CandyB

I have UHC PPO. My surgeon was out of network. My hospital was in network. My anesthesiologist and radiologist were also in network.(You need to check with these doctors before your surgery, but if your hospital is in network, your anesthesiologist and radiologist are most likely willing to accept what UHC pays). Since WLS for morbid obesity is an approved procedure in the policy purchased by our workplace, my surgery was covered. Hospital and in network doctors 100%. Surgeon 70% after meeting my deductible. The balance owed to the surgeon I negotiated with him. I was lucky. He accepted the difference between what the insurance company paid him (about $4,500) and what he "needed" to receive for the surgery ($6,000). I paid him $1,500. But I was fortunate. His office usually asks for $2,500 up front for out-of-network patients. He made an exception for me, and I'm very grateful. I am not a woman of means.

Hi Tanya, I just wanted to let you know that I have United Healthcare PPO, and they approved my surgery. (An aside: My doctor was out of network, but they paid well. I didn't owe him too much money afterwards. I did ask him, before surgery, how much money he needed to receive totally from the ins. co. and me combined. I'm glad I did that because, after the surgery, his office billed me for more that he had told me, and I questioned the amount based on what I had been told prior to the surgery. After letters back and forth, he decided to accept the original figure - whew!) Back to your question. My insurance approval was not without a specific glitch, however. But the glitch (and hence postponement of surgery) was for two reasons: 1.The surgeon's office was supposed to contact UHC one month in advance of the surgery date for approval. They only contacted them two weeks in advance, and when there was a question of eligibility by the ins. co., the answer couldn't be sorted out in such a short time. 2. The employer through which I have my medical insurance goofed on their end as far as their coverage of weight loss surgery. They told me that they covered it, but the ins, co. did not have it on their approved list of procedures. I had to get the patient advocate at work involved to straighten it out. Eventually, it was all OK'd, and everything was fine. So, be aware that it is not always the insurance company trying to be difficult. In my case the surgeon's office dropped the ball in their timing (They knew better, and yet they tried to blame the ins. co.) And the employer had dropped the ball, too. They had not given an accurate listing of approved procedures to the ins. co. Also, be aware that each employer has many options in the plan they purchase from UHC or any other health care provider. So your UHC and my UHC may not provide the same coverage at all. I hope this information was helpful to you. You should call UHC to find out if there is a problem in approving your surgery. Don't wait for them. You won't feel as frustrated if you are actively involved in the process. Best of luck, CandyB.

To any of you who live in the Monmouth County, NJ, area, please keep your eyes and ears open for me, OK? My husband got the bad news on Monday that he (and many others) has been down-sized out of his job as of 9/3. It's a very scarey feeling - we've got all the usual expenses, and I, for the most part, have been at home with the children for 10 years. He has been an order administrator with a DSL chip manufacturer for the past 41/2 years. Before that he worked 16 years as a warehouse supervisor. He is a smart, loyal, hard-working guy, and a very responsible employee. If anyone in our area knows of any job ideas or leads out there for my husband, please email me. 8 weeks severence won't take us very far. After that it's unemployment insurance and paying for our own healthcare insurance. I'm working on becoming a teacher and, for now, am subbing, but that's not very steady. HELP! I'm trying not to panic. Thanks, Candy PS My honey's true calling is as a lifelong musician. He's a talented songwriter and pianist. And, actually, that's his second job. What a guy!

Me, too. Me, too. The psychiatrist who prescribed Zoloft for me a few years ago warned me that she wanted me off it by the 2 year mark because, if you take it longer than 2 years, you can expect weight gain. So, with therapy and stuff, I was off at the 2 year point - gained weight, though. I think it was actually that last bunch of pounds that put me into the WLS mode of thinking. I had been hovering at about 30 pounds less than now for several years. But I think it may actually have been the Zoloft that sealed the fate of my already sluggish metabolism. Darn, that Zoloft really worked well. I could have stayed on it forever if not for the side effects.

