Frustrated

If you have a letter from your insurance company it should state in there both your and their rights. They have to let you know what those are. You should also be told how to appeal and what actions you can take if you disagree with their findings. It should also state what their requirements are as far as response time is. Take a look at some of your recent correspondence from them to see if it's there.

I'm still not getting e-mail notifications of new posts. I ticked all the boxes I needed to. I used another browser in case that was the problem. I posted in other threads hoping to increase my odds. Still nothing. Anyone know who to contact about this?

Don't look at it as taking away from your savings, look at it as an investment. That's what it is, an investment in you and you're worth it. I understand what your head is telling you about your size and weight. For so long we deny we're fat, or at least not as fat as we actually are. And then when you get to the point where you have to face reality and say the words out loud, it's an admission that you've been kidding yourself for too long about how you actually look. So you tell yourself you're not going to do that again because look where it got you? So your head goes to the other extreme and refuses to believe you look better because you've been down that road before and when you came out the other side you were fat. I tell ya, our bands do everything physically to help us out and it's fantastic. But something needs to be adjusted in our heads, lol.

Tweety, this is one of the excuses I was given. My weight and BMI didn't fall into the acceptable category. Initially I had a BMI of 35.9 and it needed to be 36 with my co-morbidities. If I had no co-morbidities it had to be 40. So find out what's required without co-morbidities and see if you can attain that target. During the waiting process I gained more pounds but I was about 18 short of their target BMI. I actually got to speak to the person who denied my claim. I wasn't taking enough medication for my insulin resistance (pre-diabetes). I needed to be on 2 meds instead of the 1. PCOS didn't seem to make any difference. The results of my bloodwork wasn't "severe" enough to be life threatening. In the end I said "So are you saying that in order to get this weight loss surgery what I have to do is get my BMI up to 40? In other words gain more weight?" He said "Yes, but you're never going to put that much weight on." And he had the nerve to chuckle! Well I accepted that challenge and 3 weeks later I was at the required BMI and went through the appeal process. Not a fun thing, but a necessary evil. I just found it insane that I had to gain weight in order to be able to lose weight. It may sound like a dream needing to eat anything and everything I could to gain this weight on but I never felt worse in my life. I was so worried I'd still be denied and I'd have these extra pounds to carry around. But all the insurance nightmares are behind me now. *touch wood* Hang in there and be persistent. If this is what you really need, don't let go of that goal.

Congratulations. Btw, I love your name. :ohmy::smash: Just a note for anyone out there who is starting this process, I was told that at times if you're borderline for approval/denial, quite often they'll deny you. Those who really mean business and want this surgery desperately will go through the appeal process. Those who aren't so desperate will not. Stick with it! For those making the daily calls, keep it up. Keep a log of your calls (who, date and time) so that when you get a good piece of information you can keep a record of it and if someone says something different you can respond with "I called and spoke with <name> on <date> at <time> and he said <message>. Believe me, the insurance companies have a record of each time you called and who spoke with you. Now even after you get the golden approval letter, don't let up on your good record keeping. I started my process in January 2007 and after an initial denial was finally approved in June. My surgery date was July 26. In September I started getting statements from the hospital I had my surgery to say that the insurance company hadn't yet paid and there was an outstanding balance of over $7,000. I've had to make numerous calls between the hospital, my surgeon, and the insurance company trying to get things sorted out. My insurance company (BCBS California) at one point told me that I wasn't approved for this surgery. Thankfully I had my log at hand and could tell them exactly who I spoke with on the phone when I was approved after my initial denial, the date my approval was sent and the name of the insurance physician who approved me. They then wanted ME to send THEM a copy of the approval letter. I think this was yet another delay tactic. But I did exactly that. I sent them the info. Of course I was sent a letter about 10 days later saying it was under review and I'd hear back from them within 45 days. They're reviewing their own correspondence? To make a long story not quite so long (too late, lol) I finally just 6 days ago got a letter to say that approved payment for the surgery they had already approved payment for. This process really tests your nerves and stress levels. But if I had to go through the entire thing over again, I'd do it in a heartbeat because it was well worth it. Yes, definitely worth the buckets of tears shed over just getting to the operating table.

