em1125

I've heard of people wearing very heavy clothing with large pockets and putting heavy things like rocks in their pockets. You would be surprised to see how much more weight would show up on the scale. Eat a big meal and about 16oz of Water before you weigh in. When I weighed in, my surgeon asked me for my height. He took my word for it. I made myself 1 inch shorter. That makes your BMI higher as well. Just a thought. Good luck. Em

Mert, Thank you so much for the prayers. Whatever is going to happen with this, I know God's got it. Em

Thanks NancyRN. I was hoping that this was the case. I thank you for getting back to me so soon. I'm praying big time. Emily

Hi all, I called my insurance company today to inquire if any decision has been made regarding my appeal. The woman on the phone had said that they sent my paperwork to a Bariatric surgeon to get outside advice. Do you think this is a good thing? I'm not sure. They said I should call on Friday morning or Monday. Emily

Thank you all so much for the great advice. I am so happy that I found this forum. All of you are full of great ideas and advice. Randi, That appeals guide is just wonderful. I can't thank you enough. I'm so happy to see that I followed the first step appropriately. This is truly a wonderful guide. For all of us who have been denied and who are in the process of appeals, let's pray that we will get our appeal overturned. Keep in touch. Good luck and I will keep you informed. I should find something out by this week. Happy 4th all. Em

His name is Gary Viscio. Below is the website. I think he's been away for the last few days. He hasn't called me back yet. em http://www.obesitylawyers.com/sub/index.jsp?contentid=ErKkQtKkPWd5ZBCMXKGAJL67

If my first appeal gets denied, I will absolutely hire one. I have already contacted his office but, he hasn't returned my phone call yet. I want to see if they approve this appeal. My surgeon and I both wrote another letter. We'll see what happens. Good luck.

You may get approved. Keep trying. Do you have comorbitities? I was thinking of self paying myself. I love my surgeon. Self-paying for a top NYC surgeon may run around $23,000. I don't know if I would be comfortable going anywhere else now. I don't know. I want to see what happens with my first appeal. I will appeal for the second time, but with an attorney. It seems that almost everyone who self pays goes to Mexico. I have heard wonderful things about the Dr. there. I thought it was $8,000. I could be wrong. Good luck. Em

YOU LOOK BEAUTIFUL. YOU SHOULD BE VERY PROUD. YOU'RE A TRUE INSPIRATION. EMILY Insurance Appeal in the process

So sorry you were denied. My surgery was schedule in two weeks. However, I was denied on June 26th and I'm in the appeal process. I have a BMI of 39. My insurance company stated that I did not have life threatening co-morbitities. High cholestorol and Irregular heart beats are not enough. I have other issues, but not life threatening. Anyway, the answer to your question about gaining weight to have the surgery-- Not a good idea. Don't self sabotage. Just fight fight fight. Is your BMI over 35? Let me know. Good luck. Emily

My insurance company is Health Net. Let me know. em

He didn't use those exact words. What he said in his letter is that I struggled with my weight issues for years and that I had exhausted all weight loss options. He said that he recommended bariatric surgery. em

Thanks so much for your support. I hope you get approved as well. I'm already at Stage 1 Appeal. My surgeon and I have appealed and I'm waiting to hear. If Stage 1 Appeal doesn't go through, I will hire an attorney. Keep me posted on your appeal process. Good luck and thanks again. Emily

I've contacted Gary Viscio's office two days ago and again today. I am still waiting for his call back. Walter and Kelly Lindstrom have won a case for someone on this insurance forum. It's titlted "We fought HA and WON!!!" Look it up. I am now in the appeals process as of today with Health Net. My surgeon's office appealed today and I wrote an excellent appeals letter that I got from ObesityLaw.com. They show a sample of an appeals letter. I used that letter and added my personal touch. It was a strong and direct letter. In the letter I did mention that I would take this to another level if I was not approved. We need to show insurance companies that we will not back down. I'm in the fight for a little while. Like I said in another thread, if worse comes to worse, I'll have to self-pay, but I won't give up without a fight. Good luck. Don't give up! Emily

Thanks Elizabeth. I am going to call tomorrow morning. Emily

hi all, Thanks for all of your responses. NancyRN - Thanks. I went to the website and got a sample letter. I am waiting for my surgeon's office to call me. They said they put in the first appeal. I am also going to write a letter along with my PCP. We'll see what happens. shawn and Stephanie- Thanks for the support. My BMI is 39 with Co-morbitities of high cholesterol, chronic hip bursitis, chronic neck and back pain for years in addition to having cervical spine surgery in 2002. I am also receiving cortizone therapy in my hip to relieve the pain. I had even wrote an excellent letter to my insurance company along with progress notes of one year supervised monthly visits from my weight doctor. (medifast) I also had my PCP progress notes for several years showing weight issues as well. My surgeon's office told me that I should never have had any problem getting approval. I had more than the insurance company requested for pre-approval. I will do whatever I need to do. I want to fight with them first and if worse comes to worse, I may have to pay out of pocket. That truly gets me very angry. I want this surgery before I start having major health problems. Diabetes and heart disease run in my family. That's all I need. I'm hoping that this is common for my insurance company and after the appeal they may approve. I called an attorney, but he hasn't called me back yet. Wish me luck. If you have any other input, please feel free. Thanks. Emily

pbrown, Where do you do the $11,000 self pay? I just found out I was denied today from Health Net. I'm hiring an attorney as well. My surgeon is putting in the appeal as well. I am so angry. How dare these insurance companies think they can get away with this. Good Luck. Emily