Hey, at one of our support group meetings, we were subjected to a virtual commercial by a plastic surgeon speaker. He showed way too many slides on a huge screen. Slides of naked post weight loss bodies - whew - not a pretty sight. But, alas, I know I will look just the same someday. Anyway, he said that tummy tucks after weight loss surgery are often covered by insurance. I think he said they are considered medically necessary because the - ahem - "apron" (stomach flab) can cause all sorts of nasty infections of the skin. So, at least I may be able to get some of my excesses removed. He suggested having the surgery when you are 15-25 pounds from goal. He also said that the excess tummy skin and flab can weigh 7-30 pounds! Just thought I would tell you what I learned, CandyB.

To Alexandra and to Gail: What you're saying is conflicting. Alexandra, you're saying that the "stuck" feeling comes from a full pouch where food presses on the bottom of the esophagus. Gail, you're saying that the "stuck" feeling, according to your surgeon's office, in no way indicates fullness in the pouch because sometimes the sensation happens after one or two bites. I don't know what to think! I love you all for trying to help me sort it out or for just giving me encouragement. I am an analytical person, not a faith-based person. That's why I must understand how it works. This band is a physical, scientifically conceived tool. I need to know how it scientifically and medically works. Until I understand it on those terms, I have to keep asking questions. I know I will figure it out to my satisaction. In the meantime, the band is in place, forcing me to deal with it and, hopefully, losing some weight no matter what. Thanks to all who have replied and encouraged me. What wonderful people I have pulling for me!

Let me tell those who are interested that I have a therapist. We explore whether I am having "head hunger" or not. When I tell him what I eat, when, circumstances, he is sure that I am not eating out of habit, boredom, or a need to "fill myself up." I don't actually eat all that much, and I am not craving to eat huge portions. That is why I'm losing a little bit. I am not discounting the accomplishment of having lost 29 pounds. (Believe me, just the fact that I don't snore my husband out of bed anymore is a big NSV to me). But 3 or 4 lbs. in 11 weeks? I do need to exercise more, but that does not explain away my main question about the band. My main problem doesn't have to do with rate of weight loss. The primary thing that is bothering me is that I do not believe the band is working the physical way it is supposed to, and I'm wondering if it ever will. Is it or is it not supposed to keep the food we eat in the pouch for a few hours, and keep us feeling satiated for a few hours? I don't think it is doing that at all. And how do I get to that point? A few days after a very restrictive fill (doctor had to back some saline out after he filled me to 2.5cc. I was closed off at 2.5. So I went from 1.5 to 2.0 at that fill) I could again feel the food passing right through the stoma into the large capacity part. I'm either stuck after a bite or two or I'm completely unrestricted. I would be perfectly happy to feel satisfied with one slice of pizza. That's the ideal. My problem is being able to eat only a few bites and then having to deal with being stuck. And this problem can happen with any food, tuna salad included. The inconsistency is what is driving me nuts. I never know when I will be able to eat unrestricted (not good), or when my food will get stuck after a few bites (not good). I do include chili and other easy foods just to be able not to deal with being stuck. But I know that I can't do that all the time because the food is just passing through. The guidelines from the surgery center say to eat one cup of food per meal. That doesn't make sense if the pouch supposedly holds no more than half a cup. If properly restricted, how could I eat a whole cup? If food is getting stuck in the stoma, then I must need more restriction is the way I've been thinking. I want to get to the point where food is staying in the pouch, not passing right through or getting stuck. I have no idea if this is do-able. It should be do-able, correct? I can't even talk to my sister about this, anymore, and she is my main support person. She is closed to thinking it will ever work the way we were told it works. It has been six months, and I feel as though I may not be able to get it to work the way I am supposed to. I'm happy for all who are finding success with the band. I hope I can, too.

