Lap_dancer

If it doesn't get there today, it will be there on Monday! Way to go.

Yes. I followed my right to an appeal but the wording in my contract was such that it was obvious the surgery is an exclusion. Even I could see that. My fight was not with BCBS, it was with my employer who took out my insurance policy. My position with my employer was very simple, I have a disease, there is a treatment plan, my doctor recommended it, I qualify for it, passed all exams in preparation for it but can't get it because our contract excludes it. I requested my employer pay for the procedure, adding a rider to my policy. (we have large group insurance. I cannot change the policy that my employers took out, only they can change it) I specifically requested they "amend my policy to include gastric surgery".

You did them a favor! Great news Tracy. I'm so happy. Maybe we are going to have our surgeries in the same month. That would be amazing!

Woo Hoo! Keep us posted!

Quote: That's along the same lines as what I was thinking. If they pay 50% regardless, then perhaps you could have some leverage for negotiation - e.g. I could have this done for $40,000 and you'd have to pay $20,000, but I'm willing to go to this place that charges $9,000... And usually when there's a percentage pay involved, it's a percentage of what the insurance company is billed. So if 50% is an in-network rate, you pay 50% of the network negotiated charges. If that's the case, you could be looking at a very reasonable out-of-pocket in the neighborhood of $500 - $1000. (the network negotiated amount for my surgery ended up being something like $1600 ... it makes a BIG difference what 50% they're talking about!) But do check, an insurance expert I am not. The original surgeon's office told me that my maximum out-of-pocket would be $2000. I don't know whether to trust that, though, since they failed to find out that the surgeon wasn't in-network. If that's true, I won't have to liquidate stock or get financing, because I would have enough to pay that out of my savings. If I have to pay more than $5000-$6000, I'll have to go into debt. __________________ Most definately talk dollars and cents. Definately talk about the cost difference and savings. Never hurts to ask!!

If you are an individual who gets queezy easily, do not read my post. I was placed on glucophage for my diabetes. I am not insulin resistant. I am very severly obese. From about the second day on this drug, the white large horse pill rain through me with all stomach contents to an explosive end. I had projectile diarrhea, my rectum developed several hemmeroids that dropped and soon began to bleed. After a year, I was sick, weak, mentally fuzzy, and nauseated. The only thing that would stay down and in was carbs. I gained back the 30 I lost in the beginning. I was seeing the Physician's Assistant until I insisted on seeing my doctor. He took me off the drug, spent almost an hour with me, switched my meds and ordered tests. It took about four weeks for my body to go back to normal. It took four months for my rectum to return to normal or what is close to normal. I need my surgery.

Faith in God.

I wouldn't vote for him because of his lack of experience. He's worked mostly with non profits. He's got excellent leadership skills and oration abilities. He has a law background and tremendous motivation and direction. But the oval office...mmm that is a hefty job. If you don't think it is challenging, look at how the past three presidents have aged from start to finish. They go from semi dark hair to white. I would love to see him just ride his present job to fruition. Do what he can within his own state. Gain experience. I think he was caught up like Geraldine Ferraro in the ferver of the first WOMAN to run. Experience goes a long way with voters.

Okay Here is my news. You all know I followed my BCBSFL appeals process all the way to the top and then called the State Dept of Insurance regarding my denial. The denial was based soley on my employer's policy. They have an exclusion for gastric surgery. It's as plain as the nose on your face. I was told by one employee of BCBS that the employer could buy the inclusive procedure and add it to my policy. SO... I called employee benefits and explained, sent copies, and contacts at BCBS, and then got an appt. to sit before the Insurance Committee to request the purchase of this to my contract. This happened on Wednesday. I felt so calm, like I had nothing to lose (but my weight). This committee made me feel welcome. One half hour turned into an hour. I don't think there was one person on that panel who couldn't relate. We all know people who try and try to lose weight in vain. I told them my story and then I showed them my ziplock bag of 9 medications I take each day. My request was a first. They didn't know if it was doable, BCBS reps were present and said they could draft the inclusion and would have it within a few days. One person was checking with the attorney to see if there was a problem, and the other was checking with the Board for expenditure approval. They will reconvene on Feb. 15th to submit findings. I'm feeling really good about this. :high5: :high5: :high5:

A big hug your way and rest easy. Remember this word, "Synchronicity". Look it up. I live by it. I'll make this brief by telling you that I discovered through research during my Appeals process, that my surgeon had done very few Lap Bands. By requiring a Center of Excellence, it will only assure a more experienced physician who has treats patients who primarily are obese. They also must undergo what I would call an "internship" of X number of surgeries before they are given the seal. It's only for an extra measure of safety IMHO.