I have BCBS California. My initial wait when I first submitted was 45 days. I called back and was told I'd been denied because I didn't meet the criteria. I had a BMI of 35.9 and it needed to be 36. :smile: If that wasn't bad enough, my co-morbidities weren't severe enough. I had insulin resistance which is pre-diabetes which normally would have been enough, except that I was only taking one medication for it and I needed to have been taking 2. In order to qualify without the co-morbidities I would have to get my BMI up to 40. I said "Let me get this straight, in order to get this weight loss surgery I have to gain more weight first?" He replied with "Yes, but there's no way you can gain that much weight." Further proof that I was dealing with an idiot. My weight had already increased since my application and I only needed a further 18 or so pounds to qualify. So I ate, and ate, and ate and reached that goal in 3 weeks. I went through an appeal process once my weight had gotten to the correct level. My family doctor was very helpful with this and submitted the paperwork showing she'd been keeping an eye on my weight for the past 3+ years and it had increased to the level required by them for approval for surgery. I was to wait another 45 days for them to get back to me. I kept calling and asking if they needed any further data. They told me they'd let me know. When the 45 days was up I called and asked again and was told I had been denied because I didn't meet the requirements. I told them that I did. The person on the phone checked the records and said that my BMI was too low at 35.9. It dawned on me then that they hadn't taken the new documentation into consideration and failed me on my original records. I explained that I had called a number of times within that 45 day period and asked if they had the correct paperwork, etc, etc and that they had reviewed my appeal on old data and not even considered the new. Thankfully for me I was now dealing with someone new to the company who wasn't jaded and in a hurry to get me off the phone, she actually dug around. She found my new information and made note of my constant requests (they log each time you call, who you spoke with and why, so remember that) and forwarded the information directly to one of the doctor's that makes the decision. She told me it was meant to take a further 45 days but that she would do what she could to rush it through ASAP for me. She called me back 2 days later to tell me I'd been approved and the letter was in the mail. My surgeon would operate without it. I started the process this time last year. I had my surgery in July. So as you can see it took me a while and at the time it seemed like a lifetime. Hang in there and absolutely do NOT give up if you're denied the first time around. Good luck Patti!

Hi 2gina, No regrets here. Not a one. Unless you count not opting for it sooner to be a regret. I had the same fears about not waking up from surgery or something going wrong during or after. I'm sure everyone does. But my fear of getting more and more overweight and the health complications that come with it made me realise that my health was already at risk and things were only going to get worse if I didn't do something. I tried every diet out there. I tried all the pills and the wonder exercise regimes. And it wasn't just a week or two I would try them and give up, I feel I really did give them my best. I was morbidly obese. I was insulin resistant, which is pre-diabetes. My knee was beginning to give me problems. My cholesterol was high. My free testosterone levels were high. I had PCOS (still clinically do, but the symptoms have improved a lot) It seemed like my health was slowly but surely getting worse. I wouldn't hesitate to recommend the band to anybody that asks. None at all. But I would tell them that it's not a magical cure. The band doesn't make you lose weight. It helps you. You still have to make the right choices. What it's done for me is made me realise that I was actually sabotaging my progress with the diets I was trying. I didn't realise that I was kidding myself when I was thinking it was okay to eat a huge bowl of salad with dressing on it and expect to lose weight. Then having dessert as a treat for eating well. Then maybe finishing off the pack of chips in the cupboard, or the last few scoops of ice cream because I needed room in the freezer. What the band does for me is make it physically impossible to kid myself. I can cheat any time I want and eat anything at all that I want. But having experienced the golf ball effect, when it feels like that tiny bite of pizza I just swallowed turned into a bowling ball and is trying to burst out of my chest. It hurts like hell. And I don't like feeling like that. So I make a choice, do I eat the pizza and feel like hell or do I choose something else. There'll be a time when it will be okay to eat pizza again once I've got down to my target wait and possibly unfilled my band. But until that day the band is a non-negotiable conscience. I don't always like it, but it's the best thing for me. Doing what's best isn't always easy and it can be a tough journey at times. I come here whenever I have a moment of weakness and am lucky to have people like IndioGirl to encourage me on. It really does help. Knowing the people here are going through or have gone through exactly the same thing is the boost I need to get me back on track. You can find ways to cheat your band if you really want. But why would you want to? Why would you go through the surgery only to find ways for it not to work for you? I think the hardest thing in the journey is dealing with your brain. It's been so used to needing certain foods to function and comfort that it's often on autopilot and you have to keep on and on at yourself that certain behaviours and needs are all in your head. A LOT of the time they are. And you know it. And it doesn't make it any easier knowing it. I'll never be able to enter a hot dog eating contest again. Oh darn. I'll never be able to enter a beer chugging contest again. Oh darn. I'll never be able to finish off an entire pack of Oreo's again. Oh darn. I'll never be fat and judged unfairly for it again. Sign me up. I know there are cases where the band hasn't worked for some people through no fault of their own. Or that there's been a surgical complication. I don't think it's fair though to blame the band itself for these failures. Sometimes there is no blame. And for those who find the band doesn't work for them, I would encourage them to continue searching for something that does. There's nothing that's 100% guaranteed and you need to find the best thing for you. I wish you well on your journey and hope it's one you're able to take with those of us here who are enjoying it. :smile:

