I was just DENIED!!!!!! I didn't lose the 5% of my excess weight as required by my insurance company during my 12 month MD supervised diet program.
I had a heart problem in the late summer (since been fixed) and went on a medication for five months that made me totally sedentary. I didn't want to do a stinking thing! And I gained 27lbs on it.
My high was 371, my starting weight (the one they use) was 344. So in order to qualify, I have to be 335. Granted I've lost weight since being fixed in December (I'm now 347.6), but even with a letter from my doctor stating that the weight gain wasn't totally my fault, and even with my case manager pleading my case to the medical director for the Ins Co. I'm denied!
I can try again next month...
One positive thing, once it was submitted it only took a couple of hours...
__________________ Quando Omni Flunkus Moritati (When all else fails, play dead) H371/S327/C297 Fell off the wagon in a big way, got back on with my first fill ever 4/29/08 Small AP June 21st, 2007 by Dr. James Wagner @ Hurley in Flint, MI
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I didnt' deal with an insurance company but isn't it standard to deny the first application. I think many of them require an appeal or two to actually approve the procedure. Either way, just keep trying to jump through their hoops it will happen eventually :)
We (the surgeon's office, my PCP and my insurance company's case manager) were so sure I'd be approved. We worked very hard to have everything lined up, and we did. But I had V-Tach and had to be sedentary for five months.
My case manager said that as long as everything was met, she's had many approved the first time around. So I guess I was really counting on it.
I guess it would make life easier to ba even smaller for OR, but DAMMIT! I've been working so hard already, I want the band to be that extra tool...
Maybe I just need to do Optifast now...grrrrrr!
Thanks for your encouragement, waterlily! I think you're right, I know lots of folks get denied the first time.
__________________ Quando Omni Flunkus Moritati (When all else fails, play dead) H371/S327/C297 Fell off the wagon in a big way, got back on with my first fill ever 4/29/08 Small AP June 21st, 2007 by Dr. James Wagner @ Hurley in Flint, MI
Thanks everyone. I am feeling pretty (momentarily) defeated right now. But amazingly I think I've had a pre-band NSV of sorts...I haven't picked up a fork or a spoon and shoveled anything into my mouth that I shouldn't have. I'm getting MAD.
Now, how to get another 15lbs off in three weeks... (my next PCP appt is 4/25)
I was denied 3 times, in 6 months. Keep after them, it will happen for you. Look at it this way, they are giving you a set reason for denial. I was denied with the ins company saying the band was experimental. I had to change the companies policy, you just need to fit into the criteria.....~Mandy
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~Mandy www.myspace.com/piercedqt78
weight: 242/160/145
Started in a size 22/24 now in a 11jr....woohoo!
Bandland, it's almost as great as Disney, only with no rides or characters.
optifast would probably get you down quick. if not eat lots of protien, no carbs. No sugar! Don't drink anything that has calories. No pop, no juice
__________________ Surgery 8-3-06, Lapband Center of Michigan, in Port Huron by Dr. Boutt 393/305/230 and 6'1" Now with 88 pounds GONE! 2.1cc in 4cc band
My Weight Loss is in Memory of my Mother, Jacklyn, who was lost at the young age of 49 on October 14, 2005 from Ovarian Cancer.
Julie 
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