How goes it Trace? News? I have big news but won't know absolute until Feb. 15. Will post it if I can't wait. LD

Woo Hoo I agree 100%!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Tracy they'll fix that in a snap. Just a typo.

Same goes here Synicalchick. I've got all my letters on WORD at work. Would be happy to send you what I have.

What do you have to do but time? I look at it like that. My husband is fond of saying...AW what the hell, let's appeal it just to mess with them! It actually becomes a lesson in life and fun if you figure A. It won't cost me a dime. B. I will learn something from this. C. What if I'm right? Hahahha.

Join me for a read in a contradiction in terms that is confusing at best. Here is the site: http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034084.pdf Anthem and Blue Cross Blue Shield are married in some states as one insurance company. Assuming this is your case, read this PDF document and go to PAGE ONE (P. 1) MEDICAL POLICY Policy Statement: Medically Necessary: Gastric Bypass and Roux Y procedure......keep reading..... LAP BAND...keep reading......ARE CONSIDERED MEDICALLY NECESSARY FOR THE TREATMENT OF CLINICALLY SEVERE OBESITY FOR SELECTED ADULTS.. ( Okay remember that ) Now go down Start at: INVESTIGATIONAL / NOT MEDICALLY NECESSARY Gastric Bypass.....keep reading.......keep reading......next paragraph...keep reading...keep reading.... All OTHER PROCEDURES NOT LISTED ABOVE* AS MEDICALLY NECESSARY ARE INVESTIGATIONAL AND NOT MEDICALLY NECESSARY. * It reads like if Lap Band is not listed from the beginning of this passage from "Investigative/Not Medically Necessary" it isn't listed so it isn't covered. It's confusing.

Tell your insurance company this: I went to our website for Blue Cross Blue Shield of South Carolina. I went to the search engine. I typed in TEC for the Blue Cross and Blue Shield Technology Evaluation Center I got this: http://www.bcbs.com/betterknowledge/tec/ I typed in GASTRIC in that search engine and got this http://www.bcbssc.com/bcbs/bcbs_memb1.nsf/resoabtf/TchnlgyEvl_TchnlgyEvltnCntr_1?opendocument And it says: 1. TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity (Web Page; Thu Jan 25 15:43:00 EST 2007) EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures,... Description: Laparoscopic Adjustable Gastric Banding for Morbid Obesity 2. Laparoscopic Gastric Bypass Surgery for Morbid Obesity (Web Page; Mon Oct 30 15:26:00 EST 2006) Assessment ProgramVolume 20, No. 15 February 2006Executive Summary Background Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net... Description: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. 3. Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass (Web Page; Mon Oct 30 15:27:00 EST 2006) Assessment ProgramVolume 20, No. 5 August 2005Executive Summary Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities.... Description: Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities. 4. TEC Assessments in Press (Web Page; Thu Jan 25 16:07:00 EST 2007) January 2007 The following Assessment and Special Report from the November 2006 Medical Advisory Panel (MAP) meeting are in press. Laparoscopic Adjustable Gastric Banding for Morbid Obesity Special Report: The Efficacy and Safety of... And Now just read all of the above hits at that site. Look for change in terminology from Investigative.

