I finally got an answer from UHC. According to UHC my average BMI falls within 35-40, but my co-morbidities are insufficient. Approval has been denied. I imagine Dr. V will appeal? I'll ask Kim and let you know.

I have diabetes, renal damage and have had 10 eye surgeries to keep from going blind.My insurance denied the lap band. I went to Mexico and had a wonderful experence. Being a Paramedic I was very educated on procedures and how surgery should be done. I was very impressed with my surgeon.I paid $8,500.00 that was $1000.00 higher but I took 2 people with me (my husband and a Paramedic),I will go back if I need any more procedures done. You can have a band put in that is approved in the states so that you do not have to go back for fills. I was banded 11/11/05 and have lost 48 lbs.

I have diabetes, renal damage and have had 10 eye surgeries to keep from going blind.My insurance denied the lap band. I went to Mexico and had a wonderful experence. Being a Paramedic I was very educated on procedures and how surgery should be done. I was very impressed with my surgeon.I paid $8,500.00 that was $1000.00 higher but I took 2 people with me (my husband and a Paramedic),I will go back if I need any more procedures done. You can have a band put in that is approved in the states so that you do not have to go back for fills. I was banded 11/11/05 and have lost 48 lbs.

We have a NC bander that was done in Mexico and the fills aren't the easiest thing. Most US doctors don't want to do anything to a patient that was in Mexico. I do believe most MX doctors will have a list of dr's that will help MX patients. I just didn't want you to think that any US doctor would do a fill. Unfortuntaly they want...I don't see why not but it's just the way they work.

On a better note you are doing GREAT..keep up the good work. I do know it's cheaper to go to MX - I know with the doc I work for, if you are a self pay he does offer 1 yr follow up. That is included in his charge and that includes the fill. His charge isn't to bad it's the hospitals here that charge so much!!!!

Good Luck on your band...again you are doing great!!! Keep up the good work and I know we would love to hear more from you...to see how your progress is going. You will insprie so many others!!!!

Karen, I bet you feel better now that the letter is done.

Hang in there God knows what he's doing even if the insurance companies DON"T!

His charge isn't to bad it's the hospitals here that charge so much!!!!

That's exactly right! I'm self-pay, and the fee that I paid my surgeon was just over $5,000. The rest of the almost $20,000 went to the hospital! It's crazy!

:think

I don't know if I should call the appeals service center and harrass them now or wait and see? I yo-yo between being optimistic and deeply depressed.

John and I talked about "what if I'm not approved" months ago, and he flat out said Mexico is not an option. Even if going there for surgery were an option, I don't think I could deal with the hassle of finding a doctor to do fills.

I think financially, financing is an option, but it would set our goals back about 5 years. I know that's not long in the grand scheme of things, but when you've been working on those goals for a number of years already, the thought of postponing them further makes you cringe.

Emotionally, I think I'm more afraid of staying obese than going further into debt. I may not have high blood pressure, diabetes, etc., but I am falling apart with other weight related problems.

Karen-DON"T please don't sit back and be quiet! You have done that for to long! You should call the insurance company everyday and bug them until you get a yes! Really I have heard this over and over again about the squeky wheel they will just say ok to shut you up and who cares if they don't like you calling it is there job to denie you, it is your job to get approved.

Sorry I just get so impatient with insurance companies and other offices that think they know it all and are right all the time.

hugs

OK, I just hung up with the appeals service center. They have my letter; it's logged and a case number has been assigned. I was told it could take up to another month to review and a decision made. More waiting! :Banane56:

That's what they tell you to make you stop calling for awhile....don't listen...set them up on your speed dial!

Karen I got my letter @ the office today and it say that is was because there was no coverage. I will be interested to see what your letter says when you get it at home. If your says the same then there will be no fight they just need to cover it for being stupid.

That is just terrible!!! Sometimes I think they will use ANY excuse to see if we will fight them. A couple of weeks ago, I was told my insurance didn't pay for lapband....HA....they had rec'vd my file on Feb 14th. Someone didn't know what they were talking about.

Let's hope the appeal is swift & simple.....still praying!!

Hey Kim, after talking to everyone and their brothers at UHC and the Appeals Service Center last week, the "no coverage" just means they won't cover me because I don't meet their definition of morbidly obese based upon average BMI and co-morbidities. The gal I talked to at the Appeals Service center read the underlying detail to me.

I haven't received a letter yet.

Ok well that is just weird. Other denials I have gotten have giving the reason. Like low BMI or something like that. Sorry...I was trying.

Good Luck and please let me know what I can do to help you.

My surgeon had me to complete a letter with specific topics that he included in his paperwork he submitted for final approval. I can share that letter with you via Private Message. I will pray for you because no matter what...what GOD has for you nobody can't take that from you. GOD sometimes have test and we must take them and pass. This is just a test and you shall prevail. Stay postively focused on the outcome.

God bless and thank you all for the words of encouragement!

I called the appeals line again today. The gal that answered regurgitated verbatim the content of my call on Friday, and then stated it had not been 20 days yet. When asked if it ever varies, she said it's always 20 days for prior approval and 30 days if the service has already been provided. I've marked my calendar for May 19th and will not call them again until that afternoon.

Who knows, maybe I'll have good news when we meet for lunch again on May 20th?

My heart hurts for you. I wished I could call them myself. :phanvan There are rules and reasons for them, but do you think it would help to get a supervisor involved? I always told them my surgeon said it would take 2-3 mos to get a surgery date after approval (which is exactly what I was told....I was flexible being a SAHM and got in sooner) and I needed to move this along as quickly as possible.

Another thing is, I involved a rep that worked for my husband's company (not insurance) since we are self-funded. She really was a tremendous help and put my file into the hands of the PreD supervisor and gave her a deadline. Also, I had my surgeon's office call. They got a bit more info than I was able to on my own. Not sure if this is of any help, but wanted to extend the info just in-case.

I will continue to lift you up in prayer. He is greater than anything we face in life. He is right there with you. This will happen....it's just in His time. I will pray for you to have peace while your waiting. Keep your chin up and know we are here for you as well!! :confused: