New to Forum. Anxious.

[gnortenjones 0]

Checking in after joining the forum.

My story:

My PCP suggested the band last year, but at first I wasn't open to weight loss surgery. I had always felt that it was incredibly drastic, and a sign of defeat. I told him I'd give weight loss another go, but quickly began to realize that even with weight related health issues starting to creep up, I wasn't able to maintain the motivation to drop the weight.

Finally in January I decided to start the process, and scheduled an appointment for the information seminar. The seminar was booked for 2 months, so the waiting began. It was horrible because I weighed more than I ever had, and wanted to START!!!

Finally I had the seminar, met with the nutritionist over the course of 3 months, had the psych evaluation, sonogram on my gall bladder, and had been approved by the doctor to have the surgery.

The surgery date was set at August 25th (3 weeks from now). I say "was", because 3 days later the insurance company, BCBS, denied the claim due to "evidence of severe liver disease." This was shocking because I didn't HAVE liver disease other than fatty liver, which was specifically mentioned in their policy as not considered a reason to deny a claim.

The surgery was cancelled, and I began the appeal process. That was over a month ago. This was a long month. Nothing like having a life changing procedure put on hold to sap your will.

The appeal was finally granted, and the denial was overturned on the very VERY last day of their 30 day requirement. The paperwork has been sent back to the surgeons office, and now I am waiting to hear back from them. Again.

When I decided to do this, I came to accept that I usually fall into the same pattern whenever I try to lose weight. I get really motivated for the first 2-3 months, drop a bit of weight, then stall, begin to lose the motivation, and begin to regain the weight. This is why I feel I need this surgery. To force me to continue even when I hit wall.

Whats making me anxious, is that I have definitely hit the wall. All this waiting, cancelling, postponing, rescheduling, and more waiting, is making it really hard to stay on target, and I'm terrified that if they drag this process out too long I'll end up putting some weight back on, and be denied AGAIN on that basis.

No wonder so many people self pay on such an expensive surgery.

End rant.

[greytz 4]

Congratulations on your appeal win! That is a feat in itself. I know it is difficult and causes you to be impatient waiting, waiting, but just think, you are on your way now and hopefully, you can stay focused until your surgery date. I had my first fill today and I had been waiting so long it felt like forever until that fill. There are little burdens all along the way, but to me it is so worth it. Good Luck and let us know when your surgery date gets scheduled.

[RestlessMonkey 7]

hang in there. i think many insurance companies hope people will give up. Don't give them them the satisfaction. It's worth it.

[isaviolinist 11]

Your surgery will be here before you know it! I remember feeling like the surgery was so far away and I'd never get a date, but in actuality it was just 2 months.

Congrats on your appeal win, that is great! I didn't have to appeal my actual surgery, but one of my preop tests wasn't covered at all - my insurance said they didn't cover that particular test when it was related to obesity. I appealed it (because it was a 600 dollar test) but I didn't think the appeal would be accepted. Lo and behold, it was! I felt so good about it!

Also, you can jump start your process by revamping your eating habits a little or beginning some exercise. This will give you that feeling of doing something productive that will contribute to your weight loss and health (and it won't just be a feeling lol; you WILL actually be doing something productive). It will also help prepare you for pre-op and post-op activities. If you can jump start your weight loss now, there were be less chance of any complications (like thick liver) at surgery. Try to cut your carbs and up your Protein now. You will probably lose weight even if you are not working out! And do as much research and preparation now, so when you are close to surgery you'll no what the plan is. Good luck!

[lindas0809 0]

Keep your spirits up! If you read posts on here you'll see that most of us struggle with insurance or Dr.'s offices(or both). It took me 10 months to go from seminar to surgery and at one point I almost threw in the towel. I'm so glad I didn't- two months out I'm feeling good and changing my relationship with food.

Good luck!

[SoAnnaBanana 1]

I was lucky to not have any issues with my insurance but my PCP was a total douche. She refused to fill out forms that the surgeon needed to get me boarded for surgery. She kept refering me for more test and more specialists. In the end when there were no more test or specialist to send me to she wrote a letter to the surgeon. The first line was, "This is not a letter of support or a referal". I went through all this drama for months and finally the surgeon just called her and he signed off on the surgery. If it isn't one thing... it's another. My situation wasn't as drawn out as yours but it is so terrible when someone stands in your way of something that will change your life possitively and something you want so bad! Keep your eye on the prize! I know that can be hard but it will pay off. I am having my surgery September 2nd and still can't believe I have a surgery date. Best of luck!

[gnortenjones 0]

I was lucky to not have any issues with my insurance but my PCP was a total douche. She refused to fill out forms that the surgeon needed to get me boarded for surgery. She kept refering me for more test and more specialists. In the end when there were no more test or specialist to send me to she wrote a letter to the surgeon. The first line was, "This is not a letter of support or a referal". I went through all this drama for months and finally the surgeon just called her and he signed off on the surgery. If it isn't one thing... it's another. My situation wasn't as drawn out as yours but it is so terrible when someone stands in your way of something that will change your life possitively and something you want so bad! Keep your eye on the prize! I know that can be hard but it will pay off. I am having my surgery September 2nd and still can't believe I have a surgery date. Best of luck!

Wow. I think at this point I'd be looking for a new PCP.

My PCP was the one who actually suggested getting a lap band, which was surprising because my experience with him usually boiled down to him telling me to excersize more and eat better for ANY problem I had. I used to joke that I could walk into his office with a bloody stump where my left arm used to be, and he'd tell me I needed more Iron in my diet.

btw everyone, I now have a date! August 31st. I probably should have posted it in this thread, but in the heat of the moment I started a new one the other day with the details:

http://www.lapbandtalk.com/f18/woohooo-99737/

[ParrotheadCathy 0]

My PCP "signed on" immediately! When I asked him about it, he simply said "You are an ideal candidate for lap band surgery". We discussed it further and I went for it! Now, when I see him, he praises my decision as the best thing I could have done.

If you feel you have a doctor who doesn't support you when you have a problem that needs addressed, find another doctor. It is a "buyer's market" and the only way you can truly express your displeasure is to find another doctor or, if the offense is serious enough, to file a complaint with the medical board.