Originally Posted by Lap_dancer From BCBS Association (corporate) . 5. The improvement must be attainable outside the investigational settings. The improvement in health outcomes for laparoscopic gastric bypass can be attained outside the investigational setting, if the training of surgeons and the programmatic elements are similar to programs in the published literature, and if performed at a hospital with sufficient surgical volume. However, there may be considerable variation in capabilities and resources among different bariatric surgery programs. To address this concern, Blue Cross and Blue Shield Association and the American College of Surgeons have developed criteria for credentialing and tracking outcomes from bariatric surgery programs. Based on the above, laparoscopic gastric bypass meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. http://www.bcbs.com/betterknowledge/.../20/20_15.html Source found at above website. Yeah, but isn't this just for gastric bypass? I couldn't find anything about gastric banding in this document. JB .................................................................................................. Airman, think of doing searches on this subject like a crossword puzzle. Just because you have a th_ _ K doesn't mean the word is think. You won't find some of the information easily. You should keep track of your searches via your search engine history. Book mark things, reduce the screen and open up another window to continue a new search. Open WORD and copy and paste links and language from documents. ( I do this all the time when I am researching). I'm not an insurance agent but here is what I have learned about Blue Cross and Blue Shield. Blue Cross and Blue Shield (BCBS) is like a mall. Inside the mall you have different stores that you can shop from. So you get Blue Cross, Blue Shield, Blue, Blue Options, ... Google is a good friend. Please utilize this in your efforts to gain information available to you. Google entry from me was: BCBS South Carolina weight loss surgery HITS: Suburban Surgical Care Specialists, S.C. - Bariatric Surgery Vanderbilt Center for Surgical Weight Loss, Exclusion List The Next Step for Weight-Loss Surgery Blue Distinction Centers for Bariatric Surgery That one sounds good, I think I'll try it......... (thinking, if BCBS doesn't cover it and thinks Lap Band is experimental, I won't find a hit on my search ) Inside this HIT I see it is the BCBS site, I'l go to SEARCH and type in GASTRIC HIT: Displaying results 1 - 5 of 5 items found. 1. TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity (Web Page; Thu Jan 25 15:43:00 EST 2007) EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures,... Description: Laparoscopic Adjustable Gastric Banding for Morbid Obesity 2. Laparoscopic Gastric Bypass Surgery for Morbid Obesity (Web Page; Mon Oct 30 15:26:00 EST 2006) Assessment ProgramVolume 20, No. 15 February 2006Executive Summary Background Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net... Description: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. 3. Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass (Web Page; Mon Oct 30 15:27:00 EST 2006) Assessment ProgramVolume 20, No. 5 August 2005Executive Summary Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities.... Description: Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities. HIT: TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures, gastric bypass is the most common procedure performed in the U.S., and offers the most favorable benefit/risk ratio among established procedures. Laparoscopic adjustable gastric banding (LAGB) is an alternative technique that has the potential advantages of being less invasive and reversible. Prior TEC Assessments have concluded that LAGB does not meet the TEC criteria. Objective: To review the available evidence on whether LAGB results in similar improvements in health outcomes as does open or laparoscopic gastric bypass (GBY). Search strategy: MEDLINE search for the period of 1980 through September 2006, supplemented by hand search of bibliographies and search of Cochrane database. This goes on but it tells me that they are NOT calling it "investigational." PRINT AND SAVE 1. The technology must have final approval from the appropriate governmental regulatory bodies. Bariatric surgery itself is a procedure and is not subject to U.S. food and Drug Administration (FDA) regulations. However, certain devices that may be used as part of the procedure may be subject to FDA approval. The Lap-Band® system received premarket application (PMA) approval by the FDA in June 2001 for use in morbidly obese patients. 2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes. The evidence is sufficient to permit conclusions concerning the short-term safety and efficacy of LAGB in comparison with GBY. Weight loss at 1 year following LAGB is substantial, in the range of 40% EWL, although less than that seen following GBY. The short-term complications of LAGB are very low, with serious short-term complications being uncommon, and mortality exceedingly rare. Rates of short-term adverse events, including serious procedural complications and mortality, are lower for LAGB compared with GBY. Same page, further on down the page. Airwayman, I could truthfully sit here for the next span of time and do this research for you but in the end, it teaches you nothing on perserverance. I am a teacher. I teach my students that perserverance pays off. In the frustration of learning, there is victory in the end. *I began my own Quest knowing NOTHING about the surgery, my own insurance plan nor how the process works. After six months, I can answer pretty much any question thrown my way. Tomorrow I will get my chance to educate the insurance committee at work. They were told "gastric surgery is not covered by Blue Cross", I beg to differ. http://mcgs.bcbsfl.com/ Search: Medical Coverage Guidelines BCBS HIT: 1.(61.06% Relevant)Gastric Electrical Stimulation... peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling 64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver 0155T Laparoscopy, surgical, implantation or replacement of gastric stimulation electrodes, lesser curvature ...2.(59.05% Relevant)Gastric Bypass Revision... gastrectomy or intestine resection; with vagotomy 43886 Gastric restrictive procedure, open; revision of subcutaneous port component only 43887 Gastric restrictive procedure, open; removal of subcutaneous port component only 43888 Gastric restrictive procedure, open; removal and replacement of ...>>3.(58.83% Relevant)Surgery for Clinically Severe Obesity... or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the ... 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION. Non-Covered Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines Other References Updates DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows:

