Jbright

Can't wait until I'm at 1/2 or 1 cup of satisfaction from my meals! Congratulations Dee

Hi Everyone I found out today I was denied by Aetna for not having a BMI over 40 for the last two years. Well, the reason for my BMI not being over 40 is because I have been going to weight loss doctors and be issued phentermine. My BMI has never been below 37 (well at least in the last 8 years it hasnt) Needless to say, Aetna stated my surgeon can complete a peer-to-peer review with their medical director. Has anyone else (preferrably w/Aetna insurance) had this happen? IF so what was the end result? Thanks Jbright

I'm a bit confused after visiting my WLS office today he advised me that I have 7cc in my band. He advised me at my previous appointment that there was nothing in my band when it was installed and he added 3cc at my last appointment. Today he tells me I have a total of 7cc in my band 4cc was in the band when it was placed and the 3cc at my last appointment. Today 1cc was added now I have 8cc. He says all Allergen bands comes pre-filled with 4cc. Has anyone else heard of this? This is my first time hearing of this. Thanks Jbright

I'm not at my sweet spot as of yet so I would like to know how many cc's it took to reach the spot once I arrive there.

At my last appointment, he pulled out the 3 he placed in during that appointment. I'm completely confused because if he input 3cc at the last appointment and pulled out the 3cc to show me that was in the band. Today I didn't witness him pulling anything out. However, after he input the 1cc, I asked him if he checked my total fill amount and he said yes! I personally think he is being lazy and I also think I only have a total of 4cc (3cc from last appointment 1cc today) in my band. I'm a little upset because I take my band seriously and don't feel like my WLS and I are on the same page.

Did you double check to make sure your insurance policy will allow obesity surgery treatment? I believe the sleep apnea diagnoses should grant an approval(it did in my case). Keep fighting them (aetna) for approval! If they deny you I would contact "Lindstrom obesity advocacy" they may be able to help you and you may not have to pay anything out of pocket! I contacted them while waiting for the peer review to be completed just in case I wasn't approved. Good Luck

Hi Jendkopp Yes, my surgery was approved after the peer to peer review. I was diagnosed with Sleep Apena and Aetna apparently did not consider the sleep apnea when the completed my first review. Do you have any co-morb?

I'm from Jacksonville, Florida. Currently, I reside in the DC Metro area (Northern VA to be exact) since late 2009. Man, do I miss Jacksonville weather. We received the remnants of hurricane sandy yesterday and I soo wish I was in J'Ville today. Bundle up Jbright

I had my surgery last Wednesday 10/24. I was a little worried myself so I bought the suppositories (on Saturday) however I never used them. My hubby seems to think that since I've been taking in nothing but liquids there was nothing for me to push out! Well my first BM was yesterday (6days later) and it actually occurred while we were enduring hurricane sandy. (TMI I know) JBright

This is a new experience for you (as well as myself). This is an open discussion forum and you are allowed to ask any question you feel necessary but be prepared for the positive or even negative response you may receive. People sometimes go overboard with their responses as if you are trying to break "your surgeons" or the "band rules" by asking a simple question. Inspite of the advice or information you receive on the board, I would hope you continue to follow your doctors orders. I understood your question and was interested in hearing what others have to say as well. When I attended my pre-op class at the hospital the nurse had different post op instructions for each person based on their surgeon and procedure type. I posted my post-op diet up above and forgot to add my surgeon allows me to take in two Protein supplements a day in addition to the items I already listed. JBright

Hi Rrobichaid2- I had surgery on last Wednesday 10/24. My surgeon has me on all liquids (not just clear I can have SF Jello and pudding) for 7 days so tomorrow is my last day on liquids. Then i'm on to mushy's. It's been hard but I'm still maintaining. Good Luck Jbright

I went into the office to pay my program fee and receive orders for pre-op testing. My doctor then asked me why I won't consider bypass surgery instead and people don't usually lose but 50lbs with the band. Has this happened to anyone else? I'm not considering bypass but I'm curious to know if anyone else's doctor recommended bypass instead lap band. Thanks J right

I can believe it Carrie Carrie. I just think bypass is too dangerous. I was just wondering if anyone else's doctor recommended bypass to them instead of the band. I know first hand experience (mom had bypass) how bypass works and I dont want to go that route. Jbright

WOW Carolinagirl congratulations on your success! It is really good to hear about others having success with the band. I thought it was a little odd for the doctor to recommend the bypass being that I am only wanting to lose about 80lbs. I know the weight does come off quicker with bypass but my personal choice from the beginning has been and will remain lapband. My mom had bypass in 2002 and she has had all kind of health issues since the surgery as well as having to have her gall bladder removed. She cant eat certain things til this day or she will be sick and bedridden. So bypass is out of the picture for me. Thanks JBright

Congratulations, AnnLouise! I wish you much success! I am praying my surgery gets approved. Yes, reading Aetna's clinical bulletin was helpful to me as well.

