Maggie225

Leslie called me Thursday and told me my insurance denied my surgery (I have UHC) and when she asked them why, the lady said I didn't meet the criteria, when Leslie asked what the criteria was, the lady became agitated and told her she couldn't give her that info, so I got on the UHC website and found the policy for Bariatric surgery and it said: " Bariatric surgery is proven for the following: Class III obese (BMI > 40 kg/m2) Class II obese (BMI 35-39.9 kg/m2) in the presence of one or more of the following comorbidities: Type 2 diabetes Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris, hypertension or coronary artery bypass) Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy) My BMI is over 35 and I have type 2 diabetes, plus GERD and High Cholesterol, so I'm not sure how they could have denied it. Leslie said that Dr Posner would have a one on one peer review with my insurances review Dr so hopefully it can get approved, especially since I have already had all my pre surgery tests done and my surgery date is May 4th. So everyone cross their fingers and toes for me:confused:

Ok, so BGH called today and stated I have an appointment on April 8th....OMG...I told her "NO" my appointment is April 23rd for my last weigh in before surgery which is May 4th, then she said yes I have you scheduled for that day (April 23rd) so where did they get April 8th??? I also found out that my appointment in Jan. that was billed to my insurance was not me and wasn't even Dr Posner...what is wrong with that office. If I wasn't this far along in the process I would definitely change Dr's and facility, but I've come this far and it has taken me almost a year, so I hate to start over......GGGrrrrrrrr I really have a problem with incompetent people and it certainly makes me more nervous about the surgery.:thumbup: Okay I'm done venting now, hope everyone else has a great day:smile:

Actually this whole process has taken longer than I expected (so you would think I would be ready by now...LOL) I got the application and sent ALL my paperwork (Dr's notes, letter from my doctor, etc.) in June 2009, I had my phsyc evail done in Aug (on my own) and still never got into a seminar until November and then I never had my 3 hr meeting with Barb until 01/28/10. So this whole process has almost taken me a year, and as of now I'm still waiting to see if they can get the insurance to approve it. Did it take this long for everyone else?? Maybe I'm just an impatient person :wub: LOL And does anyone else think the office is chaotic, my appointment was at 1:45 and Dr Posner never came in until after 2:00 then someone came in and got him for a meeting, so I waited and it was near 4:00 before I got out of there, and i wont even mention what happened with the billing last time I was in there :sad: But Melissa is fixing that, Thank God

I was in and saw Dr Posner for my consultation on March 8th and he set a surgery date of May 4, 2010. I didn't think I would be this nervous, did anyone else get cold feet or is it just me?

I LOVE your tattoo Jenn :smile2: Thanks for sharing it with us.

I absolutely love moons and stars. I've been thinking about getting another tattoo but I fugured I would let that be my reward after I lose some weight:smile2:

Mkat, I also had to take that true/false test and by the end of the 589 questions I was beginning to think I was crazy:blink:. The questions were outragous. I went to a local lady here where I live and I wasn't to impressed with her either. She seemed to be bothered with the whole process, go figure...she could have been a little more friendly or atleast pretend especially since I had to pay her $175.00 for the 2 hours I was there:mad: I am glad to have it all over and done with and hopefully the results come back that I'm not insane and can have the lap band surgery...LOL

Hello all, it's been awhile since I've posted on here so I figured I would let everyone know where I was at in this process. I have my psych exam today at 1:00, and I'm still waiting for my paper to see what day the seminar is this month (they told me when I went in in Aug that I was signed up for the sept. seminar so I hope they didn't forget about me) I am so excited to get this ball moving a little faster. I need to go back and weigh in again, so I can start the SB diet, but I wanted to wait and see when the seminar is so I only have to make one trip(but if it's not till the end of the month I better go in sooner :blushing: Hope everyone has a great day:rolleyes2:

I am signed up for the Sept. Seminar, WOOT, WOOT:thumbup: I have a question though. Does everyone have to have a sleep study done before the surgery or is it only the one's that may have sleep apnea? If it is a requirement I want to go ahead and get it done now. Dr hoffmans office gave me the form for the psych exam so I'm going to get that done ASAP, I just want to make sure I get everything I need done before the seminar so hopefully this process goes as smooth as possible.

I sent my paperwork in last week and haven't heard anything back yet. Should I call Dr Hoffman's office? Could someone give me the number (including the area code please) I just really want to make sure the ball keeps rolling here. Thanks :tongue_smilie:

Shar, I am just sending in my paperwork, so as of now I dont have a consult date yet, but I will keep you all posted:smile: I really hope this goes quickly. Do you have to go to a seminar before the consult with Dr Hoffman? The paperwork says they will call or send a letter telling me when the next seminar is, how long did this take everyone to get?

I also need to lose 85 lbs. and I would be more than happy if that happened within a year. I have not been banded yet and I'm still concerned my insurance wont cover it. I'm 230 lbs 5'7" with a BMI of 36. I will be sending my packet of paperwork to the surgeon's office tomorrow, so hopefully I will get a consult and be eligible for the lap band surgery. I have been very thorough to dot all the I's and cross all the T's so hopefully this process wont take too long. Keep your fingers crossed for me :thumbup:

I am so excited, I just returned from my Dr's office with good news. I had taken the liberty to write a "sample" referral letter for my PCP and when I got to his office he said it was the best written letter he had ever seen and asked if he could just copy and sign it....YAY...(I am a certified medical coder, so I used CPT codes and I think I did a fine job on the letter *pats myself on back*) :thumbup: I was afraid he would not refer me for the lap band but he thought it was a good idea, so for now I'm on cloud nine. I have all my paperwork in order now and I'll be mailing it back to Dr Hoffmans office tomorrow, so hopefully this goes smoothly. I'm keeping my fingers crossed. And another good thing happened, my Dr said that if they require a sleep study, he would be more than happy to do that (since he is the sleep study Dr at our local hospital) now how lucky is that, my PCP is also a sleep study Dr. I think this is truly meant to happen for me, all the pieces seem to be going into place. Hope everyone else has a great day too.

Thank you all for posting to this thread. After reading everyone's stories I feel much better. I am currently 5'7" and weigh 230 lbs which puts me at a BMI of 36, but for the past few years my weight has gone up and down and at times was under a BMI of 35, so I am extremely nervous that my insurance will not pay because I have gone below the 35. but now I think I might still be able to have this surgery in Mexico (at a reasonable price) if my insurance turns me down. You all give me hope, thanks again:smile2:

I received my application from BGH. I got most of it filled out but I need some dates from my PCP files (because I can never remember dates) so I called his office today and requested my complete chart to be copied so I can make sure everything I need can be sent together (whats that saying "if you want something done right, do it yourself":rolleyes2:) I really want to make sure I have all my ducks in a row before I send in my application and hopefully that will save me time in the long run, plus I would feel much better having my chart handy so I can make copies if I need them. I am trying not to get too excited but I really want and need this surgery:thumbup: Everybody keep your fingers crossed for me