Dear Gail, Believe it or not, your posting this problem, which seems to be the norm, is so far the most helpful thread I've read since I've been banded! My sister and I were banded almost 6 months ago, and we're continuing to have the "stuck" feeling at all sorts of unpredictable times. She is more restricted than I am, has had three fills, and usually cannot eat anything solid for Breakfast or lunch, and seems to be totally open at dinner time, where she makes up for lost time, eats too much, and is not losing any weight. So, her "stuck" times are more predictable than mine are. But she is so miserable that she is seriously considering having her band unfilled. She is ready to give up on the whole thing. I have had two fills. I never know when my band will restrict me. Some mornings I can eat a bagel(!) Other mornings I can eat only yogurt. Lunch and dinner are much the same. I never know when I will be able to eat unrestricted and when I will be stopped (uncomfortably) by my band. I never feel full. I experience two extremes, and it's driving me crazy. I can either eat 2 or 3 bites and feel "stuck" or I can eat without end, never feeling full. The placement of the band is supposed to help with hunger, but so far that has not happened with either of us. I think if the restriction was more consistent, I would learn to change my eating behavior, but since I never know when it will happen, my old behavior and psyche have me testing all the time. I have lost a total of 29 lbs., but since my last fill, 11 weeks ago, I have lost only 4 lbs. I realize I have not made a successful adjustment to banded life, and I'm wondering if I even have it in me to do so. I know I need another fill to get the restriction I need to lose weight, but I don't know if I can handle it. I don't know if I want to handle it. The feeling in the chest happens so often, it has made mealtimes tenuous for my family and me. My children are quite aware that I am running off to the bathroom several times each week. It's not good for my seven year old daughter to be aware that I often can't keep my food down. I feel like I'm teaching her how to be a bulemic. The result for each of us seems to be discouragement. Neither of us expected this factor of banded life, and it seems to be common. We have been fearing that "stuck" equals full. The more experienced bandsters seem to have mastered when to stop eating. That seems to be the key, but I'm nowhere near even approaching it. And I have no idea how the band helps with hunger. From reading this website, I realize that some people are very successful at controlling how they eat, and they seem to feel full on less food. This idea is still a mystery to me. I actually made a phone call to the surgeon's office to arrange to have my band emptied. I needed a break. But I know I need more saline. This is probably the hardest thing I have ever done in my life. I know that with a fill, I will be forcing more discomfort on myself. It will be worse than it is now. I guess what disappointments us most is that we expected, with proper restriction, to eat less food and feel full. That's not the way it works, we fear. Will we ever get to the point where our food is sitting in the pouch, making us feel comfortably full? That's the way it's supposed to work. Not feeling food "stuck" or feeling it pass right on through into the lower part of the stomach. If I didn't have my sister going through the exact same scenario as I am, I would be convinced that I must be mentally ill!

Sweetie, I hate hearing how much emotional turmoil you're going through. I'm glad you are so open in sharing what's going on inside you. You are a voice we all love hearing. I think we all fell in love with you right away. You've given us all so many laughs. That's why we're all sounding so passionate about what you're dealing with. And we're all pissed-off for you! And I'm sure you will weigh it all out before you come to conclusions and take any action. And I fully understand how you feel about your home. Mine is heart-wrenchingly special to me, too. It was the home my parents found and rented for 4 years when we moved from Pa. to NJ. After having lived in the original "little boxes on the hillside" (Levittown), we all loved it - it's a fine old Arts and Crafts home built in the '20's with all of the quality those days offered:solid as a rock, brass fixturing on all the doors, glass or brass door knobs throughout, custom double front doors, stone columns on the porch, matching stone fireplace in the living room, funny staircase that goes upstairs or down to the kitchen from the landing, three original stained glass windows, plaster walls - that's a good and bad thing. Oh, did I mention that for all of it's charm it will be a money pit until we die? It sits on about an acre of land, and we love it. I would never want to leave it. We bought it a few months after my mother died. I felt like she was leading me back to this house the day I sat and cried in the driveway and called the realtor to make arrangements to see inside it. It had been 30 years since I had been in it. (My parents had bought a house in another town). So I know how you feel about your home, like it's almost worth putting up with your husband's crap just to not disrupt your lifestyle. Well, that's a decision we all have to make for ourselves. I am not judging. I know it's hard to have the courage of our convictions. Selling our first home was the hardest decision I have ever made, but it was a no-brainer once I realized that I was working to pay a mortgage, and I wasn't even in the home all day. My baby was in day care in someone else's home all day. I realized that I didn't have a child to be away from him all day and miss out on the most valuable time in my life. The realization made the decision for me. The mortgage had to go. We had to sell the house. I grieved over that for a long time, but I knew that I had made the right decision. I had to choose once-in-a-life time with my child over materialism and societal expectations. I have never regretted selling that house. What makes you think, though, that you would lose your house in a divorce settlement? With your husband's financially irresponsible pattern, I'll bet the judge would declare that the mortgage would be safer in your hands. Can you swing it on your own? Or do you have a friend who could move in? I'm not saying that you should divorce the guy but that you should keep your options open and not feel trapped. And you should take steps to protect yourself financially. As far as cutting your heart out goes, we've all gone through a couple of those experiences and lived to tell about it and learned from it. I hope you are working on these problems with your head a little bit more than your heart. Your heart might keep you in a forever-doomed-to-repeat-itself situation. Your head is what has allowed you to be the problem-solver you have always been. Good luck in these next few confusing weeks. Candy