If you're crazy, we have the same membership subscription, lol. I didn't tell anyone other than my husband and this forum when I made it to Onderland. In fact, not too many people at all know I've had lap band surgery. As far as they know (neighbours/friends) I've been making better diet choices and exercising regularly. That much is true. I just don't want to go through the discrimination I've seen others go through when they've opted for surgical help with their body image. It's the same with my breast surgery. Not too many people outside of this forum know I've had it. For the same reasons. I know and can feel and see that I've lost weight, but you're right, at times I still feel like I'm still in the "morbidly obese" category. I'm not ready to tell people yet what I weighed at my heaviest. If they know what I weigh now or how much weight I've lost, they'll do their own math in their head and say to themselves "holy crap she was fat!!!" I don't need to be told that. I know. I carried it all.

I stopped at the gym this morning for my usual 30 min treadmill fix. Normally I have my favourite machine that doesn't have the morning sun shining in my eyes and isn't close to the mirrors. Today it was occupied which was a surprise in and of itself as I'm usually the only one in our gym in the morning. So I got on one of the other treadmills and did my thing. When the machine stopped I turned to get off and got a look at myself in the full length mirror. And guess what? I didn't feel ashamed at what looked back at me! I was shocked. So shocked in fact that I spent time actually looking myself up and down and turning from side to side. Now I'm by no means ready to model lingerie, but this was the first time in I don't know how long that I haven't been disgusted by the view in the mirror. I avoid mirrors and only use the bathroom one to get my hair done and my face presentable. I'm so proud of me! :smile:

I usually have a Protein shake or cream of wheat. I'd like to have oatmeal but don't know if I could bring myself to eat it without brown sugar and cream. :smile: Sometimes I'll have different melons or berries. I think I'll try the suggestion of weetbix. It was my favourite cereal growing up. Snacks - Those 100 Calorie packs. But remember to only have one! Jello cups or yoghurt (unless there's a chance they'll get warm and melt or turn watery). A serving of Protein powder in a shaker that you just need to add Water to. Snack bags with berries or nuts (chew, chew, chew). Crackers. Water, water, water. I've fallen off the water intake bandwagon of late and just got back on today. I forgot that it would often help curb my appetite if I kept to my daily intake requirement. If I'm hungry between snacks and meals I also chew sugar free gum. Sometimes it's just the chewing action I miss. There are days when I'll go through a LOT of gum to stop me from eating.

Thank you Kat. Your post was extremely helpful. I have the same tight restriction in the morning and it eases as the day goes on. For me, my trouble time as far as food goes has always been in the afternoon. If I can make it to 7pm without emptying the fridge into myself, I've done well, lol. I still struggle with any kind of bread and have a 50/50 shot with chicken. Other meats seem to go down alright. I still haven't tried the more fibrous vegetables yet. I don't know that I'm ready. But yes, my eating habits now are so much different than they were 6 months ago and that's something to be proud of. You made an excellent point about the Water. I've gotten lazy with that recently and it's time I was more diligent about my intake. Thank you again for your post. It was most helpful. I'll hold off a little while longer and see what this latest strategy does for me.