Thanks for the support. I just went online to Obesity Law and got a lawyers name that deals with denials for this surgery. As a matter of fact, the lawyer is a bariatric patient himself. I'm so angry I will do whatever it takes. Thanks so much. emily

Hi all, I am so upset. I just found out today that I was denied the surgery. They said it was not medically necessary. I have a BMI of 39. If I'm not fat enough, that is truly pathetic. My surgeon's office is appealing the denial. Is that usually the course of action. I was thinking about writing a letter in addition to the surgeon's appeal. What does the surgeon's office do as far as appeals go? I need help. Please let me know what you all think I should do. I was scheduled for July 11th and now who knows when I'll get it done. Emily

pplqueen and anyone else who had recent lapband surgery hi, you say you were banded four days ago. I have put everything on hold. My husband and kids are going away 7 days after my surgery which is scheduled for July 11th. I did not plan on going. My family is going to California and I was afraid of flying and heck, what would I eat? If I could go, I would love it. Do you think I would be up to flying. You say you're feeling great. If I knew that I would be feeling great, I would make a reservation today. I don't want to disappoint my kids, but at the same time, I don't want to say I'll go. I'm afraid I won't feel up to it. Let me know what you think. I'm open to hearing from anyone else as well. Thanks so much. emily

Hi Lisa, I'm scheduled for July 11 pending insurance approval. Your attitude is exactly like mine. I'm very excited but at the same time very nervous. I'm nervous about the surgery, major change, lifestyle, etc. I know in the long run it will be the best thing. I'm 41 and I'm 65 pounds overweight. I would like to lose a total of 75 pounds. I have two children and a great husband who mean the world to me. I quick smoking 15 years ago when I found out I was pregnant with my first child and I never looked back. I knew if I didn't quick smoking I wouldn't be around long enough to watch my children grow. It's the same thing with weight. The problem was, I substituted my cigarettes for food. And here I am today- very heavy and very upset at myself for getting to this point. If I don't get this weight off, I'm going to have more problems in the future. You said it well. Your scared of what is to come if you don't have the surgery. You're right. You're also very young. That's exactly the way I feel. I want to live a healthy and long life. God willing. Good Luck Lisa. Keep reading and researching, researching, researching. You can never get enough. God Bless. Emily

Suchadiva and anyone else who can help, The one thing I'm very nervous about after I have my surgery in July is how to eat. I've read everything about the first two weeks post op. But when they say mushies, can you give me examples. Potatoes, vegetables etc. Do you puree everything or use very small pieces and break with the back of your fork. Do you have interesting recipes. The other problem I'm worried about is when I leave for vacation. I'm having surgery on July 11th and I go on vacation Aug. 5th. What am I going to eat? At that point I will be almost 4 weeks post op. Help! I'm so nervous about the PB's. Like so many people have said, it's trial and error. However, I don't want to have many errors on vacation. I haven't told anyone about the surgery. I truly feel that this is very personal. My husband and mom are the only ones who know. I will be on vacation with friends and extended family. My eating habits will have changed drastically. How will I do this without opening any eyes? Thanks. Em

I have to agree with Tricia. I haven't had my surgery yet. I'm scheduled for July. I did a lot of research. The surgeon I chose has done over 2000 RNY's and about 500 lapbands. I would not go to a surgeon who is not skilled with this type of surgery. You said that he's done many RNY's which is a very delicate and difficult surgery in terms of re-routing the intestines. He's probably a good surgeon, but I would research more surgeons in your area that have done lapband surgery. Good luck with your decision. Em

Hi Again, Debi - you may find this article very interesting. Dr. Fielding wrote it. It's excellent. Anyone would truly be inspired by this article. The site address: http://thinforlife.med.nyu.edu/media/stories/dreams Let me know what you think. Em

Hi Debi, Dr. Fielding is a lapband patient himself. I'm from NY and I did a lot of research before I decided on the surgeon. I have to say, you're pretty lucky getting an appointment so quickly. I had two surgeons on my list who came very highly recommened. Dr. Ren and Dr. Fielding and Dr. Roslin at Lenox Hill. I first called Dr. Ren and I couldn't get an immediate appointment. I then called Lenox Hill hospital- Dr. Roslin. I got an appointment for a consult one week later. That's what landed me there. I am thrilled with how the consult went and I'm scheduled for July 11, 2006 pending insurance authorization. You picked a great surgeon. I heard many wonderful things about that group. Good luck and let me know how it goes. I think you will be very happy. I'm glad you decided to look around. If you don't mind me asking, was the doctor who recommended RNY from NY? Em1125