Dear Lisa, Before I start in on you, let me forewarn you that I am extremely practical about money. I have to be. We hardly have any! 11 years ago I chose to stay at home with our children, giving up over half of our income, and learning to live with less stuff. We actually sold our home and rented a cottage for 7 years so that I could afford to be a (mostly) stay at home Mom. I've always worked part time evenings, though. Anyway, we eventually bought another home, and are of course saddled with all of the bills and work and headaches and pride that parenthood and mortgage-ownership implies. So, we're still strapped, more than ever before. (After all, we live in NJ, where everything is taxed, even tooth whitening procedures. We are the state with the "Smile" tax. And that is just the tip of the iceburg of corruption in our state). Sorry, I digressed. I wish everybody would stop rationalizing and down-playing what your husband did in making a huge purchase that you didn't approve together beforehand. That's a marriage deal-breaker, and you're fooling yourself if you think it isn't. Even if you could have afforded the Harley, his buying it w/o your agreeing would still be a deal-breaker. Reading about how you've bailed him out before and how responsibly you've handled money shows me that he is someone you have allowed to treat you this way. Love has a great deal to do with responsibility to each other and it has everything to do with trust. Unfortunately, you can't trust the guy. I don't care how cute he is or how much fun he is or how good it is when it's good. Without mutual trust and mutual respect and mutual responsibility there is a lack of true marital love. Sorry, Babe, I think he has proven himself unworthy of you. Don't be fooled by his sudden energy. He doesn't want to lose you. You are VERY valuable to him, but in what way? I hate to say this, but I wonder about the choices we make before we are all grown up. Sometimes they turn out to be good choices, sometimes not. Do we have to stay with the choices we've made even when we realize we've made a huge mistake, that we made them before we really knew what we were doing? You have no children to complicate a marital split. Marrying for better or worse does not mean remaining married through every rotten thing a spouse can do to you. It means weathering the storms life presents both of you together. I wonder if you will feel as forgiving of your husband's outrageous behavior when you feel better about yourself. As far as allowing yourself a revenge-financial splurge, I doubt you will do it, and of course you shouldn't. Maybe it would be more constructive for you to keep your anger focused on the rightful subject. I feel bad for your troubles. Lord knows my own life is full of many, but after reading this thread today, I am going to show my husband a lot more appreciation for being the financially trustworthy husband he is. I'm thinking about you, Candy

Oh my God! I can't go an vacation and stay away from this web-site for 4 or 5 days without missing a ripping hot comedy routine. DeLarla, where do you come up with this stuff? You're going to be required to do at least an hour of stand-up if we all ever meet. Your replies to Donali about restriction are priceless!!!!!! You get even funnier when you get bored, Candy