Hi Diane and Katy, I was banded in July of last year and had my second fill around Halloween. I'm considering another one now but haven't really made a firm decision. For the past month my weight has fluctuated between 194 and 199. I notice you've both been members for a while and wondered if there were weeks or months even when you felt you might need a fill but you'd just wait and see for a little while? When my weight goes up to the high end of this curve I'm desperate, when it starts to drop and/or stabilise I'm no longer sure. I don't want to be a fill junkie. Any personal experience you can share about plateaus would be greatly appreciated. This is open to any and all.

Hi dustout :eek: First of all, good for you for being so diligent with your exercise regime. It's tough keeping on top of so many lifestyle changes. Exercise, food, Water, chew-chew-chewing. Stick with it, but don't burn yourself out. Make changes to your activities unless it's something you really enjoy. I do treadmill 5 times a week and thought I'd be bored stupid in no time, but I my iPod keeps me company and I really enjoy singing along in my head while I trudge away. The time goes quickly and makes me feel great both physically and mentally. As for your sweet spot question. I'm not sure I really know what that is. I have a 4cc band and got 1.25 fill after a few weeks and another 1.50 fill a month later. It's been 3 months since the second fill. After the first fill my hunger seemed to disappear and it felt fantastic. There wasn't a lot of restriction, but I felt I only needed about 1/4 to 1/2 at most before I was full. That full feeling subsided though after about 3 or 4 weeks, so I was back in for a second fill after my weight plateaued. After the second fill I felt the restriction immediately. In fact for the first 2 or 3 days I was woken in the middle of the night choking on my own spit. So perhaps too much restriction in the beginning, but it did ease up before I felt it was too much of a problem. My doctor told me that if my weight stopped decreasing for 2 weeks or started to rise again, to call and ask for a fill. He's weighed me each time I've gone, but he's never made me feel guilty for wanting a fill. He told me to expect to lose only 1-2lbs per week. I think that having this low goal stops me from getting anxious if the scales stop for a week. If I were meant to be losing 3-4lbs per week I'd be quite concerned. Aim low and if you're lucky enough to reach higher, good for you. If you aim high and miss a goal, it doesn't feel so good. But they shouldn't be averaging your weight per week. If that was the case and you have a terrific week and lose 10 pounds but then gain back 2lbs the following 3 weeks, you doctor would just look at the numbers and say "You lost 4lbs this month, that's enough." I'd be concerned with an attitude like that. What I've learned from this forum is that for every surgeon out there, there's a different list of advice and/or guidelines to follow. So what my doctor recommends could be different to everyone else who had surgery on the same day as me. Having said that, I find the doctor you're seeing now to be very unprofessional and unhelpful. If it's at all possible, could you see somebody else from the same office? I find talking with one of the other nurses or assistants can help a lot. A different perspective on a different day. So back on topic (sorry for rambling :cool:) if you're not happy with the amount of weight you're losing, first make sure your goals are realistic. If you're pretty restricted but still feel hungry, it can be hell dealing with a tight band. I don't know what gives us that "not hungry" feeling, but I've noticed it's not around as much the further out from your surgery date you are. So a sweet spot for me would be one that makes me not feel hungry, not one that stops me from eating because I physically can't. As tempting as that seems, I'd just be miserable with that. If you feel your goals are realistic, and you have to be objective about it, then insist on having a fill at your next appointment for whatever reasons you feel it's justified. Have a list of your reasons handy. Yes, write them down. I always forget something otherwise. Explain that you were misinterpreted during your previous discussion and left feeling frustrated and very disappointed. This is meant to be a life-saving and life-changing journey for us bandsters, and people like the doctor you saw that day do nothing to help us keep that journey a joyful one. Hang in there. :tongue:

