SOMEONE PLEASE HELP ME!!!!!

Paula from Dr Barba's office just called me and told me my insurance (BC/BS) denied me. They denied me on 2 fronts. They first said that I need 6 months of documented nutritional consulation. Ok, fine, I can live with that and that is something I don't mind doing. BUT...then they denied on the bases that Lab Banding is experimental. EXPERIMENTAL!!!! I have no idea what to do now. Paula suggested that I might want to try laproscopic bypass. I just don't know if I want to go that route. I have never wanted bypass but maybe i'm just not informed enough about it. It just seems so radical and so many people seem to have issues with dumping and malabsorption, yada, yada. I knew Lap wouldn't be a walk in the park but I assumed it would be a bit "easier" than bypass. Why is this happening to me. I called my insurance company 5 times to make sure this procedure was covered and they said it was..." if deemed medically necessary". No one ever said anything about it being experimental. OMG....I am just sitting here crying and crying. I just cannot believe this is happening. Please, someone tell me what to do? I just have no clue what to do now. My endoscopy is today and Paula said to go and get it done...and I am. At least one thing will be out of the way. If anyone has any advice, please give it to me....the good, bad an/or ugly. Thanks everyone. Sorry to be such a cry baby and a downer but I just never thought it would come to this. Thanks, Gina

Hi Gina... I hate all the hoops these insurance companies make us jump through...:: They have done it to all of us (at least it seems that way) I was in the same boat you are. I wanted Lap band, and thought Bypass was "too Radical" for me. but after going through all the hoops - tests, 6 month diet and all of that- they still denied me the lap band... same thing EXPERIMENTAL thwy say (even thought FDA approved it I believe in May of 2004 and THOUSANDS have been done in THIS country) I hired a laywer and fought .... I would NEVER take no for an answer after I got them to say it was MEDICALLY NESSISARY.... but when I got down to the end of a calendar year (after fighting 18 months) and my Ins was going to stop ALL bariatric surgeries the following year, I had the Bypass. (I started looking into it shortly after they denied the lap band) Any way, best thing that ever happened to me! Everything happens for a reason (I believe) and I was MEANT TO HAVE THE BYPASS! I had it Dec 29 2004 and I lost 108 and have reached my goal.... Look into the bypass with an open mind and ask your Doc if he/she thinks you would be a good canidate for it..... and feel free to email me anytime! Best wishes for the best possable outcome for you! Hugs Sweet Mammy (aka Byrne)

Hi Gina, You are getting a lot of other peoples views and opinions here. You have to do what is best for YOU!! Everyone is different and expect different things and do things for different reasons. Do research. Dr. Barba is a GREAT doctor. Talk to him and find out what he thinks. He will NOT steer you wrong. Don't panic, but don't wait. Call your insurance and talk to them and find out what exactly they will cover. Prepare your self. I have BC/BS and I didn't have to have a 6 month diet evaluation. I called them first and found out what I needed and got names of people I talked to, so I could verify what they told me. I wasn't taken any chances. I even had them mail me what they verified. This way I had it in writing and I wasn't getting cancelled. I was approved right away,as soon as I was put in by Dr. Barbas office. I had the gastric bypass but was considering the lap band. I researched both. I talked to Dr.Barba about both. I did what I thought was right for me. If I wanted the lap band, and I didn't get cleared by the insurance, I would of switched to the bypass. It is all good. I wanted something permanent. I am glad I made the decision I did. You will find people that have lap band, that will say " OH it is the best" and you will find people that had the bypass that say " Oh it is great" But they are not you. So you need to research for yourself and make YOUR decision. Hope this helps. Hugs, Sarah

First off, either (any, for that matter!) surgery can be undone by poor habits and such, so don't let someone else' success or lack thereof lead you to make a decision. The only choice you have is to get proactive in your own healthcare, at this point. All right, they won't allow Lap Banding...is there another ins. policy available to you that does? When is your company's open renrollment? Is that an option? If not, then, you've got to get a FIRM answer directly from your insurance about EXACTLY what forms of weightloss surgery they cover when medically necessary- get CPT codes! Then, you know what your options are. Don't take someone else's 'word' for it. Go to the horse's mouth. Then, go and speak to your surgeon of choice about the options you have. Only you and your medical professionlas can decide what surgery is right for you. Gastric bypass is NOT for everyone, nor is Lapband. I originally wanted lapband and went seeking that, but after careful consulting with my surgeon, we decided that it was not right for me. Making the decision to go full RNY was a big one! But, making the decision to have ANY surgery to assist with your obesity is a BIG BIG decision not to be taken lightly. Some people feel Lap Band is 'safer' since it's removable and have the attitude of it not being permanent. But, that's just not exactly true...nor is it a good mentality for the long run. Nor is it particularly true the RNY is more dangerous in the long run. BUt, there ARE shades of gray on the issues. I guess what I'm saying is, figure out WHY you wanted lapbanding, and go from there with your medical professional. There are many arguments for one surgery or another, but the only ones that matter are the ones that apply to your cir****tance. Best of luck in your decision and insurance battle. Lisa C