I have to agree with Tracy on that backwards comment. If they cover weight loss surgery but don't consider Lap Band weight loss surgery than what do they consider weight loss surgery?

SWIMMING WITH JOY FOR YOU!!!!!!!!!!!!!!!!!!!!!!!!!!!! Way to goooooooooooooooo! You must be thrilled. I am soo very happy for you. All the best, you inspire me. I look forward to reading about your appt.'s, your procedure, your recovery, your slim new body and seeing PICTURES!

You have to go to the beginning of these threads to sometimes get answers. I guess it means a "productive burp" and by productive I would say something comes with it...like a productive cough, you whip up loogies, by the description it sounds like if you eat too much, or too fast, or take too big of a bite, don't chew properly, you get something like what the cat hacks up. Chew to Goo...that's a good one. I will remember. Also "Eat baby bites". I have to train myself for this one as I am a gulper of food.

This is helpful info. Makes sense. Thanks a bunch.

Not sure what you are looking for Airwayman but I'm sure it's somewhere on the BCBS site. If all else fails, just use GOOGLE.

From BCBS Association (corporate) Laparoscopic Gastric Bypass Surgery for Morbid Obesity Assessment Program Volume 20, No. 15 February 2006 Executive Summary Background Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. Among different surgical procedures, gastric bypass offers the most favorable benefit/risk ratio. Gastric bypass was originally developed as an open procedure, but can also be performed as a laparoscopic procedure. Objective To review the available evidence on whether laparoscopic gastric bypass (LGBY) results in similar improvements in health outcomes as does open gastric bypass (GBY). Literature Review Literature Review The MEDLINE database was searched electronically for articles for the period of 1980 through May 2005, supplemented by hand search of bibliographies and search of Cochrane database. Selection Criteria Comparative studies of open vs. laparoscopic GBY that included at least 25 patients per treatment arm, that reported on the outcomes of weight loss and/or adverse events, and that had at least 1 year of follow-up (for weight loss outcomes) were included in the Assessment. Single-arm studies with the same characteristics were included if the minimum number of enrolled patients was 100 or more. Results Weight loss at 1 year was very similar for laparoscopic and open procedures. The data on longer term weight loss were less rigorous, but it appears that long-term weight loss is similar as well between the two approaches. Summary estimates were made for perioperative and long-term complications. The estimated mortality rate was low for both procedures, but somewhat lower for laparoscopic surgery (0.3% vs. 1.1%). The laparoscopic procedures had a higher rate of postoperative anastomotic leaks than open procedures (3.7% vs. 1.9%) and a somewhat higher rate of bleeding (4.1% vs. 2.4%). On the other hand, open surgery had higher rates of cardiopulmonary complications (2.6% vs. 1.0%) and wound infections (11.0% vs. 4.7%). Long-term adverse event rates were reported by a smaller number of studies, lending less precision to these data. For the laparoscopic group, the rates of reoperation (9.9%) and anastomotic problems (8.0%) may be higher than for the open group (6.0% and 2.0%, respectively), while the rate of incisional hernia is higher for the open group (9.0% vs. 0%). The evidence did not allow a rigorous examination of the impact of programmatic elements or hospital setting on outcomes. Documentation of a thorough preoperative assessment was used as a proxy for a comprehensive, multidisciplinary program, but sensitivity analysis on this variable did not reveal any clear patterns. Conclusion The evidence is sufficient to conclude that weight loss is similar between the two procedures. In a previous TEC Assessment performed in 2003, evidence on the comparative rates of adverse events was not sufficient to form conclusions. A number of new studies available since the previous report provide additional evidence on adverse events, thus addressing the primary deficiency in the evidence reviewed at that time. The profile of adverse events differs between the two approaches, with each having its advantages and disadvantages. LGBY offers a less-invasive procedure that is associated with decreased hospital stay and earlier return to usual activities. The mortality may be lower with the laparoscopic approach, although both procedures have mortality rates less than 