1) I am just really nosey now... what is everybodies Marital status...??? Married with 10 year old son. 2) Does everyone live alone and cook for one?? I'm home alone during the day, so prepare breakfast and lunch for one. Dinner is a family affair. 3) Who prepares family meals and who eats what they cook their family? I prepare all of our meals. Being a stay-at-home mother I see it as part of my job. But I enjoy it. A lot. Besides, my hubby would be lost in the kitchen, lol. Sometimes I'll have a small portion of whatever it is I'm cooking or I'll substitute part of the meal and cook a single portion of fish. I struggle a lot with chicken still so only have it once in a while. I made a big batch of Jambalya last week though that I really enjoyed. I just put the chicken back in the crock pot. I REALLY enjoy slow cooked meals, I've just changed a few of the recipes so they're not as creamy. 4) Or... do you prepare special meals just for your bandster self? This is an interesting question. I think I always made special meals for myself, even before being banded. But now my special meals are more health conscious. I no longer make extra meals, that's for sure. I don't eat secretly anymore. I've definitely become more accountable and stopped lying to myself. With the food police continually patrolling this thread, it keeps me on track. :eek: I just have to make sure I come back all the time to keep me focused. Yes, I'm using you all for my own selfish needs, lol. :smile:

Something similar happened to me after my second fill when I went to bed. I would wake up several times in the middle of the night choking on my own spit.:smile: It didn't occur to me at the time, but I'm thinking if I experience the same thing on my next fill, I'll sleep more upright. Maybe our bands swell at night (I know my feet do). I have a wedge pillow and slept sort of upright after my lap band surgery and breast surgery for different reasons, but maybe not allowing any "backwash" (I hate that word :eek:) will help.

Mine doesn't work either. I've decided to Bookmark the thread instead and just check in on it when I have the time instead of waiting for an e-mail notification.

That's great news Karri. Glad to hear that things settled down for you and you can go back to enjoying food again. And so nice of him to put you on a priority list for appointments because of the distance. :smile:

Dini!!!!! OMG you look fantastic! :Banane42::smile: As for your friend, call her again and see if she's free. If she really was busy, it may have slipped her mind to get back to you. If there's a problem, there's no time like the present to find out what it is and what can be done about it.

CONGRATS TO THE PACKS! :smile: *sigh* Cowboys. :Banane42::frown:

Hi jackie. Thanks for your advice. And you too Karri. I'm going to start eating more salads. Also get some spritzers. That should help. :frown: I'm doing catch-up at the moment. I haven't had any e-mail notifications of new posts, but I was busy this weekend anyway. I saw my plastic surgeon on Friday and he gave me a thumbs up as far as healing goes. I have to massage my small breast every day to keep the scar tissue from going hard and making his job more difficult. It was a little tender the first time he showed me how, but he explained that I've been favoring my side and some of the tendons in my arm and armpit have become tight. They certainly have. So I'm gently massaging and moving and stretching my arms out to loosen things up and keep them loose until my next surgery. Making sure any scarring in my breast is kept as soft as possible and doesn't have a chance to harden. He gave me 6 weeks of healing time. I have mixed emotions about that because on one hand I want to give my body the time it needs to heal, on the other hand I want to get the implant back in to even my body up and start that new healing process right away. Healing, healing, healing, that's all my life has become. Sad but true. :smile: I see him again on Feb 22 and he will decide then when to schedule me for surgery. It shouldn't be too long after that. He has an operating theatre in his office so he doesn't have to schedule hospital time. It's still a little ways off. I was hoping to get a fill in before then and it may work out well for me, seeing as how I can't get in to see my band surgeon until early Feb anyway. One thing I don't want is to be dealing with band restriction issues on top of breast surgery issues. One drama at a time thanks, lol. I've been very good since my last rant and haven't succumbed to eating everything out of the fridge and pantry, although I've been tempted and tested many times. I've enlisted my hubby's help. It's time I started getting more people involved with my problem who can and will assist me. Instead of keeping my hunger to myself and trying to deal with it on my own and failing and pigging out.... well, you all know the procedure.... I've decided that when I feel hungry, I'll go to my husband and tell him so. Sometimes it just helps being able to scream "I'M STARVING!!!!" and getting it off my chest. We've gone for walks, gone for a drive, played on my son's WII, cleaned out a closet.... something to keep my brain off food. It's been a big help. He's terrific. My weight today was back down to 196. I'm on the treadmill again most mornings and I'm enjoying it a lot. It's tough dragging my body out of bed early, but I have to get up anyway to get my little man off to school. By the time he's out the door I'm too awake to go back to bed so I hit the gym in our apartment complex and feel better both physically and mentally. So strange that exercise has become such a friend to me. :Banane42: I need to frame that sentence. I don't think I've ever said it before. lol All the hardest battles with everything seem to go on in my head! I wish there was some kind of brain surgery to fix me up, lol.

