em1125

Sorry Penni, I wrote your name as Pam. It was a typo. Please let us know your grandson's name. My church will lift him up in prayer on Sunday. My prayers are with you and your family.

Pam I hope all goes well with your grandson. I am praying for him big time. I have two boys and I can only imagine how heart wrenching this is for the family. Keep a positive attitude. God's got it and all will be okay. Please keep us informed. hugs,

Thanks Mert. I am scheduled for Sept 5th. I will have an answer on the appeal Friday. Hope your feeling better and enjoying the banded side. em

I didn't think so. My surgeon just said he would write the letter as he has done many times to employers stating that the patient had surgery. I think that's all they need to know. em

cindyn, Can you give me some ideas on what you're stocking up on. broth, Jello, etc. Anything else. Protien shakes? Let me know. I just started thinking about this tonight. I am being banded on Sept. 5th. Another issue I was thinking about is cooking for the family. I told my dh that I won't be doing much cooking b/c it may be a problem for me. I'll be on liquids while everyone else is eating the steak I cooked for them. I don't think that may work for the first few weeks. Let me know.

sweesue, Does Human Resourses need to know what the surgery is? Or the letter could state that I will be out for a week b/c I had surgery. (Not being specific on the type of surgery).

I agree with Elisabeth. First off, exercise is a wonderful thing. However, if you exercise 7 days a week, it will be a matter of time before you quit. That would go for anyone that is just beginning. When it becomes a job, it's not enjoyable. He should have started you out 3 to 5 days, 30 minutes. You do what you're comfortable doing. I say, if your moving much more than you were, you doing a good job. Do what you can. Don't do more than you can handle because you will get bored. Biking and brisk walking are a great way to start. It's also very enjoyable. Good Luck! Regards, Take it from someone who did the seven day boot camp type exercising. It's time consuming and not enjoyable whatsoever. I paid the pricer for exercising 7 days a week for a little over an hour.. I blew my knee out and I have serious hip bursitis. Too much wear and tear on my hip. It's a slow process and one that you could eventually build yourself up to if you choose If not, do what you feel works for you.

Cindyn I am in the same boat. I only told one of my sisters. My other sister doesn't know. I chose not to tell her because she doesn't have very good bounderies. She tends to tell people/friends things that I find are very personal. I do, however,feel terrible guilt.I don't know what I will do later on after the surgery but for now I chose to leave it the way it is. As far as my co-workers, it doesn't bother me in the least. It's my business and not anyone elses. Good luck. Regards,

It's very tough to trust people. In your case, even your friend. I know many friends that would tell their husbands. It's a normal behavior. However, if someone tells someone something in confidence, it should remain that way. I'm so sorry. I also told my best friend who is a psychologist by trade. They are trained to keep all things confidential. Besides, I would trust her with my own life. I know she hasn't told her husband b/c she feels that he has a big mouth (non-malicious). I felt if I kept it to my DH, mom, sister and best friend it shouldn't go any further than that. Good luck.

I am in full agreement with you. My feeling is that many people are not coming from a good place. People gossip and can say mean things. I don't want to be under scrutiny nor do I want to be the topic of my co-workers conversations while I'm not there. Our family and friends care and are concerned about our well-being. Although many of us have great relationships with our co-workers, I don't believe it's any of their business. I will have to be out for a week or so. My surgeon said when his patients are out of work from WLS, he writes that the patient had surgery and will need to rest for approximately one week. And when my co-workers ask me, (some of whom I'm close to) I will tell them I had a hiatel hernia repaired. I googled it and I seem pretty comfortable with that diagnosis. It's pretty much the same type of procedure minus the installation of the band. Regards,

I have been working with Kelley and Walter for the last two weeks. They are just wonderful people. They sent the most amazing appeal letter to my insurance company as well as the NY State external appeal board. The letter was 18 pages long and written so well. I would be completely shocked if I don't get approved this time around. My surgery is scheduled for Sept. 5th. I should know by then. Either way, I'm having the surgery. Whether I have to self pay or have it covered by insurance. This is my last shot so I wanted to make it count. You will love Kelley. She is honest, upfront, and very quick to get back to you. I should find out within two weeks or so if I got approved. I wish you all the luck. You will love working with them.

I am in the same boat. I thought I would have had my surgery this summer but, insurance denial has held up the procedure. I am now scheduled for sept. which means I am back to work. I can't come up with something believable. I don't know much about Hiatel Hernias. I was thinking about telling everyone that I was having emergency Gall bladder surgery however, I'm afraid that one day I may need that surgery and I truly don't know much about the surgery. I work in a school and the school nurse asks many questions out of concern. I may answer something completely wrong. I hate lying. The only people who know are my husband, mother, and sister. Help me please.

Congratulations Mert. I am sooo happy for you. Take care of yourself and keep us informed on how you're doing.

Hi Bettina, Who's your surgeon? The surgeon who will be performing my surgery did Al Roker and I'm not sure but I heard from a few of his patients that he also assisted in Carney Wilson's surgery.

Luckily, I don't need to finance. I know there are loans out there. Somewhere on LBT they spoke about financing the surgery and banks that offer this. Put it out there and see what type of responses you get. I know someone on LBT will give you banks that offer this loan. Good luck.

