Jim1967

Call your old Doc in MA and see if he/she can connect you with someone local.

They should. Just call them and ask them if they can send you a copy of the gastric banding coverage guidelines. Rep at Cigna emailed me my copy.

Still make sure you get a copy of the coverage so you will know exactly what you need for approval. With this type of thing you cannot assume your Doctor will know the insurance guidelines. Insurance companies can be tricky. To give you an idea of what I mean here is my insurance companies requirements:: CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met: The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following: a BMI (Body Mass Index) ≥ 40 a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity, including but not limited to the following: mechanical arthropathy in a weight-bearing joint type 2 diabetes mellitus poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management) hyperlipidemia coronary artery disease lower extremity lymphatic or venous obstruction obstructive sleep apnea pulmonary hypertension • Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: weight current dietary program physical activity (e.g., exercise program) Programs such as Weight Watchers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. Thorough multidisciplinary evaluation within the previous 12 months which includes the following: an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery unequivocal clearance for bariatric surgery by a mental health provider a nutritional evaluation by a physician or registered dietician

Exactly!! I had a coworker who got the band a year before me and we didn't change insurance companies at work which is why I asked for the written policy. Insurance companies don't want to pay for the procedure if they don't have to and then they make you jump through hoops to get approved. Insurance company says this is in place to assure them that the person is serious and willing to make a commitment...personally I think it's all about the money. Get more info out of them even if takes involving your HR Dept if you have one to advocate on your behalf. Remember you are the Customer and pay into it. Good Luck!!

I've been to a Longhorn Steakhouse since surgery and didn't have any problems. Waitress was probably annoyed cause I was eating so slow and she couldn't turn the table. They were slammed that day. I had a 6oz ribeye a little mash potato and a little bit of veggies. I avoided the bread all together although I love it. I am not so sure I can eat that meal now with this 3rd fill. I eat a 4oz pc of meat and a little veggy now and I am done...

I wouldn't give up so quickly. I have Cigna and when I called and asked about it they told me the same thing. I asked them for their written policy and low and behold they cover it if certain criteria was met and it was medically necessary. I was banded in April after starting in October 2011. Cigna required a 6 month supervised diet.

Unfortunately, you're in bandster hell. That time when the band is placed (most likely empty) and the time you get your fills. Food intake is going to be all on you until you get some fills in you. I wish I had more suggestions for you. Make sure you're taking in a lot of fluid it may help with the hunger and hopefully you can avoid over eating. Good Luck....

Here in NH we have Tokyo Japanese Steakhouse. They cook all the food right at the table. Little pricey but nice. I would like to go again some day but none of it really that good for you when you consider all the sauces they put on the food. Plus their portion sizes are crazy huge.

Awesome!! Congrats....

It is easy for us on the outside looking in to tell her to drop him like bad habit because he is not supporting her decision. It doesn't bother me so much that he is not supporting it but as to why he is not supporting it. From what I read he seems to have the attitude that fat people just eat too much and are lazy...and that is sad. As passionate as we are about being banded and treating our obesity would you just up leave your significant other who also happens to be the father/mother of your children???? It's a complex situation I am sure. I am glad I didn't have to deal with that with my Wife. She has been nothing but supportive. She was not happy at all when I was considering bypass but it was because she was afraid of losing me on the table. She warmed up quickly to the Band....BUT, I will tell you this at 44 years old the decision in the end was mine. It may have been a lot more difficult if I had children. What I will say is, Krissy based on the 89 in your username I am assuming (and probably wrong) you're 23 years old. If that is the case then you have time to make decisions. Try and get him to the seminar and to the Doctor and maybe it will open his eyes. Do the 6 month diet and make sure he is observing that and when you are struggling make sure he knows. I am not suggesting caving in by any means but see if he'll come around.

I would request an appointment with your actual Surgeon and see if he can do the next fill and inform him of your experience. Even if your intent is not to get anyone in trouble he still needs to know if one his/her people need some training. My place doesn't use lidocane and I am a pretty big guy and they have have no problem finding my port. One shot equals a fill. I never bruised with any of the the three that I've had. A little bit of blood is all.

Unfortunately, its a majority of attitude from society that WLS is an easy way out. I have heard people make statements such as "stop eating and you won't be fat". If only it were that easy. Obesity awareness as a disease has come a long way over the years but we still have a long way to go. I have been over weight all my life and I once had that skewed view that surgery was the easy way out. I did Atkins for 19 months and lost 174 pounds. Fast forward to 2011 I had gained it all back plus an additional 89 pounds!! Like some of the others have said this is not an easy way out by any means. This takes just as much hard work and will power as any other non WLS alternative. Band is a tool to help control your portions and from what I have seen with myself so far is it suppresses the desire to over eat, snack and such. Like Mis73 stated see if you can get him to a seminar. It is an eye opening experience... If he still won't support you then you have some difficult choices ahead...If I were in your position I know what my choice would be but again I am not so maybe it's easier for me to say that. You have one ride down this road of life...enjoy it the best you can so when you reach the end you have no regrets!! Good Luck....

For a lot of us losing is not the problem. Keeping it off is!! I wonder if him saying that is really a cover for something else? Like others said he could be concerned about the surgery but there could be other factors as well. I would sit him down for a serious conversation and probe a little more.

Sorry, A lot of us make assumptions people have Lapband or Realize band. I was just reading up on the Midband which is used in Australia. Makes sense to me now.

You might consider http://www.5daypouchtest.com/plan/theplan.html 5 day pouch test. At least it's better and a healthier way.

Thanks Maria,, The Biggest Loser while it can be inspirational you can see where the show fails. They seem to be so hell bent on getting the weight off the person that they don't consider the real reasons for the weight. Maybe it's just editing but you certainly do not see much education and mental therapy. People should be in support groups to help them or see psychologist. Just my opinion anyway....I still like the show it is inspirational in some ways.

Congratulations!!

I got my 3rd fill this morning and what I did was lay flat on the table and then brought my chin up to my chest and made my stomach muscle contract and it makes finding the port easier. Being stuck 3-4 times for a single fill I could see that hindering your confidence in the person doing it.

I'm with you brother!! I have taken my wife to every Nicholas Sparks and Zac Efron movie under the sun but I told her she can go get magical with her friends...LOL

Congratulations and welcome to the banded side!!

That's exactly how I felt and was thinking I would be a lucky one and not need a fill but what you described about yourself above was me spot on back in late April. Unfortunately the lucky ones not needing the fill are few and far between. I just got my 3rd fill this morning and I am hoping this will be the zone for me. My appetite has diminished and the need to indulge has faded. I got another cc this morning because I told the Nurse my stomach would growl after about 3.5 hours. Hopefully this did the trick.

It is quite normal to have reservations or doubt. I wasn't so much nervous for me as I was nervous for my family should something happen. From the day I first started researching the band to the day of surgery I kept asking myself "am I doing the right thing? Should I have had bypass". In the end I am glad I made the decision and stuck with it. I would do this over in a heartbeat. Try not to be nervous about how different life will be. Get excited about how you'll feel and what you will be able to do once you hit goal. Think about the things you look forward to the most. Good Luck and know you are not alone. We all go through the what ifs....even us guys even though we may not always admit it.