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More woes and a question....

piercedqt78

By piercedqt78, in Insurance & Financing

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piercedqt78    658

piercedqt78
Posted

I have once again been...denied. The original submission was denied then, the peer to peer was denied, and now the "fair expidited review" was denied. I was told today that a company called MCMC of Boston would be doing an indepentant review. Anyone ever heard of them? From what I understand this is what they use instead of an independant evaluation. My husbands company pays them to review such cases. ~Mandy

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I'llsucceed    1

I'llsucceed
Posted

sorry to hear of you denial again. I hope your review sheds some better news for you. I too was denied several times & finally as the months past ( 6 months) said I don't wish to wait on someone else anymore & I ended up being a self-pay.

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Alexandra    55

Alexandra
Posted

Mandy, you may have your best chance with an independent reviewer. My fingers are crossed for you! That's how I won my battle with Aetna. Through all of Aetna's internal appeals the people doing the deciding were Aetna employees so the outcome was a foregone conclusion. It wasn't until a third party got involved that I got the right result.

Good luck!!! :)

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piercedqt78    658

piercedqt78
Posted

Alexandra,

You have always had a positive note of encouragement for me and I thank you for that. You are so sweet and kind with your words and suport.

If they will not approve me I am not sure what I am going to do. Selfpay is going to be difficult, we are a single income family and my husband has changed jobs in the last 8 months so getting a loan will be hard. I am sure that this will work itself out as things in life seem to do. My husband and I have never had anything handed to us and we didn't expect this to be any different. I am keeping my head up and staying on my new lifestyle diet (no pop, small bites and eating slower) that way even if I have to wait a while for the band I am still getting healthy. ~Mandy

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piercedqt78    658

piercedqt78
Posted

For everyone that is following my progress I just wanted to let you know that I have been approved!!! My date is July 28th. Thanks for helping me through all of the denials now at the end of the road I get approved, fighting really did pay off. ~Mandy

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HotLikeHer    0

HotLikeHer
Posted

Wooooo HOOOOOO yay!!!!!!!!

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sandie1958    0

sandie1958
Posted

mandy, i have thinking about you . i am so happy . when is your big day i just got approved united health care was really quick for me . who is your carrier. maybe we will have the same surgery date. go mandy goooooooooooooooooo!!!

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      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💪
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