UPDATE - Denied...but ready to fight!!
Ok here is the updated on what is going on for anyone interested. I am posting this because I realized one of my strongest and best resources are the people here. I received so many kind words as well as a few emails with resources to explore...
So after I get all "tough" I called the ins co back and complained. Before I started this process I called back in October to be sure they did cover it. My ins book/information said that "any surgerical or non surgical treatment for obesity is not covered, including morbid obesity". ( I realized today a lot of us are very familiar with this phase). So according to this it is not covered BUT when I called the insurance company (12 different times!) they all said it is not covered UNLESS you have a documented diagnosis of morbid obesity. Ok so I had hope. I started this process in october and it included getting tested positive for the H.plyori yadda yadda yadda. Well i got the first denial the week of christmas - Merry Chrismtas me! 
- well again once I dried up and called them asking why was i told it was covered but now i am being told it is not. I spoke to a "rapid resolution expert" and she told me the three things I needed to do and then it would be approved. They included a current BMI over 40, medical records showing BMI over 40 for five years, and a psych exam. Check, check and check - all done and sent in. Well today i called ( i have been calling everyday for the past month ) and they told me it wasn't covered. And when I called back to again complain and find out why I was told it was a possiblity they sent me back to the "rapid resolution expert" again. She looked into it and found this - one EOB or explanation of benefits say that is not covered even with morbid obesity (the book i have) and one EOB or explanation of benefits (a detailed version) says it is if you are DX with morbid obesity. She said they normally approve with a BMI of 35-40 so i was like HELLO mine is greater than that. She went on to explain that if the appeals company looked at the EOB that says it was not included they would have denied it. IF the second EOB is correct - the one that does approve it - then there shouldn 't be a prob that she would contact them and put the paperwork through again. She said she would have to contact the person who wrote the plan for the company I work for and see if they know which one is correct. (sorry for the long winded explanation)
So on the other side I am yet waiting - she promised to have some type of answer by close tomorrow. I have been trying to come up with back up plans just in case. I was wondering if anyone has had anything like this happen to them or if anyone is experience with ins and their writing etc. I also even thought about what kind of case i would have it i sought legal help since I have put a lot of money out for copays, medicine, and lost time this past month due to galbladder pain and waiting on the gastric bypass. I know people make mistakes but a part of me thinks it is the ins co fault if they dont cover it but yet they have told me all along that they do - does anyone have any type of legal experience?
I am so in the need for any advice or experience with this stuff. I have even considered self pay if it came down to it but I am not sure where to get the loans for the funds or however.
I want to thank everyone for being there and just letting me get my saga out helps!
Love ya!
Nicole
- well again once I dried up and called them asking why was i told it was covered but now i am being told it is not. I spoke to a "rapid resolution expert" and she told me the three things I needed to do and then it would be approved. They included a current BMI over 40, medical records showing BMI over 40 for five years, and a psych exam. Check, check and check - all done and sent in. Well today i called ( i have been calling everyday for the past month ) and they told me it wasn't covered. And when I called back to again complain and find out why I was told it was a possiblity they sent me back to the "rapid resolution expert" again. She looked into it and found this - one EOB or explanation of benefits say that is not covered even with morbid obesity (the book i have) and one EOB or explanation of benefits (a detailed version) says it is if you are DX with morbid obesity. She said they normally approve with a BMI of 35-40 so i was like HELLO mine is greater than that. She went on to explain that if the appeals company looked at the EOB that says it was not included they would have denied it. IF the second EOB is correct - the one that does approve it - then there shouldn 't be a prob that she would contact them and put the paperwork through again. She said she would have to contact the person who wrote the plan for the company I work for and see if they know which one is correct. (sorry for the long winded explanation)
So on the other side I am yet waiting - she promised to have some type of answer by close tomorrow. I have been trying to come up with back up plans just in case. I was wondering if anyone has had anything like this happen to them or if anyone is experience with ins and their writing etc. I also even thought about what kind of case i would have it i sought legal help since I have put a lot of money out for copays, medicine, and lost time this past month due to galbladder pain and waiting on the gastric bypass. I know people make mistakes but a part of me thinks it is the ins co fault if they dont cover it but yet they have told me all along that they do - does anyone have any type of legal experience?
I am so in the need for any advice or experience with this stuff. I have even considered self pay if it came down to it but I am not sure where to get the loans for the funds or however.
I want to thank everyone for being there and just letting me get my saga out helps!
Love ya!
Nicole 
I'm sorry to hear about all your trouble sweetie! I can only imagine how mad you are! I hope that the ins. co. will cover it after the review everything. I know that there are loans out there that you can get for the GBS; the doctors office should have some info on it.
Vent away sweetie! We're here for you! I must go finish having an arguement with the boyfriend! *SIGHS*
Love & Hugs~
Kimberly
P.S. Keep your chin up!
Nicole,
First, stay persistant!!! I will be thinking postive thoughts for you until you hear back.
Second, most attorney's, especially in a small firm or independent, will talk to you for no cost, but work on a contingent basis. In other words, if you are looking for a settlement, they won't take the case if they don't think you can win.
Third, funding and loans... (this is my speciality/banker girl here) check with family first; if that is not an option, or limited, look into your home equity, if you are a home owner. Last, consider a loan against your 401K/pension plan. My employer allows a LOAN instead of taking the money out, so you are assured of getting the money back in and no penalties.
Good luck and keep us "posted"!
Hugs,
Tammy
Hey Nic,
Girl I told you yesterday this WILL happen. It IS meant to be. We will never let you give up. You are fighting and that's GREAT! It's a journey we fight to take and is worth every bit of it. I truly hope that things work out and you are approved. I've still got you on my prayer list here and won't take you off even WHEN you are approved. I will continue to pray that you are blessed with the journey many of us have and are taking. Good luck baby! You know I'm here. Is GREAT to have a friend like you. 
Love ya,
Kitty Kat 
Love ya,
Kitty Kat 
Hey Nicole,
I really do sympathize with you concerning the insurance. I know first hand just how depressing it is to think you are going to get an approval and then.......POW you get knocked down again. I'm still pre-op and playing the waiting game. Just don't give up. I am almost at the end of my 6 month dieting (medically supervisored) that my insurance requires but I didn't know that until I changed doctors. I had Richmond Surgical Group and they submitted my paperwork twice and it was denied because it was incomplete. Once I called Commonwealth, they told me right off the bat what my insurance company required and I got everything in line and hopefully after the end of April I will have everything in order for an approval. I have been working on trying to get approved since July of 2005. I thought it would be an easy journey but it hasn't. I keep telling myself that anything worth having is worth waiting for. So I am plugging along and waiting, hoping and praying for an approval. Honey, you just have to hang in there and hope for the best. I have put this in God's hands and I am believing for my miracle. I will keep you in my prayers and thoughts. I am believing for a miracle for you too.
Keep us all informed as to how things are going and know that I am here for you. I am sure that everyone here is pulling for you. Don't give up......this gift is too precious not to fight for.
Lots of Love
Kathy 
Nicole,
Although I don't have any "legal" experience I know from my own insurance problems that if you have everything documented, each time you call write down the time, the name of the person you talked to and if possible the majority of what they tell you. I've noticed that names, dates and time seem to make an impression.
I wish you the best of luck!
Liz
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