Candle

Have you spoken to your doctor and/or insurance company about this? I know many insurance company's require you seen a dietician/nutritionist for a period of time (6 months usually - I know that's the requirement here in NY) before the surgery anyway. Most doctors require you see one after the surgery. I think it's good you are interested in seeing someone - seems the earlier you make diet and lifestyle changes, the easier the transition will be after you are banded. BUT ... you could be wasting a lot of money.

I'm back ... I think my tantrum/break down is over - lol - *blush* Thanks for the kind words. I am looking into it a little further. The office for the doctor I am interested in using, is going to have their insurance biller call me back on Monday to give me a better idea of what my out of pocket expenses would be. I also need to check with BC/BS to see if I re-join my current plan in a year (after the surgery) and have any complications, they will still cover me.

Maybe once you are banded and start to lose some weight, feel better about yourself and gain self-confidence ... you'll be able to look at the relationship more objectively? Based on what you have posted here (and there are 2 sides to every story) you ARE in an abusive relationship. I can not even imagine someone who is suppose to be my other half, my partner, my support, the closest person in the world to me ... treating me so poorly I hope for the best for you and am sorry you are in such a bad place right now.

Good luck!!

Follow up on my own BCBS battle: Turns out the exclusion is not my employer's doing but actually BCBS. We have a small business policy which is classified as "commercial". WLS is not covered with a commercial policy. I've been looking for another insurance plan that would cover it and really had no luck. Unless I want to pay upwards of $1,000 per month. I'd rather self-pay and not jump threw all their hoopes. Unfortunately, self-pay of not an option for me right now. I'm going to submit a formal request to BCBS and try to fight it. Most questions about fighting exclusions seem to go unanswered, I assume that's not a good sign. I even contacted 2 lawyers and neither have been very good about getting back to me or even answering any of my questions.

You can do it!!! Count yourself lucky - I have Anthem BC/BS and they won't cover it with my policy AT ALL.

I might be in a self pay situation - insurance - errrr Are you guys worried about complications? Would your insurance (if you have it) cover removal, if something went wrong?

3 things spring to mind: I had just started dating my first real serious boyfriend. His little brother was about 6 at the time and had a friend over. They came into the room giggling and whispering. My boyfriend asked them what they wanted. His brother looked at me and said "We want to know why you are so fat." I was soooo embarrassed. (that was about 60lbs ago :phanvan ) I think I was in Jr High, me and my little sister had made lunch. macaroni & cheese and hot dogs. (Everything my mother bought/cooked was pre-packaged crap - hmmm .... wonder where my bad eating habits started?) We had just sat down to eat and my mother walked into the room and looked at our plates, which were exactly the same, then looked at me and said "God! When are going to stop being such a big fat pig!? That's a big fat pig lunch!" I was real little, maybe like 9, and we were at the lake swimming. My mom's friend and her hyperactive child were there with us. I over-heard my mom and her friend talking about how hard it was raising a hyperactive child and how some days her friend felt like she couldn't handle it any more. She was too embarrassed to take him in public most times. My mom said: "I totally understand. Having fat kids is really hard too." My brother was always heavy like I am and my sister was a little chubby.

An actress on that show came out about having an eating disorder. I saw it on one of those gossip shows - she was a redhead and really sickly skinny. I'm convinced Kirstie Alley and Anna Nicole both did *something*. Imagine how many lawsuits would crop up against Trim Spa and Jenny Craig if I am right and it ever came out? I think Oprah has the band for sure.

Sharon said on Howard Stern a few weeks ago .... and she really really tried to avoid the question .... that she had acid reflux and that since the band needed to be replaced every 10 years anyway (I've not heard that - is it true?) she was just going to have it taken out and try on her own. She didn't state acid reflux as *THE* reason but more as *A* reason she wants it out. I was kind of wondering if she is having a problem with it but doesn't want to publicize the problem in fear of scaring others away from the band. If that was the case though, why would she even go public with removing the band?

I also have a small group plan through Anthem BC/BS in CT. I was told by BC/BS direct that they cover the Lap-Band but my employer excludes it on my specific policy. My employer knows nothing about this exclusion and told me to call our broker. Our broker indicated that with small group plans “commercial plans?” the Lap-Band is not covered. My coverage was just changed from HMO to PPO as I no longer live in CT. I contacted an attorney that posts on this forum, Gary Viscio, to find out if it’s even worth it try and fight BC/BS. I’ll update if I find anything out.

Thanks, girls! The encouragement and understanding on this forum is amazing!! This particular "worry" is small in comparison to all the others circling in my head right now but it is hard to ignore. When we first started dating and he'd tell me I was beautiful I would always say "thanks" and kind of 1/2 smile. He asked me one day if I really believed him and I admitted I did not. He told me he was going to tell me everyday until I belived him and once I did ... twice a day after that. He's truly is one of a kind and a big motivation/support in my decision . I want to be happy and healthy, so we can have a long life together, fulfilling all the plans we've made. (I want to be sexy too though - shhhhh :biggrin1: )

Thanks Lap Dancer! I am going to check with my employer today as well. I am lucky in one respect - I know my employer will try and help me as much as possible - I'm not just a faceless employee in mass of many. We are a very small company, I'm sure they just picked one of the cheaper plans to at least be sure we all have insurance coverage. Hell - I'd even be willing to pay for the rider and/or change in my policy to be covered. It can't be more than the $25,000 the surgery costs! I'm wondering about the appeal process though. Once you are turned down by the insurance company and then appeal with your employer, is this how people end up getting approved ---> the employer gives in and purchases the rider? (again - I have BCBS as well)

Thank you ReneBean - I am going to check with my boss tomorrow - we don't really have an "HR" Dept. I work for a very small company (8 people) I was hoping to not have to disclose any of this to anyone at my job but I guess that's being un-realistic. So, the owner of my company is the one to decide if insurance will cover the proceedure? Wouldn't they have to change everyone's insurance policy in order to have it covered for just ME? I know the owner of my company would do what ever he can to help me but I doubt they are going to want to pay increased rates for all 8 of us. This is soooo frustrating!!

shutuplena - I was looking into your doctor - any advice?

shutuplena: Your doctor is one I have been researching - anything you have to offer?

This is my first post here: I have a policy with BCBS. It was an HMO plan w/ Anthem in CT, that was recently switched to a PPO plan so that I have coverage in the state I now live in, NY. I haven't even found a regular doctor here in NY yet actually. They told me that they won't cover the band because my employer doesn't cover it. Just to be clear - should I submit paperwork to them anyway and then try to appeal after I'm denied? Have people won on an appeal in a case like this? Or do they (people that have won after appeal) mean they were turned down and then won the appeal because their plan actually covered the procedure and as an individual, the request was turned down? Does that make sense? hehe To appeal, does that require an attorney? I'm very upset to find, after all my research, that my insurance plan does not cover the band. I was really scared by my doctor recently when told I am headed for type II diabetes and they want to put me on medication. The insurance will cover that but not the band?! So stupid!! I guess it's the same as covering you to have a baby but not for birth control. Thanks guys.