em1125

That's a good sign. However, I thought after my letter and the letter from my PCP it was going to be a slam dunk. Boy was I wrong. I had every health document plus and I was still denied. You approval looks good. If the insurance company is already paying for your pre-op then I would assume they will pay for the procedure.

My insurance covers the procedure. As a matter of fact, most insurance companies cover WLS now however, they make the process extremely difficult. Insurance companies want to see a BMI of 40+ (I don't have that) or a BMI of 35+ with two co-morbitities. (I have that) The problem... If the Insurance company does not find it to be "medically necessary" they could deny you. Basically, that means if we don't have life-threatening co-morbitities, they won't cover the procedure. Obesity is a disease and as we all know a disease that could potentially kill us. That alone should be the deciding factor in determining medical necessity. It's a scary thought. I know my insurance company and probably most insurance companies would approve with a 40+ BMI as long as the patient has been at that BMI for atleast five years. Then again, I have heard of people getting denied with a BMI of 44, 45, and 46. So who knows. I honestly think that insurance companies deny patients hoping that the patient would back down after the first denial. Are the tests that you're taking Pre-op? Are you in the process of pre-authorization? Who is your insurance company? em

Is that true? I never heard that. Thank God I'm not doing that. That's the last thing I need to do. lol em

I'm not banded yet, but I suffer with severe chronic hip pain and lower back pain when I'm about to fall asleep. I have to take AMBIEN to help me fall asleep and not wake during the night. If I don't take AMBIEN, I would be up most of the night. It's great and it's safe. Your PCP would have to prescribe the medication. If all else fails, try it. It gives me a solid 7 hours sleep. Feel better. Em

AWESOME! Congrats. I wish you all the best. After 3 denials and all of your hard work, you truly deserve it. I bet the insurance company thought you would eventually quit after a few months. Good for you. You fought for one year and now it paid off. In the year of fighting with the insurance company, did your weight increase, decrease or remain the same? I am very happy for you. Hopefully, I should be hearing something soon and maybe I'll be celebrating em

HOLY **it !! Too much chopping. LOL However, it was absolutely worth it. The soup is awesome. Thank you. I'm not starting the soup diet yet because I'm going away. But for the next few days, it's great as far as eating light and healthier. When I get back from vacation, I am definetely going to try this diet. em

I am so happy to hear things went well with you in Mexico. Congrats! I can't thank you enough for sharing your experience. It is truly helpful. I am in the appeal process and I'm getting extremely impatient. If the appeal doesn't get reversed, I am going to self-pay. I have a wonderful surgeon in NY but he comes with a hefty price tag of $23,000 including hospital fee. My husband wants me to have it in NY and just self pay but hearing such wonderful things about Mexico is truly making me think. I have only heard wonderful and positive feedback from from LBT. It means so much. Congrats again. Be well. Regards, Emily

Welcome Kathleen. I too am waiting for approval. However, I am now on my first appeal and waiting for the decision to be reversed. Hopefully, I will know soon. You couldn't have come to a better place. LBT has been the best thing for me. I have learned so much here. The support from all of the wonderful people on LBT has been unbelievable. You will learn a great deal. Welcome aboard. Emily

I have been seriously considering Mexico. My family and PCP are totally against the idea of me leaving the country to have this procedure done. I am totally fine with the idea. I have only heard wonderful things about Raumbault. It's funny, my DH and I have been truly considering this. If I have my surgeon perform the surgery, it will cost anywhere between $23,000 and $25,000 in NYC (which I have already considered paying). We'll see. em

Hi all, Just an update. My PCP called my insurance company to see if he could get any feedback. He spoke with the medical director who was ultimately the one who made the final decision on my denial. The medical director told my PCP that the reason he denied me was because I have not had a BMI of 40+ for five years. He also said that my appeal is with someone different and that this person may feel differently. Basically my BMI went from 32 to 39 within the last five years. I would say looking at this record I'm definetely on a upward slope here. So we'll see. No other info to report. I'm getting very impatient and truly want to have this procedure done asap. em

pbrown, Good luck to you. I should be having the surgery arounde the same time as you in August. I'm waiting for my appeall to be reversed. I should know something in the next week or two. If I don't get approved, I am hiring an attorney (i think). I just don't know if I could wait more than a month. I'm getting very impatient. If I have to, I will pay. However, I'm nervous about self paying. I want to use the surgeon in NYC and he's very expensive. We'll see what happens. I am very happy for you and wish you only the best. Emily

Thanks so much. I'm with you as far as getting it done as soon as possible. I told my husband that I will fight up until the end of July and then I'm done. I will self-pay. I work in a school district and I'm off for the summer. I chose not to tell anyone about the procedure except for my husband and mom so I need to have it done before I go back to work at the end of August. Thanks. I'll let you know what happens. I should know something by the end of next week. Em

That's great news! Good luck. If everything goes well with my insurance I will have the surgery around the same time.

