MelindaH

You would be eligible for the procedure as long as you purchase dependent coverage. If WLS is a covered benefit, the lap band should be covered as it meets the standard of care for bariactric surgery. The rest you are going to have to get from the ins company or your wife's HR. I have heard of some aggravation with UHC plans. They do have a strict protocol that you will have to follow to qualify for the surgery. Good luck on your decisions to improve your health. Melinda

So happy to hear about everyone's approvals, but esp the BCBS Federal ones. May I ask how many co=morbities you are required to have? I have high cholesterol. GERD, sleep apnea, pre dabetic, hypertension, arthritis, DDD, knee replacements. Are these viable? Thank you, Melinda

I believe that the hospital cuts you some slack for an emergent admission. I would hope so. They will verify benefits and usually call you in your room (which I hate) or come and see you and make arrangements for payment. If you gave them correct billing infor in the ER, sometimes they just verify benefits and go on. Insurance people in hospitals tend to get behind, especially on a weekend, and if you have good ins, they just send it on over for billing. I did this for several years. Mon and Tues were usually extremely busy. Melinda

Yes, the ins co-ordinator is usually willing to call for you after a certain time frame. Melinda

With my insurance, BCBS Federal the only way they will pay for bmis betweek 35 and 40 is for defined co-morbities. I think you have to have at least two, but I could be wrong.. I hope that you can get yours turned around on appeal. All the best to you! Melinda

I see both sides of the issue. When you are immediately post op, it is critical that you call your MD. They try to educate you pre op as to how to proceed. None of us are medicallly qualified with the exception of RN and MD. You can open up liability suits really quick should you give erroneous advice. I have noticed that most rn's are very supportive but their bottom line is CALL YOUR DOCTOR. Unfortunately, the days or free advice lines are over. But I think that they really provided a service to the community and it is unfortunate that they have been eliminated from most hospitals. If people want to share infor- mation if should be worded carefully from their own experience.and not general knowledge available on the internet. Sanction, I do not know if this is your personal view, or have the powers that be clamped down on this? Thanks, Melinda

How many fills did it take to feel restriction? don't know yet, I have heard people with several different time frames. Any of you became pregnant while having the lap band ? Were there any complications? Did this negatively affect your weight loss journey? I am beyond child bearing years. Again, my clinic asks that you wait eighteen months to two years to try to conceive. Sorry I missed these,lol MH

Thank you for sharing your story and giving me hope. You look awesome. Your resolve is tremendous. Keep it up. Melinda

Hi and welcome to our forum I am on a high Protein, low carb diet. They want me to get in at least 75 grams of protein a day. Your servings should be done on a 6" plate. Half should be protein and the rest 1/4 vegies and fruits and 1/4 starch. I had to lose 5% of my weight before it will even be sent to my ins for approval. It is generally about four to six months between your initial consultation and surgery. Mine is going to be about seven. I gained weight the first month so was one step behind. I have learned a lot in that time that I feel will be useful in the future. Hope you are able to go to a Center of Excellence. The quality of care has been just what it says, excellent.. I am very impressed with the way the clinic is run. All the best to you, Melinda

I am really sorry about your insurance coverage. I would appeal it as many times as it takes. Gather your medical records of old if you can. Show them your attempts at weight loss. Surely they know how stupid it is to deny coverage. I guess they would rather pay for diabetes and heart failure over the years. Send a copy to the insurance commission in AZ and while you are at it send a letter to your congress person and to the two senators. Send it to the white house, you never know. I know I sound flighty but I am dead serious about letting the government know where people are at. I have seen a lot of people post that they have used obesity law.com. Keep us posted. Don't give up. Melinda

you will get separate billing from the surgery center or hospital and anesthesia. I do not know of anyone where you are as I am in Oregon. I just want to wish you well as you journey to good health again. Melinda

Go for it, Maura! Congratulations on your weight loss and TT. Keep us posted on your progress! You can and will do it! Melinda

Interesting, black cadillac, just reminds me that I do not know it all! Thanks! Melinda

You are very welcome! If you have any questions, please feel freee to message me and I will be glad to help.

I would calll both the surgeon and hospital. Someone will want money and could cancel your surgery if you are unable to pay it. I would expect to have to pay half of it before surgery. Better to communicate preop before you arrive at the hospital. I used to work in a hospital and this was standard policy ten years ago. I can't imagine that they have loosened their requiremets. But communication with the business offices is critical. They will work with you and usually set up a payment plan. But do not ever be late. I hope this helps. I just do not want you to be in admtting and a clerk asking you for money and you not having it. It can be embarassing for both the clerk and you and can delay the OR, which is frowned upon harshly. All the best to you in your journey to good health. Melinda

I can't imagine that they would make you start over.....I would think it would be good for a year at least

I have had numerous endoscopies for swallowing problems and GERD. Last year, I developed ulcers from NSAID therapy. Good news is that they healed. More good news is that maybe I won't have such severe GERD. I also need two hernia repairs. I have always been treated with kindness. The last thing you probably will remember is a nurse putting a bite in your jaw. It is all through your mouth. Mannometry is done through your nose. I have woken up twice when they were finishing with dilating my esophagus. The next time the MD added a little benedryl to the mix and I have never woken up again during the procedure. I have my GI's blessing on the lapband. He feels that it will make a significant change in my quality of life. Feel free to ask any further questions, best of luck to you, Melinda

I gave up diet coke three years ago when it went over $4.99 a twelve pack. Just couldn't justify it. I would go through a twelve pack in two or three days. Began to drink Water, water, water. My GFR, a measure of kidney function had been down and it has returned to normal, I am sure because of no soda. Really, the thrill was just the opening of the can and the first slug of a cold, cold diet coke. Better than s*x, lol. Maybe once a week, I will have one while I am where my husband plays live music on the weekend. I am still pre-op. It just doesn't taste right and I give it to my husband. I think of my kidney function and all is well. My dad dield of chronic kidney failure and I would prefer not to go there. Even if insurance is paying for or has paid for your band, it is an investment that should be guarded and treated. Instructions should be followed. You went through a tough surgery to not follow the rules? I say, stay away from it even if you get the ok from your surgeon. It is just so freak** addicting and expensive. Just my two cents, for everyone to decide what is best for themselves. Sorry for the rant, I am frustrated today Thanks. Melinda

Just happy to report that I lost six pounds in six weeks which qualifies me for the pre-op classes for the lap band. So relieved. Five more and I can have it sent to Blue Cross for approval and then get it scheduled. Praying that it can be done in Dec--don't care if it is Christmas Eve or New Year's Eve either. I thought that I had probably gained this time as I have been unable to exercise due to my back for about six weeks. It is getting better and I have been doing gentle exercise this week. Just shows that Protein, Water, Vitamins and exercise are really the rules of the road. Melinda

This was not so much an insurance requirement but a clinician's. He asked me to lost 5% of my body weight to shrink my liver a bit. It makes it easier for the laparsope to move around. I think that it also shows your motivation and willingness to follow directions. Thank you for the compliment. It has been hard and I lose weight so slowly partially due to all the medication I am on. Hope to get rid of at least half of it with the surgery. Melinda

Hi all, I found out at the bariatric cneter today that BCBS Fed now covers the gastric sleeve. Apparently this happened in JUly of this year but nobody told anybody on the inside! Sounds like the gov't to me but that is another long post. Just thought I would spread the news. Melinda