Ahh, Don't cry, Donali. DeLarla must be a natural-born comedienne! You're going to have to "settle" for being crowned "MOST PROLIFIC AND CONSISTENT INFORMATION-GIVER", and a bandster we thank god we have reading and responding to our posts. Love, Candy

DeLarla, You are a pip! You're the funniest person on this site, and just what I need right now. I'm struggling so with my eating (too much). Probably need my third fill. But I'm just being so bad about learning to eat a new way. I swear I'm going to have to find a band-related therapist (hypnotist would probably be what I need!) to get me on the right track. I'm not feeling discouraged - just learning that this is really up to me. I was banded in February. I'm still a plebe with a lot to learn. Candy

We are feeling very discouraged. We need to hear from those who have had fills and gotten to the effective point of restriction. How did you keep your spirits up while you were able to eat way too much and knew you needed another fill? Did you diet during that time? Did you know soon after your fill that you needed another one? Did your doctor ask you to wait 8 weeks between fills, like ours did? Our scenarios : Surgery for both was 2/24/04. Sister has had two fills under Fluoro. She is at 2.2ccs. I have had one fill under fluoro. and am at 1.5 ccs. Even though doctor was watching the liquid speed through the stoma, he would not add more saline than he had added. He said we would be calling him that night because we would be throwing up even water. If the fills are done under fluoro, why can't the doctor get our stomas to the correct point of restriction? He swears he is being aggressive about the fills. All I can say is that neither of us feels the least bit restricted and have not yet started utilizing the band in our weight loss. We tease each other that any weight loss thatwe have will be a result of the "placebo effect." We feel like we are living in "the twilight zone" when we tell our surgery center's director, the one who schedules the fills, that we need another fill. She is exasperated with us. She says, "Are you telling me that you can eat as much as you could before the surgery?" We tell her that is exactly what we mean. We are not trying to eat as much, but the only thing that seems to be stopping us is sensibility and willpower. She seems to think that any amount of band restriction should help with food restriction. We think that as long as the stoma is large enough for our food to slip through into the big old lower stomach, the band is not working to keep us feeling full with less food in the stomach, and what good is that? Will those who have dealt more effectively with this stage of bandsterlife please step up and tell us how you handled it? Do we just wait and wait until we have enough saline in our bands to begin real weight loss? Do we diet as hard as we can for as long as we can and pretend the band is working for us? Do we pressure the surgery center for more fills until the doctor gets it right? We knew the day after our fills that nothing was different. We knew that we would need another fill. We're wondering whether the doctor is prolonging the process so that he can collect many fees from from us. We're hoping that is not true, but at $250. per fill.... No, I'm sure he doesn't need the money. He just seems to think that a fill of any amount of saline at all should keep you restricted for a period of time. So, we need to know: is it all or nothing with the stoma, or is any restriction better than no restriction? Maybe our anatomies are such that we will need the full 4ccs. Who knows? We just can't fathom having to wait 8 weeks and then another 8 weeks and then another to find out. Please, successful bandsters, give us the benefit of your experience. We are feeling lost and perhaps regretful that we didn't choose the bypass. I know it's sacreligious to say that on a bandster website, but we are truly frustrated and upset. We're feeling like we're not going to be able to make it work. Thank you, CandyB.

