Notice of Adverse Determination

My Dear Laryssa....do not give up. And ditto to what everyone else has said. You will have your surgery. You have to keep "chanting" that. Like the Little Engine that Could...I think I can, I think I can. Except yous will be I Know I Can, I know I Can. I think so many insurances think they know more than the Doctor knows. My husband just had a case where his Doc prescribed a med and he has to "clear" it through the insurance....give me a break. What do they know. I know they have Doc's on their boards but....you would think if the Doc said he needed it.....he needs it. This is a Doc he has gone to for a long time. Anyway...back to you.....you will get this. Don't let them intimidate you! With the help of Dana and everyone else I know you will be there. Patience and perseverance. I am routing for you my dear. I am praying really hard....and I know you are meant to have this. So...you just get up and fight!!! Love you, Dianna

Dear Dianna~ Can you come to Ny and hold me hand along with my friends through here...then i know I CAN do anything! Thank you so very much, you are so encouraging and sincere, I can hear it in your post. See, the fact that your husband had to have a prescription 'cleared" through them, is just proof, that these insurances are so "tight" lately. it is so sad for so many reasons, that they make everything so complicated. I would've thought that the fact that my cardiologist wrote my letter would have been pretty good, but they care about what THEY want and not what the doctors' who know us recommend. Grrrrr I am keeping my chin up and fighting until they drag me to the ground..without hope and faith...you'd just throw the towel in! I see you and the strength that you have, the positiveness and the love you show and that makes me say "I KNOW I CAN". I have been keeping you in my thoughts and prayers too...you are so wonderful! Love you, Laryssa

Insurance companies can either be our best friend or our worst enemy. I'd like to yours right now!!! I really thought that I would be denied and so I started an appeal letter--I will send it to you to maybe use as a rough draft for your letter. I hope that will help a little bit! I feel so helpless here and want to do whatever I can to help!!!! Kristin J

Ohhh Dear Kristin, You are so great!! Thank you so much, not for just the support and response to my post, but for being a friend. It means alot to me and I know that without you and the others, I could not fight as hard as I want to now. Now I am angry.....got to fight back!! If you still have your letter and do not mind sending it to me, I would be so thankful, I need to start everything I can right now. Maybe we all should gang up on GHI..show them that we know about the procedure!! Thank you again.. Love ya, Laryssa

Now that's funny, how many times have I read that just a 10lb loss would help you and your obesity-related problems?? I think LOTS OF TIMES. And the lapband has proven to help people lose AT LEAST that amount. Other surgeries have high risks and I'd send a copy of all the posts on the memorial page that show that someone died from the bypass. I think in BIG RED LETTERS I'd put on the front page of the appeal is: I WANT THE LAPBAND BECAUSE THE PERCENTAGE OF DYING FROM WLS IS EXTREMELY SMALL,1:2000, NOT LIKE BYPASS WHICH IS 1:200. I'm still of the mind that insurance companies are run by ******* (bleeped out so the ceiling won't fall on my head ) . Send copies of everything and Inamed has information they can send you on the results of the lapband. Good luck on fighting these *******!!!!

Dear Granny LaLa~~ You are so right and I am going to do just that also! Hey, you can never have too many things to cover your own ***!! I so agree and am so thankful that you brought that idea to my attention. I did place an e-mail in with inamed and a few other places, hoping I will get some responses soon! Thank you again! Love laryssa

There is also a yahoo group called ExtraordinaryBandsters. It's those that have lost over the normal amount of weight with the band. I think starting with losing 200lbs and more. Normal weightloss would be in the 100-150 pounds. I think you can get some really good information from these Extraordinary people!

awww, man - laryssa i'm so sorry that you have to go through this - insurance companies are soooo glad to see you are appealing - don't give up! we are here for youthrough the whole journey lisa r 300/215/150

Laryssa~ Sometimes I think the insurance companies deny us on these requests because they think they will get away with it. Someone might just give up and not try to appeal and therefore they get out of paying for another surgery. We basically have to be our own attorney and offer them a case and reasoning that they cannot refuse. I was initally denied by United Healthcare but I appealed and won. You can too. Keep plugging on! Good Luck! Angelene B.

Dear Angelene~~(what a beautiful name) I agree, and sadly there are people out there who do not fight and the insurance companies jump for joy i am sure. I am planning on doing whatever I can possibly do to try to win this and put upa great fight!! Thank you again, I am so glad you too, are another person who is proof of this "battle" Laryssa