Ok, I'm depressed

Hi all,
I am in the process of seeking a revision to my RNY from 2000.  When the first letter went out to BCBC, they said I needed a nutrionasl eval and a physic(sp) eval.  Well I did that and I just called the doctor's office and spoke with Ashley (insurance person) asking if the letter had gone out to the BCBS.  She said yes, and they denied me for a revision.    Dr. Anez is out of town and when he comes back they will appeal.  He will schedule an one on one with the insurance doctors and hopefully they will approve.  I'm just afraid the ventral hernia will start to give me trouble before they approve my revision for distal rny.  I also have a haital hernia, terrible acid reflux.  With my original surgery I lost 137# but had gained half back.  I have now lost about 10# of the regain but still need the revision.  So i am some what depressed about the denial. 
But on a great note, I am a 1yr survivor of Breast Cancer.   I know God has watched over me and He has truly brought me this far.  I will keep my Faith, and if it is for me to have revisional surgery for my RNY that will also happen.

Thanks for letting me vent and Praise God.
Marianna

 Hi Marianna,

Hang in there! You and I are in the same boat. I just got an email from my Dr.'s insurance department about the denial letter that I got from Blue Cross Friday, and she said that my surgeon has requested a phone conference with Blue Cross. Hopefully, both your doctor and mine will be able to get our revision surgeries approved. 

Blue Cross always denies me for every type of surgery that needs pre-authorization, but I've been able to get every surgery that I needed so far (over the span of 20 years with the same policy). It's a pain having to deal with their stall tactics, but the good news is that they usually do come through, at least when a doctor is kind enough to call up and explain the details of the case. I guess all we can do now is wait and see what happens. 

I can tell you that when Blue Cross denied a knee surgery for me once and my surgeon had to call them, I was approved as soon as he got off the phone with them. Let's hope it works that quickly in this situation! 

Hi,  I may be depressed but I won't give up.  This revision is going to happen. I have to think positive.  The hardest  thing is the wait.  My first surgery was approved in no time. I went to the doctor in October and has surgery in November.  No hassels no evaluations just approved.  No they want me to jump through hoops. I had BCBS before but it was Trigon BCBS, different but the same I guess.
Thanks so much for the words of encourgement

Marianna,

I am really sorry to hear that you were denied your revision.

I know that you must be heart broken.

I do know that I have seen a lot of people who were initially denied their revisions, but were approved after they appealed.

We are gonna focus all of our positive energy on making sure that your appeal is solid and they have a detailed list of all of your co-morbidities and how they affect your life daily.

I am also very happy that you are a one year Breast Cancer survivor that is a celebration in itself and something to be very happy about.

I lost my aunt to Breast Cancer and it is a very tough and debilitating disease to over come.

I will pray for you and I just know that everything will pull through.

Hugs.

Hi Teena,
I hope your recovery is going well.  I hope you are feeling well and moving along fine.  I read your post and was glad you had drs approval  to be driving so early.  Was your surgery open or lab?  I am going to keep a positive attitude regarding my revision surgery.  I just have to wait which is very hard to do.  I had wanted the revision done before the end of this year.  I have already met all my deductables for this year. 
I am sorry you lost your aunt to Breast Cancer but I thank and praise God every day that my cancer was found early.  I tell every women I know, have your mamagrams done regularly.  I went every year since 1993 and missed 2007.   When I went in 2008, the doctor told my daughter it was there about a year.  So all ladies and men, don't play Breast Cancer can choose anyone at any time.
Take care of yourself.  Sip, sip, walk, walk, just don't overdo.  Let your body heal.  When we don't let ourselves heal, we pay for it later in life.

Marianna

Marianna,

I am doing great.

My surgery was open.

Every since my aunt's passing I have been going to get mine religiously since it runs in my family and I am high risk.

Early detection is saving lives everyday.

I am so glad that you are doing well.

Keep your head up regarding your revision as it will happen.

Hello
I was also denied but approved within 2 weeks of denial...you need to write and then fax directly to the grievance dept, a passionate letter coming from you..why you are seeking the revision, struggles that you have gone through in life, make sure that you explain to them that you and your doctors are the only ones that should be making yey or nay decision in regards to your health...I think that you will find them listening to you...Good luck...I am 1 month out of my revision orignial surgury in 2000....

Hi,
Thanks for the information, I will try this and see what happens.   I am going to be off from work this weekend and I will try to get a letter started just in case the doctor's office gets another denial from BCBS.  It was so easy for the originial surgery but this time it seems to be much more difficult.  I was so sure it would be a breeze but it didn't happen.  I thought I would be back on the losing side again by now.  BCBS put the brakes on me.

What type of revision did you have?  Did you do well after the surgery and are you doing ok now?  I am very interested in what everone is able to eat, drink, problems with gas and how fast or slow are they losing?  Just interested in what to expect before, during and after surgery.

Again thanks for the suggestion and information.
Marianna

Your very welcome..I was thinking the same as you before my original denial...I actually had the Y revision done...I don't know the correct term...I did really well...there is definitely a difference between the first surgery and this one...I don't get the same "full" feeling to the point of getting dumping, runny nose , yawning etc...I guess because my system has adjusted to my eating habits since the first surgery...I do get a satisfied feeling however..I have lost 20 lbs in the first month however havent lost any additional in 1 week....but, I have read that weight loss is slower with the revision...I am staying true to my diet, can only eat 3 oz comfortably..I drink a homemade protein shake 2 x a day...concentrate on my protein....and excersise....I feel really good and I have made the decision to stay off the scale...I look better and feel better so I'm not going to be so much about the number...just grateful for the opportunity to get back on track and living healthy....the revision surgery like my original, is only a tool not a lifetime solution. 
So keep me informed on your progress...what state do you live in ..I am in Mass....I think if you write your letter like your writing it to yourself, like telling yourself that this is it your not a failure you deserve another chance, You deserve this, you have to show them that you are committed to yourself more than anyone else could be....again good luck!!