Hi all, Wantlapband, I am so sorry I'm responding a week later. My surgeon's office sent all of my documentation, ie. 1 year of medical weight loss supervision, 5 years of progress notes from my PCP and notes on my back surgery as well. My PCP and surgeon sent a letter on my behalf stating that it was medically necessary. I was denied. We then appealed and sent another letter of dispute from my surgeon. I was denied again. The denial basically said that I have not had a high BMI for a long period of time and I don't have life-threatening co-morbitities. I have scheduled my surgery for Sept. 5th. I am self-paying. However, I have hired Kelley Lindstrom (Obesity Law Advocacy) who is in the process of appealing to the external review process. (my last shot) In the meantime, I don't want to wait any longer. If it gets approved, GREAT. If not, I tried my best. With all the stress that I have been under, I hit my BMI of 40. Kelley had me see my PCP so that we could include that progress note to the external review. The only problem is that the insurance company wants to see a BMI of 40+ for over one year. The denial letter had stated that my BMI has been between 28 and 39 for the last five years and for the most part my BMI has been 35. I have gained the majority of my weight in the last year and they don't see that as a long history of morbid obesity. My insurance company states that surgery is covered if the patient has a: BMI of 35-35.9 with 2 co-morbitities or 40 + BMI with no co-morbitities. Kelley feels that we have a good shot with the external reveiw board. We'll see what happens. I would also like to say thanks to all of you. Everyone on LBT has been so supportive. If I just need to vent, someone has always been there. I have learned so much from all of you. At this point, I am so well informed that I have to say, the only thing I couldn't do is perform the surgery. LOL. I would never have known about appeals, obesity law, writing appeal letters, without the support and guidance from all of you. You all have helped me become stronger during this process. I am so thankful to have found such wonderful and caring individuals as I have on LBT. My prayers and thoughts are always with all of you. hugs, em

Thanks Bettina. Good catch! You're lucky. Anyway, the insurance letter reads that I have a BMI of 39 with no co-morbitities such as sleep apnea, severe heart conditions, diabetes etc. So the answer basically is that I'm too healthy and not fat enough. I'm so upset. I am going to self pay and maybe pursue reimbursement later on with an attorney. The only thing that scares me is if I self pay $23,000 which covers the Hospital for overnight and Operating room costs, surgeon cost, general anesthesia costs and upper GI series. However, if complications arise, that would be an additional cost to me. If the lapband needs to be removed due to complications that's an additional cost of $20,000. That's very concerning to me. Hospital costs can run very high. MY PCP does not want me going to Mexico to have it done. He wants me to have it done here. So that's my story. I'll keep you informed. Please let me know your status as soon as you find out anything. Good luck. My prayers are with you.

Hi all, Thought I would give you an update. As of today, my appeal was denied again. I can't believe it. Anyway, I spoke with my surgeon and I am going to self pay. At the same time I am hiring Kelley from Obesity Law to try and get my money back. As of right now my surgery is scheduled for Sept. 5th. I'm trying to get it done sooner. We'll see. hugs all

Not at all. Thanks Bettina. Let me know when your insurance company gets back to you. I'll keep you informed.

Another thing Bettina, they have denied me based on my past history of obesity. I have had a BMI of 39 for less than 2 months. Before that it was less. They are basing thier decision on my 39 BMI with no life-threatening co-morbitities and not being overweight for at least five years. I of course appealed that because that's a bunch of crap. Like I said before, Obesity is major and causes more life threatning co-morbid diseases. I may not have Diabetes or high blood pressure, but the odds are very much against me if I don't do something about my weight. According to my insurance booklet, I do meet the criterion for WLS. I think they feel I may just back down from this eventually. They are highly mistaken. I feel very strongly about this issue. I have to say, if you look around the LBT forum you will see that many of the people here are self pay. What does that tell us about insurance companies?? It's scary. With all that said, I just wish you all the luck. I know your nervous but hopefully your insurance company is a lot easier than mine. Keep me informed.

I have had blood work and a cardiac workup due to other issues i have had in the last month. We submitted that to insurance and they covered it. But that's not considered pre-op. I will need a recent EKG and blood work done. That won't be a problem getting that done and paid for. But for surgical reasons, the testing cannot be older than a month old. That's why I'm waiting a little bit. I am also having a sleep apnea study done but I'm waiting for insurance approval to have that covered. This is just possibly more amunition for me to get approved. A GI series will be done once I have been approved for the surgery. Good luck to you.

sorry for the mispelling. It's a write-off at the end of the year.

There are medical loans but I'm not sure how to go about it. If you have an equity loan you could borrow from there. Not to mention--it's a right off at the end of the year. I would also ask for help on this LBT website. There are so many people here that are educated on these issues.

Absolutely call them. I call my insurance company once a day to follow up on my appeal. They underdstand that we're anxious. My insurance company told me that it could take up to 60 business days on an appeal. For the pre-authorization it shouldn't take longer than 20 business days. I would definetely call every day until you get an answer.

I have not done pre-op as of yet. My insurance has not approved the surgery yet. My surgeon is requesting (after approval )from the ins. comp that I receive an upper GI serious, EKG, and blood work. I can't do this unitl I know the reality of when the surgery will be perfomred. I will tell you this. I AM HAVING THE SURGERY IN AUGUST NO MATTER WHAT. THAT HAS ALREADY BEEN DECIDED. Whether I'm approved or not. I can't wait another day as it is. I spoke with my suregeon's assistant and she promised that she would schedule/squeeze me in for mid-august should I have to self-pay. It's a big nut to crack but, I'm done with the battling. I will not wait a year of fighting with them. I'm in the position to self-pay however, I could have found better things to do with $23,000. Just a thought... I may hire an attorney to fight this battle to see if I could get my money back. I've heard of these things happening. I honestly feel that the insurance company is completely wrong and unethical. Hey, maybe I'll feel differently about them should my appeal get overturned.