insurance says 1 weight loss surgery a lifetime

[Roselockett 0]

O.k. here is my problem, anyone one who can relate please help me... I had the lapband june 08. From day one had problems.. Had 6 upper GI's 4 endoscopy's in over a years time and could not take a fill.. The Band was too tight from day one.. DEC. 09 band eroded had it taken it...Now insurance company changed their laws 3 months AFTER I got the band.. ONE weight loss surgery a lifetime IF You had THE LAPBAND ..

Otherwise you can have another surgery... Geez its so stupid.. So now my new Dr is writing a pre determination letter to the BCBS AL, to hopefully get approved for my SLEEVE... BCBS AL, covers the sleeve. but again because I had the lapband they say they wont now.. anyone have this problem ever???.

I cant APPEAL unless I am rejected and I am praying to God I will not be rejected on this pre-determination letter...

Sine Dec. I have gained back 35 lbs from the loss of 85 lbs.. and I only lost all that weight cause I could not swallow foods.. It all had to be mushies or it would not go down.. Ice cream became my best friend.. I got rid of all my big clothes and now I have nothing to wear cause I gained weight back.. Please Really Keep me in your prayers about being APPROVED RIGHT OFF... Thank you all and God Bless...

Rose

[MINI-Me 196]

O.k. here is my problem, anyone one who can relate please help me... I had the lapband june 08. From day one had problems.. Had 6 upper GI's 4 endoscopy's in over a years time and could not take a fill.. The Band was too tight from day one.. DEC. 09 band eroded had it taken it...Now insurance company changed their laws 3 months AFTER I got the band.. ONE weight loss surgery a lifetime IF You had THE LAPBAND ..

Otherwise you can have another surgery... Geez its so stupid.. So now my new Dr is writing a pre determination letter to the BCBS AL, to hopefully get approved for my SLEEVE... BCBS AL, covers the sleeve. but again because I had the lapband they say they wont now.. anyone have this problem ever???.

I cant APPEAL unless I am rejected and I am praying to God I will not be rejected on this pre-determination letter...

Sine Dec. I have gained back 35 lbs from the loss of 85 lbs.. and I only lost all that weight cause I could not swallow foods.. It all had to be mushies or it would not go down.. Ice cream became my best friend.. I got rid of all my big clothes and now I have nothing to wear cause I gained weight back.. Please Really Keep me in your prayers about being APPROVED RIGHT OFF... Thank you all and God Bless...

Rose

Will definitely keep you in my prayers.

I think you may have a good case due to the medical issues you had with the band. I'm sure your surgeon's office has had practice dealing with these type of issues.

Most likely, you will get a denial letter, but your surgeon can present an appeal case and should be able to win it. Fingers are crossed and prayers going up.

[Tiffykins 672]

I'll keep you in my thoughts for approval. Keep us posted with what is going on.

[katinhouston 0]

Did you ever hear anything about your approval? I'm just wondering because I had United Healthcare try to pull the "one surgery per lifetime" card with me for my revision. It turns out that was not in my husband's company's policy at all and they were trying to deny saying it was something like - obesity surgery standards--blah blah blah. They said they would remove or replace my band only.

They denied my case, I immediately appealed and just heard back last week that they are overturning the denial and will be paying for the revision. My advice is if it's truly what you want then don't give up! I'm not going to say it's an easy thing. It's extremely stressful both physically (putting up with the band and weight gain for longer) and especially mentally! You just have to decide if it is something you want to fight for.

[pnw218 14]

I am so sorry to hear that Rose! I realize it is all about profits, but they also have to be realistic when dealing with health issues. Do they really want you to gain all of your weight back and have a zillion health problems???? I remember when insurance would not cover the birth control pill. Seriously?? They were $20 a month back then and lots cheaper than a pregnancy!

I would also think that due to the complications, you would be able to appeal. Its not like you purposefully ate candy 24/7 and gained back the weight.

Big business amazes me. They often use very little common sense.

[lmmore 0]

Don't give up.........fight for it.

[Roselockett 0]

Katin,

Thank you so much for your letter.. I needed to hear what you said.. I actually read the bi-laws and saw where it says one weight loss surgery a lifetime IF you had the band.. BUT they said if my Dr sends a Pre- determination letter to them they will review it and it Can be overturned.. This is not the Appeal stage.. Thank God.. Because I am trusting in God to have BCBS overturn my case by excepting the information from my pre- determination letter.. I IWLL NEVER GIVE UP... and yes it is very hard to go through all this again.. On top of this my husband wants a divorce because he hit his mid life crisis... But no matter what is thrown at me .. I will throw back.. and God will give me the strength to do it...Please keep in touch with me.. I need to talk to people that understand about weight loss surgery.. My friends say they understand but they have no idea what it was like to lose the band and start all over...

God bless you..

Rose

[Roselockett 0]

truer words were never spoken.. thank you .. I am feeling so much better today reading these letters... I am fighting them big business or not and I WILL WIN.... Giving up is not in my vocabulary.... Thank you and God bless you for taking the time to write a post on me...

Rose

[Roselockett 0]

oh sorry and the letter was not sent out yet.. you know how those Dr offices drag their feet.. I also said send it to me first to read for approval before you send it out.. She sent it last week and I think from reading it it took her 5 minutes to write it.. I said thank you for the starting template but I will tweek it and send it back.. I want the dates of all my upper GI"s in there and my endoscopy's and emergency room visits in there.. I say make the first letter count big.. I dont want more months of playing games with BCBS.....

[Roselockett 0]

o.k. I am done .. My Bariatric doctor has the pre determination letter done. My own personal letter, my family doctors letter, and my psycholigist's letter is done... I called BCBS and asked them if I could add my own letter to my Dr's pre determination letter and she said the more the merrier.. So all the letters are done.. BUT.. just so I have this right.. I kept saying I wanted the Vertical sleeve. and my Dr said No you are asking for the surgery where we cut your stomach to the size of a banana and dispose of the other part of the stomach.,. I said yes.. He said that it is called the Gastric sleeve , or sleeve gastrectomy..

So is this the surgery you all have had????

Keep me in your prayers.. The Bible tells us ASK AND YOU SHALL RECEIVE... Which means leave DOUBT out of the picture.. Don't pray , ask , and then say Gee I hope God does this for me. Because at that point I put doubt in the picture... SO I am believing that I am getting approved for my revision surgery. And doubt is not even in the picture...

Thank you all so much for your support.. This is so mentally draining but to win, to get what we deserve, we have to help each other in support.. Some of cant get it any where but here...

God bless you all and please keep in touch with me as I will keep in touch with you all...

Rose

[Tiffykins 672]

Rose, I hope you hear something soon. The Vertical Sleeve Gastrectomy procedure (also called Sleeve Gastrectomy, Vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Gastrectomy and even Vertical Gastroplasty) are all the same surgery.

Keep us posted, and let us know if we can help in any possible way.