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Hi Linda, I definitely favor keeping my decision to myself with the exception of a few: husband, sister who was banded with me, son, and one friend (who I now realize I didn't really need to tell). A lot of others know just because they are in my bariatric surgery center, and I go there for follow-up, and those in the support group I attend obviously know. I have found that having these people know provides plenty of support and a feeling of being truthful. I have also found that opening up to the members of this forum gives me those same feelings. What I realized when I decided not to tell the rest of my world is that I don't want to use my time and energy explaining myself - my decision, the logistics of my surgery, the aftermath of my surgery - to the rest of the world. I'm too "old" (I hope I mean mature) for that nonsense. In the course of my obese life I have found that no one - NO ONE- understands obesity except an obese person - not my surgeon, not his support staff, not the helpful reps from Inamed, none of the not-obese people in my life. That sounds harsh, but it is the truth I have found in my 49 years. Since I had my surgery 14 weeks ago, I have been tempted several times to share what I'm going through with other friends and co-workers. That sharing would give me a form of instant gratification. Having the band is a huge part of my life. But it is not my whole life - it is only part of who I am, and after the moment of temptation passes, I'm ALWAYS glad I kept it for myself. Not telling preserves a sense of self-control within me, and self-control is something I need to work on. I've always been a sharer by nature, but as I've grown up, I realize that it feels better in the long run to be selective. It's OK not to give all of myself away to everyone. I've also found that it is actually healthier for me to have friends with whom I don't talk about this at all. Because the surgery and aftermath are so encompassing, I find it a relief and a n emotional vacation to have most of my acquaintances and friends not knowing. It's good to have a break from talking and thinking about it. I do enough of that every day. Just wanted to give you my thoughts and encourage you to go with your gut feeling. You may find out why your instincts were correct later on in the process. Best of luck, Candy

Dear Alexandra, Our meeting, mostly made up of Dr. Borao's WLS patients and prospective patients, is at Monmouth Medical Center, Long Branch, NJ. We meet on the 4th Thursday each month, from 7 to 9. Anyone interested in joining our group (please do!) can call the surgery center for info: call 732-923-6070. We do have one Dr. Abkin patient who comes to our meeting. She lives in Toms River; so, this one is closer for her. She also likes our meetings. We had Gary, too, and a woman named Susan at our meeting. Yes, I think it's kind of neat that we USA bandsters are in on the early stages of the band in our country, and we're getting a lot of necesary attention from INAMED who wants to make certain their product is well-supported. Gary and Susan provided a wealth of information supporting our choice to have the band vs. bypass. And I was so comforted to hear that everywhere else in the world, the band is the "gold standard" for WLS. It is only in America that bypass is still considered the "gold standard". Did Gary tell your group that there are bypassers who have gained back their weight and have added a band to their bypass so that they can lose weight? That blew my mind! I always thought it might work the other way around. I feel so good about my choice now. Thanks for your consistent support, Candy

