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Sanity Prevails!!!

ReneBean

By ReneBean, in Insurance & Financing

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ReneBean    3

ReneBean
Posted

:flypig: :flypig: :flypig:

Hello Friends and Loved Ones...

As many of you know, I have been trying to get pre-approval from my beloved insurance company for an Adjustable Gastric Band procedure... :confused:

From September thru December, I was denied, appealed and was denied again. Blue Cross determined that I was too fat for Lap Band surgery for weight loss... (!) :mad:

I researched, wrote fabulous arguements and sent it all to the State of California for an Independent Medical Review. I waited, and waited and waited some more. :rolleyes

I got a letter in the mail the night before last - addressed to me, from the Center for Health Dispute Resolution in Rancho Cordova, CA. :nervous

You can imagine my excitement - I was finally going to get The Answer.

I ripped open the envelope to find a letter addressed to some guy named Bruce!!! ARRRRGH!!! :faint:

So, I scurried in to work yesterday, and called. I thought that if I had Bruce's letter, maybe he had mine. Logical, right? WRONG. :tired

The gal who called me back told me that they were waiting for the last document from someone, somewhere, and it was due in that very day. She told me she would call. I waited for the rest of the day... no call. I called again and left a message. :help:

By last night, I was about ready to explode into thousands of tiny fat particles... But, I managed to survive the night and this morning, I got a call from the CHDR.

AT LAST, I am rewarded for my good karma, patience and ability to craft an arguement. The State of CA has determined that the Adjustable Gastric Band procedure is Medically Necessary - and I will be receiving a letter from them, and from my insurance company, to acknowledge this, soon.

:Banane10: :eyebrows: :confused: :Banane41: :Banane52: :not_ripe:

:) :Banane09: :Banane17: :Banane06: :Banane48: :Banane04: :Banane47: :) :) :Banane44: :Banane10: :Banane21: :Banane10: :Banane42:

:rofl::rofl::rofl::rofl:

Now, I may have to have some of the medical test re-done, since a great deal of time has passed since the first one - but now I know that the Delightful Folks at Blue Cross will be forced to pay - whether they want to or not.

Life is Good.

Thanks to ALL who wished well, crossed fingers, said prayers, stuck pins in dolls and thought good thoughts.

I am Stupid Dog Happy right now. If I had a tail, it'd be wagging.

:]

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Alexandra    55

Alexandra
Posted

Renebean, I know EXACTLY how you feel. It's mindbendingly wonderful to succeed in this way!! In June of 2003 I got a letter just like the one you opened. CONGRATULATIONS!!!

You've struck a blow not only for your own health, but for patients everywhere. Every time one of those external reviews overturns the denial, a tiny chip is made in the insurance-industry fortifications. You've done a great thing, and I know you'll be a terrifically successful bandster.

YAY!!!!!

:biggrin1: :biggrin1: :biggrin1: :confused: :) :) :clap2: :clap2: :clap2:

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Guest ASPHALT ANGEL   

Guest ASPHALT ANGEL
Posted

Congrats!!!! Hope You Get Your Surgery Soon,

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Mita    2

Mita
Posted

I am so Doggone Happy for you Rene..:clap2: It could not have happend at a better time. What a way to start of the year Gettin what you want or making that give it to you.. In no time you will be on the banded side of life..:biggrin1:

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aaamom    0

aaamom
Posted

WAY TO GO GIRL ! Good for you for never giving up !!!!!!:clap2:

The next big thrill-getting your surgery date !! YEEEHAAAAAAWWWWWWWWWW

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chichigirl    1

chichigirl
Posted

Oh Rene, I am so thrilled for you!!!!! I have been sending lots of positive thoughts and prayers your way, ever since I heard about your dilema. You have been so persistant, fighting the good fight, you deserve this sooooo much. I hope you also realize how much you have helped others traveling the same path. You are very special and I am so happy for you I can barely stand it.

Wishing you the best New Years ever!!!!!

Cindy

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mousecrazy    2

mousecrazy
Posted

I'm so excited for you, I don't know what to do!!!!!!!!!!!! I know I can uncross everything now, and finally breathe a sigh of relief. I'm so excited I might just burst into a round of aerobic exercise! I'm proud of you for sticking with it, and fighting this battle. Hopefully, you will have also helped somebody else while doing so! Congratulations, Beanie! Hugs, Cindy

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Go To Topic Listing Insurance & Financing

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    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
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    • Doughgurl

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      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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