1%. Postoperative wound infections and incisional hernias are also less common with LGBY. On the other hand, anastomotic problems, GI bleeding, and bowel obstruction appear to be higher with the laparoscopic approach, but not markedly higher. Given these data, it is not possible to say that one procedure is superior to the other, and overall the benefit/risk ratio for these two approaches appears to be more similar than different. Concern remains about the generalizability of published results, which largely represent high-volume, academic programs, to other settings. While evidence exists to support a positive correlation between volume and outcomes for bariatric surgery in general, the evidence is not sufficient to determine the impact of other programmatic elements and/or hospital setting on outcomes of LGBY. Based on the available evidence, the Blue Cross and Blue Shield Medical Advisory Panel made the following judgments about whether laparoscopic gastric bypass meets the Blue Cross and Blue Shield Association Technology Evaluation Center (TEC) criteria. 1. The technology must have final approval from the appropriate governmental regulatory bodies. The intervention under consideration is a surgical procedure and is not subject to U.S. Food and Drug Administration (FDA) regulations. 2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes. The available evidence is sufficient to form conclusions on the benefits and risks of laparoscopic gastric bypass compared with open gastric bypass. Weight loss at 1 year is similar for laparoscopic gastric bypass compared to open gastric bypass. The profile of short-term adverse events differs between the two approaches, with each having its advantages and disadvantages. Given these data, the overall outcomes of laparoscopic gastric bypass appear to be similar to open gastric bypass. 3. The technology must improve the net health outcome. The evidence is sufficient to conclude that laparoscopic gastric bypass improves the net health outcome. Data from non-randomized comparative trials are sufficient to establish that health outcomes are improved following bariatric surgery in general. Among available bariatric surgical procedures, gastric bypass with Roux-en-Y anastomosis appears to have the most favorable benefit/risk ratio. The current Assessment establishes that the overall benefit/risk ratio of laparoscopic gastric bypass is similar to that of open gastric bypass. Therefore, it can be determined that laparoscopic gastric bypass, as well as open gastric bypass, improves the net health outcome. 4. The technology must be as beneficial as any established alternatives. The main established alternative to laparoscopic gastric bypass is open gastric bypass, and this Assessment concludes that the benefits and risks of laparoscopic gastric bypass compared with open gastric bypass are similar. Therefore, laparoscopic gastric bypass is as beneficial as established alternatives. 5. The improvement must be attainable outside the investigational settings. The improvement in health outcomes for laparoscopic gastric bypass can be attained outside the investigational setting, if the training of surgeons and the programmatic elements are similar to programs in the published literature, and if performed at a hospital with sufficient surgical volume. However, there may be considerable variation in capabilities and resources among different bariatric surgery programs. To address this concern, Blue Cross and Blue Shield Association and the American College of Surgeons have developed criteria for credentialing and tracking outcomes from bariatric surgery programs. Based on the above, laparoscopic gastric bypass meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. FULL STUDY Laparoscopic Gastric Bypass Surgery for Morbid Obesity Full studies are in PDF format. You will need Adobe Acrobat Reader to view all studies. Download Adobe Acrobat Reader here. http://www.bcbs.com/betterknowledge/tec/vols/20/20_15.html Source found at above website.

Will do! and good thoughts going your way for a succesful outcome.

Tracy! I was thinking of you today! Great to see you posting here. How is your case doing? I have a meeting on Jan. 31st with my employer's medical insurance committee. I am appealing for the purchase of a rider on my policy for the surgery. Apparently this is not an odd request as I was told they often get requests for items. I am hopeful about this. I have all my notes in order and am actually excited about the meetings. My plan C if this doesn't work is to self pay and fly to Mexico for Dr. Ortiz.