about losing weight. Guess they just want to see if I’m really crazy! Now all I have to do is keep my fingers crossed to see what my service provider says. If anyone reads this, please wish me luck!