Sis and I had our fills yesterday morning (Next fill we're insisting on afternoon appts). The doc was able to pull out 1.5ccs, my whole first fill, same for sis - no leakage (whew)! I think he is trying to work with us. He put 2.5 in, and I was completely blocked. Pulled out .3, still blocked. Pulled out .2, and he thinks it's good restriction (second fill for me). So, I'm at 2.0. Sis is now at 2.75 (third fill for her). Another good thing - our surgery center's director assisted the surgeon with our fills - HE'S TEACHING HER HOW TO DO THE FILLS! I do feel that the center has begun to respond to the needs of the banded patients. When we had our surgery in February, our center had just been set up. Before that, our surgeon's colo-rectal surgery practice was handling everybody. So, I think things are getting better. Also, I asked him to numb me this time, and I'm glad I did. I felt squeamish during the first fill. I didn't like the feeling of the needle being moved around while he was finding the right spot to get the saline in. It was much better for me to have the numbing shot, especially since he had to stick me three times to add and pull out saline. This part doesn't bother my sister at all, perhaps because she was a nurse. But I highly recommend numbing before a fill. (Just as I highly recommend an epidural during labor and delivery)!! Another piece of follow-up: It was so satisfying to have our support group meeting last evening, a helpful ending to a fill-day. Our center's director, again responding to our urging, FINALLY split us into two rooms, bypassers and bandsters. She arranged for two INAMED reps to be there and a 13-month bandster for us to barrage with questions. It was a very, very helpful meeting. We finally felt safe and comfortable in asking our nitty-gritty questions - all of the band intricacies that the bypassers don't deal with. We truly were wasting each other's time when the meetings were not separated. Our director had us fill out a questionnaire about the split, and I think she really gets it now: WE WANT OUR OWN MEETING! The INAMED people were adamant about our insisting on it. I think the most important reason for the bypassers and the bandsters to have separate meetings (and this came to me last night) is that, although we all chose WLS, and I love every one of the people in the group who have made this courageous choice, we chose different paths, and the individuals in each group need to feel that we made the right choice for ourselves.We need to feel good about choosing the band. They need to feel good about choosing the bypass. We need to be allowed to "band together". We need to feel free to talk about why we chose the band and not the bypass and vice versa. We need to be able to discuss the difficulties of each process, the downsides of each process without feeling like we're hurting the other guys feelings, or even expressing doubts about our own choices. The bypassers need to be able to rejoice in their amazingly fast weight loss. The bandsters need to be able to rejoice in the ways we feel our surgery was a better choice for us. I know we're all adults and can handle these differences, but it is a very primitive need to feel that your own group is best - it is called ethnocentrism. ( I admit it - I was an anthropology major, and I love the fact that I actually remember terms like this one)! Back to the meeting:The INAMED reps were interested in what we had to say and could respond to our questions, comments, and frustrations, but they are not banded. They didn't seem to understand the "psyche" of an obese person who has chosen WLS. I guess that's what we all really need - the support of people who understand us on a deep level. Having a successful bandster there completed the support we needed. The INAMED reps could tell us how hard they are working to get our center up to speed for the bandsters. The bandster told us her trials and successes in the last 13 months. She looks fabulous, by the way. Her name is Colleen. She is tall and thin, has lost 105 lbs, and is maintaining at 150 lbs. She is not much of an exerciser, she admitted, but she tries to get some exercise - she likes to ride her bike - although she is trying to get more consistent about her exercise. So, yesterday was a good day. Now, today, we will find out if we really have restriction. Since yesterday was a liquid diet day, we can't yet tell how each of us will feel . We're hopeful, and, at least, if we decide in a few weeks that we need more restriction, we know that we can get a fill within in a week or two of when we decide we need one. Feeling much better than I was a few weeks ago. Thanks for reading this looooong post. Candy

I want to thank all who posted replies to my plea for support. I have never felt so well-supported as I do in this forum. I have been thinking about all of your answers and questions. You have given me a lot to think about. Most of all, you have given me a realistic sense of hope that my band will work. It is essential to talk with people who have made it work. Progress report: my sister and I are going in for another fill this Thursday. We will make our best attempts to get the doctor to do the fills effectively. I will definitely be telling him some of the information you shared with me. Another very good thing: at our next support group meeting, we will be able to talk with a two-year bandster. Our surgery center's director has been responding to our requests for band-related meetings. I'll let you know how the next fill feels. I'm hopeful! Thank you, Candy

I don't want to sound discouraging but, at our most recent support group meeting, we were informed by the director of our bariatric surgery center that many (most?) insurance companies have begun to require that a WLS candidate must prove that he/she has been on a supervised weight loss program for a duration of at least 6 months sometime within the last 2 years, and either failed to lose weight or to maintain weight loss. Some of the people in our group who are still waiting for a date are scurrying to meet this requirement. I know I couldn't have proven that in my case. One member, who has a borderline BMI is afraid that if she has to go on a diet to meet this requirement and loses weight before her surgery, she will not qualify for the surgery anymore.

DeLarla, Thanks for the words of encouragement. I'll let you know if my outlook improves after my fill. I'm not looking for quick weight loss. I'm looking for weight loss due to a band that's working for me. The waiting is what's so hard. Thanks, Candy

Sorry to give you the impression that we have lost nothing at all. It feels like I've lost nothing because it has been so long, 6 weeks, since I've lost anything. We each have about 110 lbs. to lose, and we have each lost 18 or 19 lbs. That initial loss was in the first 2 - 3 weeks after surgery while we were on liquid and pureed diets. After about two weeks, hunger returned, and the weight loss ended as we were able to eat more quantity and various foods. My sister hung on with willpower for awhile, but is now eating too much to lose weight, as I am. The surgeon will not fill before 6 weeks, which is considered the appropriate healing time. My sister had a 1.7cc. fill at 6 weeks, and is not much more restricted than before. I missed my fill apt. on the same day due to a sick child at home. We're both scheduled for a week from today. Looking forward to being a "loser". Not regretting my decision to have the band - just feeling impatient and frustrated that my doctor is so busy that I couldn't get another appt. for 4 weeks. I thought about trying to find another doctor for fills, but I'm hanging in with my guy because he is an excellent surgeon, and I have become comfortable dealing with him and his staff. My best to you on your journey, Candy