Elizabeth, That had to be scary for you as well. Thank God you did well. I see you had your surgery done in NY. Are you from NY? Em

I met with my surgeon individually. Loved him. I chose him because he's a very well known bariatric surgeon in NYC. He has done several celebrities and has been in the media alot in the last few years. Your BMI is not very high however, you have life-threatening co-morbitities. That alone should get you approved. You probably mentioned this on one of the previous threads. I don't remember. Why are you on blood thinners? What's wrong with your circulation/heart? Talk to you soon. Em

Good Luck! I'm so happy for you. I had a dream last night that I had the surgery already and I was 60 lbs. lighter. It was awesome. Too bad it was only a dream. One day. I should hear from the insurance company Monday or Tuesday hopefully. em

I had one year of documented weight loss from an MD diet doctor (medifast). I also had five years of documented weight from my PCP. I also had open heart surgery. I suffer with irregular heart beats. Sounds bad but my heart surgery was and ASD repair (hole in my heart). I have very high cholesterol. I had cervical spine surgery 3 years ago and a bad lower back. I have chronic hip bursitis and I'm receiving cortisone injections to reduce the inflamation. The hip problem has limited my walking and sleeping. In addition I have a huge family history of heart disease and diabetes. This was all documented to my insurance company. The denial letter stated that my co-morbitities were not life threatening. Imagine! That's why I'm so passionate about fighting the insurance company. I didn't realize that morbid obesity wasn't a life threatening disease. HA As far as wearing weights, did you get your last reply on the other thread. One man had said whoever cheats the insurance company doesn't have INTEGRITY. LOL I laughed and had to respond to such an ignorant remark. Anyway, I think I had the appropriate documentation for my insurance company. My PCP also called the Medical Director of my insurance company today. We'll see what happens on Monday. Regards, Emily

WOW! You look AMAZING! What a difference from before and after. Congrats. em

You're in my prayers. You'll do great. Good luck. Want to hear from you soon. Emily

Mert, Gary never returned my phone calls or e-mail that I sent him. However, Walter Lindstrom is willing to take my case. I gave him all my info. He feels that I have a very good chance of getting this decision overturned. I am not hiring his services as of yet. Like I said before, I am waiting for my first appeals to be answered. If my insurance company denies me again, I will use Walter Lindstrom's services. He has three payments that you can choose from. $450 which includes a look at all your information and an appeal letter sent to the insurance company. $850 for a letter of appeal, telephone services to client and insurance company, as well as follow up to the end. $1100 if you need an appeal done within 3 days. If my appeal doesn't go through, I am hiring him as my advocate for $850. He has a very good reputation. He's with ObesityLaw.com. I know I told you about Gary, but after 4 phone calls and an e-mail, I don't want to use him. I was very impressed with this lawyer. He was very thorough and gave me all the infomation I need to start the ball rolling. We'll see. Hope this is helpful. Em

Mia, Congrats! You should be very proud. I can't wait to be in your shoes. Thanks for the inspiration. em

I wouldn't be so quick to judge whomever decides to cheat the system. No one should be judging anyone. For some people it takes desperate measures. And if there's someone lacking integrity, you need to look at the people in the insurance companies making life decisions for patients who are in great need of WLS. I am in full agreement about not gaining weight for surgery. That's purley self-sabotage. However, I'm not going to call these people weird or nuts. If Weight Watchers, supervised MD diets, or other support groups were successful, three quarters of the people on this site would not have had WLS. FYI, only 5% out of 60% of Americans who are obese will lose their weight and maintain it for many years. The rest will continue to gain weight, lose some and gain more back or just maintain their dangerous levels of weight. Instead of critizing people, it would be more beneficial to this post to come up with ideas to help people in need. There's no need for any kind of name calling. We would all appreciate good advice and ideas. We are all here to help one another not be judgemental in any way. My advice to all - if your in the process of an insurance denial, fight it. Don't be discouraged. Em

Iulizbug, If by chance I would have to self-pay, what happens if I have a medical emergency regarding the band. What if it slips or erodes? Would I also have to selfpay that. What would happen if the patient needs to have an extended hospital stay due to complications? What has been your experience? That's the one thing I'm truly nervous about. Let me know. Em

My surgeon's office and PCP thought I would not have to appeal this. They felt that I should get approved without a problem. Who is your insurance carrier?

Iulizbug and wantlapband That is one hell of a creative idea. Love it. Atleast you didn't truly gain the weight. I don't believe that is a healthy way to go. After all, there is a good chance that you won't get approved right away. Then what. You now have all this extra weight that you need to take off. Wantalapband - Add a ten pound ankle weight on each ankle. lol As far as insurance companies go, Hey, I say, whatever works. I don't believe in cheating the system, however, I have read so many of these posts where men and women have been denied WLS with a BMI of 44 and even higher. All I can say is shame on every insurance company that gets away with this. I ask, who is truly cheating the system? I have a BMI of 39 and I'm in my first appeal. I have just got notified from Walter Lindstrom, Obesity Law, who is willing to take my case. He believes I have a solid case and I should not have a problem getting the decision reversed. If the decision does not get reversed with my assertive but strong letter of first appeal, I am going to hire Walter for as long as I need to. I am very upset at how inusrance companies are get away with this. I will do whatever I need to get around this BS. I say fight until you win the war. They may have won the first and second battle, but I believe in the longrun, we can all win the war. I also think it's very important for everyone concerned that we continue to fight the insurance companies and not give up so quickly to self pay. I'm in the position to self-pay but, it's truly not about the me paying out of pocket. This is about a serious issue that is affecting over sixty percent of Americans. The 60% consists of overweight or obese individuals. Not to mention that about 600,000 Americans die each year from diseases directly attributed to morbid obesity. I could go on, quoting statistics. Instead, I would like to see the Insurance Companies open their eyes to this serious epedemic. This is why I have chosen to fight to the bitter end. And if I have to pay out of pocket at that point, I will. I just think about the many many people out there who cannot self-pay. And for that, I feel very strongly about this. Fight Fight Fight!!!! Hope I didn't put you to sleep. Good luck. Emily