Alexandra

Hi Beth, Unfortunately, the therapist my surgeon sent me to didn't share her actual letter with me. I just got a sort of pre-printed checklist on which she indicated that I was "cleared for surgery." I don't know what else she might have had to include. I think the psych eval is more a requirement of the surgeon than the insurance company. Dr. Borao probably just wants the therapist to say that you clearly understand the risks and consequences of banding surgery and that he believes you would be compliant. If he mentions an absence of depression or any compulsive behaviors that would be a good thing too. It makes sense that it's the surgeon who requires it because it's on his head that he's recommending you for surgery. The insurance company only wants to know that HE is declaring you fit for surgery. So the letter should be written in that vein, to Dr. Borao, about your comprehension and ability to comply.

Froth is just another way of saying "carbonation." Carbonated drinks are strongly advised against, so maybe the froth on a capuccino should also be avoided. Seems to me you're basically just swallowing air, and that fills up your pouch almost immediately! Did the coffee itself bother you?

Beth, different insurance companies see things differently. I've heard of situations where all fills and followups through the first year are covered. I've heard of other situations where only one "adjustment" is included, and others where the fills are treated as completely separate procedures that have to be approved on their own. I think there's a VERY strong argument that can be made to an insurance company when it comes to fills. If they approved the device in the first place, they should also cover at least three followup/fill visits. These are a NECESSARY part of the process to make sure your device is working properly. They'd never deny a doctor's visit to adjust your pacemaker, right? I take it you're in NJ? Who is your carrier? And have you been approved?

I had a talk with my guardian angel yesterday (that's my boss, the insurance genius), who gave me some good advice. (Anyone can PM me if you want to know more--I don't want to say too much in "public.") Yesterday I spoke with a very nice and helpful person at the NJ HSS, who said this was a very unusual problem for them. Usually, when a decision is overturned, the plan in question has out-of-network provisions that can be put into play. But I have an HMO, so it's up to Aetna and its participating providers to reach an agreement. My role is to put pressure on them to negotiate IN GOOD FAITH, and be sure they are not violating the letter or spirit of New Jersey's external-review regulations. Anyway, I'll have some more to report on Monday. In the meantime, I refused to allow my doctor's office to change my date--we have until August 13 to make a "deal" and I know it can be done by then. Fingers crossed!!

Hi Jersey girl! I have good news for you. I know for a fact that Horizon BCBS does cover the band for people who qualify. It's not an automatic denial like it is with Aetna and Amerihealth. Drs. Nicholas Bertha and Alexander Abkin have done lots of lapbands, and Bertha was involved in the FDA trials way back when. I don't know offhand if they participate in Horizon's HMO network, but it would be easy enough to find out.

Wow, Roxanne, congratulations on your quick approval! Can you share some information on your insurance? Who is the carrier, and what sort of plan do you have? (And what state are you in?)

Looks yummy...if you're on a liquid diet!

Can I ask how old you are? I'm going to have a big problem with loose skin, I think--but I could be wrong. The last time I lost a lot of weight it didn't even occur to me, but of course I was only 30 then (and the weight didn't stay off very long, anyway). But 11 years and two children later, my stomach skin already has a mind of its own. I'm hopeful it's not a foregone conclusion that I'll need plastic surgery to cure hideous rashes! :sick

Hi Lettie, For a quick introdution to the LapBand visit www.inamed.com and follow the links for Obesity Solutions. At your weight your BMI is about 35.4 (according to our handy-dandy BMI calculator!), and that's not considered "morbidly obese" according to the AMA guidelines. The Band is recommended by its manufacturer only for people with a BMI over 40, OR with a BMI of over 35 if accompanied by at least two co-morbidities. In English, that means that unless you suffer from negative health effects of your weight--such as high blood pressure, sleep apnea, bone or joint pain, etc.--you are probably not heavy enough to make bariatric surgery of any kind medically necessary. If you do suffer from these or other related health ailments, you might be able to qualify--but that's your doctor's call. All of this is irrelevant if you plan to go out of the country and self-pay for the surgery. Doctors in Mexico and Europe follow different guidelines for choosing their patients.

I so hear you about the short lengths! Add being 5'10" to the mix and you really have a problem. I don't think I've worn anything not called a "tunic" in ten years.