Hi, Don Mills at INAMED told me to go to www.lap-band.com to find surgeons and fill doctors. I can't imagine you will have to go too far to find someone since lots of doctors seem to be jumping on the WLS band wagon. Good luck with your search. My first fill is next week, 10 weeks post-op, and I desperately need it. I'm eating almost as I used to - how sad. My sister was banded when I was, and she's going for her second fill, 10 weeks post-op. We're both so ready to begin losing weight with our bands. We attend monthly support group meetings where most of the attendees are bypass patients. At 8 weeks post-op, they're usually about 50 pounds down. As we go around the room introducing ourselves, it's hard to say, "I have an empty band; so, I haven't really started losing weight yet." The people who run the meeting don't really get the fact that the two processes are different. The fills are EVERYTHING! Can't wait! Good luck to us all, Candy

Oh, I must admit I'm jealous on several levels! First, though, congratulations! Wow, 50 lbs! Your doctor is banded? That must be the best-case scenario. I constantly feel like I am educating my doctor's office staff about what I am going through with the band, and trying to get them to understand the struggles to lose weight without restriction. Also, I have to wait and wait for my first fill because my doctor is so busy. I'm scheduled for May 6. That's 10 weeks post-op for me. I'm down 18.4 (to be exact!), but I had lost 18 within the first four weeks. Now I'm eating and eating. It is so discouraging. Let us know how you do with the fill. My sister and I were banded on the same day. She had a fill last week of 1.7cc. and so far feels no restriction. So, she is feeling discouraged. Again, congratulations. I'm hoping to be down 50 in six months. Oh, you men! You always lose weight faster than we do!!!!!! Keep going, Candy

I figure I'd better start trying to get an answer to this question now. My sister and I are scheduled for our first fills 4/8 with Dr. Borao, Monmouth Medical Center, Long Branch, NJ. The director of the bariatric surgery center where we are having our post-op care informed me that the hospital portion of the fill (radiology) will be covered by insurance. But the doctor's fee, which is $250., will probably not be covered. Why? Because, according to her, a satisfactory code does not exist for billing the insurance company for the doctor's fee. She said that none of Dr. Borao's lap-band patients has ever been reimbursed for his fill fee. HELP! I feel like we are at the mercy of an inept or uncaring billing clerk at Dr. Borao's office in Shrewsbury, where the billing for HIS fee is done. (Bariatric Center bills for radiology fee). I was speaking with Don Mills at INAMED and mentioned this problem to him. He gave me some codes which have been succesful for getting reimbursement for the fill procedure. I have shared them with the Bariatric Center director, and I am composing a letter to Dr. Borao, urging him to get his billing clerk on-board in exploring which codes are going to work for reimbursement. (For the doctor's fee INAMED suggested 90799 - unlisted therapeutic prophylactic or diagnostic injection) Can anyone give me input on this financial problem? Has anyone's surgeon included his/her first fill fee with his initial surgery fee if done within the 90 day post-op follow-up period? Borao billed my insurance company $12,569 for his surgical fee. Since he does not fill at all at the time of surgery (understandable), I think the first fill (necessary to make the band work) should be included in his original fee. Of course, I'm the one who's paying, and my logic would be VERY different than the surgeon's! If I have to switch doctors for my fills I am willing to do that, too, since Dr. Borao is out-of-network for me, anyway. So, are there any Monmouth County, New Jerseyites out there who can recommend a trustworthy fill doctor to me? I would really appreciate your input. Thanks, Candy