HI twinkee, the pills does not do anything for me except keep me from gaining weight. I do not lose an ounce of weight when I take phentermine. Sounds like we are in the same boat. I stopped taking the pills in June and have gained 15lbs since June 2012. I am tired of taking pills as well. Good Luck with your banding!

BandingMI, congratulations on your banding... I wish you much success!! I was tested for sleep apnea and was issued a CPAP machine. For some reason I thought the sleep apnea diagnose's was sent in with my case. Nonetheless, I found out today that my file was submitted that I was tested for sleep apnea. After speaking with the pre-cert department at Aetna the communication of me having to sleep with the CPAP machine as well as they didn't have my diagnoses which is 327.23. I will be calling my insurance coordinator (at the surgeon's office) first thing in the morning to ensure ALL of my information is submitted. Also, since the peer to peer hasnt been completed yet, I will also request my doctor mention the sleep apnea during the review.

I was denied today. While I was initially devasted too. Was down for a couple hours I then started thinking about all of the hard work as well as the things I have done to get this far and I am deciding to fight!! Our health and quality of life is at stake!! I stayed on the phone with Aetna for 45minutes for them to research and look into why I was denied. Which happened to because my BMI has not been over 40 for the last two years. The reason why it hasn't been over 40 the entire time is because I have been taking diet pills. Determine why you were denied and file an appeal. Thats what I'm going to do! Good Luck

HI Jen I kinda feel I gave them too much information. Oh well everything happens for a reason..I am awaiting the results of the peer to peer review if that doesn't grant an approval for me I plan to contact the Lindstrom Obsesity Advocacy group (well I have already put in a call to them) As you can see I am a very persistent individual. Congratulations and Good Luck with your surgery, I am sure everything will go well

Hi ALL, I have been following this board for a couple months because I've been considering Lap Band. I honestly feel like I know some of the people here personally especially after reading about their journey. About me lets see..... I'm 33 and have been overweight for years. After having my first child in 1998, I started taking Metabolife. I managed to loss 45lbs or so. When I took metabolife, I watched my what I ate and exercised four times a week, I was in the best shape of my life. Then I became pregnant with my son. I managed to continue exercising while I was pregnant. Although I gained 48lbs while being pregnant, I lost all but 10 pounds after I delivered my son, in 2001. In 2003 and at 170 pounds, I began taking Phentermine diet pills to maintain my weight probably for the past 9 years (off and on). While I didn't lose much weight while taking the pills I noticed when I went off of them, 10 pounds or so would creep on. I workout and try to eat right but the weight would never come off. So, I decided to kick the phentermine to the curb once more and since July 2012, now Im 15 additional pounds heavier(instead of the normal 10). I am now tipping the scale at 243 (my highest weight). Being overweight is genetic (well at least I believe it is). My mom had gastric bypass in 2002 she was almost 400 pounds she has lost and managed to maintain her weight at about 220. My mom's weight issues has always scared me thats why I would workout and try to eat right. I have Aetna POS II and I have been awaiting their approval since September 21st. I am remaining hopeful about this whole process and pray I am approved! I can't not continue to take phentermine pills as they no longer work for me. I have been calling Aetna everyday asking for a status since September 24. Everyday, the status has remained as pending. I am wanting this surgery to be approved so that I can go on with my life. I have completed the 3 nutritionist visits (as insurance instructed me to do so) psychological test, sleep apnea (which I found out I have a case of and was issued a CPAP machine. Does anyone think calling the insurance company everyday is considered being too pushy? Also, my two years of weight history happen to all be through the dietary programs (which I paid for) that prescribed me the phentermine so I am hoping and praying Aetna will recognize my attempts when they are reviewing my file. BTW, beside the sleep apnea I do not have anymore co-morbids. My BMI is 42. Anyone else has any similar stories they would like to share about two years supervised weight history? Best of luck to everyone!!! Jbright

Thanks everyone for the replies..Sadly to say I found out this morning I was denied as well because they stated my BMI hasnt been 40+ for 2 years. My surgeon and the medical director (at Aetna) is supposed to have a peer-to-peer review. I am praying this is approved. If not then I will be consulting the Lindstrom group as well for assistance. I am really kicking myself for attempting to lose weight with a supervised medical professional and not just letting the weight creep on up maybe I would have been approved. I am so upset about the whole process!