Congratulations on your banding! I'm glad to see that you can get to the computer after two days. I expect to try to get online the evening of surgery day...I'm crazy that way.

Hey Alexis, thanks for reminding me about the wake-up moment! That's what I need to concentrate on, not the rest of it.

Larry, you've already lost as much as it takes some folks two months or more to lose. Your body has to take a breather after such a drop--I mean, were you hoping it would continue to come off at that rate?!? PLEASE don't worry about the scale at this point. You have surely heard that the prefill stage is not about weight loss, it's about healing. Your body has lost a lot of fluids and it needs to recoup and you need to heal completely. Whether you lose any more weight right now or not, by the time your first fill comes around you'll be way ahead of the game already. Relax! 15 lbs. in the first TWO MONTHS is a great weight loss, and you have gotten a great jump out of the gate.

What did you drink? A helium highball?

Hi Dawn, I see your point about this article, but rest assured that articles like these have literally no effect on insurance companies' decisions. They might affect potential patients, and it's these people I worry about. I mean, holy crow, of course if you're going to put cheeseburgers in the blender or stay up all night chewing just so you can down an entire pizza, you have deeper problems than a band can fix. Those people won't succeed with the bypass either! What really disturbs me about this article is that the morbidly obese patient is characterized as an obsessive maniac. We all know you don't have to be a monstrous gorger to gain to a BMI of 50! I have never once told a waiter to "keep them coming," for Pete's sake.

Lori, I'm blushing! Thanks for the cheers!

Trying out my Moderator wings, I moved this to the Support area. Hope nobody minds!

I'll know more about their support groups after my pre-surgery appointment next week. But when I attended their WLS seminar last year, it was clear that the VAST majority of the people seeking surgery were there for the RNY. (The hospital runs a huge obesity clinic with several doctors attached. Only Bertha and Abkin do the band, so far.) I must admit I was shocked at the number of people at this seminar. There must have been more than 300. I wonder what that group looks like now, a year later, and whether the more recent seminars have more people seeking the band?

Thanks, Wednesday! It's so cool to have this group of people who are as excited about this experience as I am. Few of my real-life circle are really interested, and sometimes it's all I can think about. I'm so glad we have this place to come and share our hopes, dreams, and progress!!

I've never seen this before, and am of two minds about it. It's a little clutter-y...but now that I'm thinking about it more I do think it's a good idea in this context. I take it all back.

I remember being in your shoes like it was yesterday. In fact it was a year ago, and I've only recently gotten surgery scheduled. I'm not saying this to bum you out--you may not face the insurance hassles I did--but rather to commiserate about the lack of patience. It was about this time last year that I first heard about the band. I couldn't do anything about it for another two months--summertime, you know--and then it wasn't until November that all the testing and certifying was done. Then the insurance appeals began, and went on and on and on. But all that time I was reading and learning and becoming ever more convinced that I was on the right path. And then one morning I woke up, and here it was--a year has gone by and I'm finally on my way! I'm not really sorry it took so long, since I put the time to good use. I hope you will too and find peace aside from the impatience. It's hard, I know!!!

Another August Bandster-to-be!! You'll be home and resting when I go under the knife two days later. Congratulations!

Thanks, Wednesday! I'm going to keep my goals more modest than a marathon or triathlon, that's for sure. They are: 1. Learning, again, how to ice skate. 2. Rollerblades! 3. Keeping up with the girls for a whole day, even if it involves roller coasters. 4. Having the remotest possibility of swapping clothes with my daughters, some day. I want to be their size--not the other way around.

The process may be similar to what happens when an alcoholic enters recovery. There are lots of "friends" who fall by the wayside when partying leaves the picture. Then there are those who also enter recovery when they see a close friend or relative learning how to enjoy life in a healthy way. Everyone makes their own choices, and the trick for us is keeping their choices from affecting our resolve to make a better life for ourselves.

I just want to share how thankful I am that the band arrived when it did. For the very first time in my life I feel like I might have the help I have always needed, and that the second half of my life might be lived in the 'normal' world. That is, normal without constant stress, feelings of deprivation, self-loathing, and failure. I think I really might have a guardian angel.