This morning I decided it was time for a fill. I've been fluctuating back and forth between 195 and 198 since the beginning of December and have had a fill in the back of my mind for the past few weeks. But recovering from breast surgery and knowing I had another follow-up surgery to come at some point had me putting it off. Well this morning I got on the scale and it was 199 and I'm panicking that it'll go back into the 200s if I don't do something. My appetite has increased as has my ability to eat about 1-1.5 cups of food in a single sitting. So I was on the phone with the doctor's office this morning. He only does fills on Fridays and he was fully booked for today and next Friday, then he goes on vacation for 2 weeks. She's unsure of his fill schedule until he gets back from vacation and makes his decision then. *sigh* She told me to call back at the end of the month. :smile: This doesn't sit well with me. I'm going to need a lot of control over the next month. It's been tough for a couple of months now, and I feel I've been doing okay some of the time and not so okay the rest. But the tide has turned and I'm losing more battles than I'm winning. I don't expect to win them all. That's unrealistic. But my band is the weapon that I need to tweak from time to time to help me get back on the winning track. And now I have to wait it out on my own for the artillery to fight this war. :tongue::frown: /rant

Salsa, you have to make your own call on that one, but if it were me and I were still able to get in my protein and water, I'd hold off. At least for another couple of days. Why not try taking smaller spoonfuls of food and waiting a couple of minutes in between? I wouldn't have been able to handle that kind of torture pre-band, but I did it when I got my second fill that seemed a little too tight in the beginning. It took me a good half hour to eat 1/4 cup of food. Something I thought was impossible! Have you tried fish crackers or those 100 calorie snack packs? At times when I'm having tightness problems, I can still get in a few crackers or chips/cookies from those calorie packs. I don't think you're whining. It's good to get your thoughts out and hear/read what other people think. Call your doctor and explain what's going on and see if they have any suggestions about what you can do to get more food in. Oh, and I'd check around to see if there are other doctors close by who won't charge you an arm and a leg for fills and unfills.

I wish! For me I can feel that huge lump in my chest and know that I''m not going to feel better until it get rid of it. Most times it doesn't want to go down, so it has to come back up and out. It's awful. It's just a big blob of slime, tmi. I've cheated with water and drank it before and during a meal at times because I know if I don't, something's going to get stuck. It's probably not the best thing to do, but sometimes I'm really hungry and haven't been able to get anything down in the morning and want something to put in my stomach just to shut it up! But I'm with you. I think I've been slipping with my water intake a lot of the time and need to keep track again. It starts again today. Now. *runs off to get water bottle*

Is it possible she's wearing an underwire bra and that upper roll of tummy fat that seems to be quite popular :rolleyes is lifting her port in the direction of the wire? For me I notice once in a while (often when I'm shaving my legs, lol) that when I turn a certain way my port will dig into me. Not near my ribs or anything, but I'll feel a definite lump.

Maybe you should stick with liquids for a couple of days. Soup, juice, protein drinks, etc. Then see how things like jello or yoghurt go down. I would stay away even from the pureed food. Your fill might settle. I've mentioned before that for the first two days of my second fill, I was waking in the middle of the night choking on my own saliva because it wasn't going down. Seeing as how you're so far away from your surgeon, I would wait unless you were really in pain. But yes, definitely check out the bariatric surgeon closer to you and see what they charge. It could work out to be a big saving in money for travel and the time taken out of your schedule to do so. Keep us posted Karri.