Skinny_Krissy

2muchfun, Jesrose MAY be right IF the employer is self-insured. Why would we assume this is the case? UHC does sell self-insured products to large groups and municipalities, but it also sells fully insured insurance policies (typically, though not always, to smaller groups - my 1,400-employee group uses a fully insured plan). I've had the misfortune of working for a series of companies who were fully insured, and in these cases it is not the employer who customizes the plan benefits - UHC does. So I will dump on UHC because it's an awful, heartless, amoral company and I've stood in phewforaminutethere's shoes when it comes to discovering you're covered by one of UHC's WLS exclusions. At least in my market, UHC sells its fully insured plans on an as-is basis and won't even price riders for WLS coverage for employers who want to offer the benefits. If that's not bad behavior then I don't know what is - especially considering that UHC ended up paying way more for my obesity-caused comorbidities over four years than it would have for the original weight-loss procedure. More to the point, it covered all sorts of "elective" procedures for non-fat employees (vascetomies for several male coworkers, an $800 wig plus matching eyebrows for a girl in the mail room with hair loss and even an eyelid lift for one woman who apparently convinced them this wasn't a cosmetic procedure) while excluding my medically necessary treatment. I'm not begrudging those people their healthcare, but we should be able to access care, too - isn't this part of the point of working, so you can get treatment when you need it? UHC has been a market leader in restricting access to WLS and it makes it impossible for even the most sympathetic employers to offer this life-changing procedure to its employees. Anyway, I wanted to add two more longshot options that the OP should explore. The first is called an "ex gratia" provision. It basically allows your employer to pretend WLS is a covered benefit and pay for your surgery. You may also be able to access the insurer discounts UHC wrings out of hospitals and physician groups. My last company explored doing this for me, but I didn't feel I could move forward because it wasn't clear that either the company or the insurer would be contractually obligated to cover complications that followed from the surgery. On the contrary, it looked to me like they would still be excluded, though even UHC's lawyers couldn't seem to parse the language for me as they'd never encountered a situation where this was used (I am also a lawyer). I was willing to pay out of pocket for the procedure, but I wanted an iron-clad guarantee that complications would not bankrupt me. I'm glad in retrospect that I insisted on this. The other longshot if you're not married but you have same-sex friends who work for employers that do choose to offer medically necessary treatment to their employees is to ask one of them if they'll become your domestic partner. Many large employers offer health insurance to domestic partners in states where same-sex marriage isn't legal and I actually convinced my best friend to register me as her domestic partner (neither of us is gay, but being gay isn't a prerequisite and she saw how painful it was to lose my entire 20's to obesity). However, she was laid off two weeks before the coverage would have become effective. That sucked. Last thing: If you're under 26 and can join a parent's insurance policy, keep in mind that you will lose WLS coverage (including coverage for complications) on your 26th birthday, not December 31 of that year. Some groups now kick you off as of Jan 1 of the year you turn 26, but that conflicts with my understanding of the Affordable Care Act. This was my problem, as my mother did have coverage when I was 25 and searching for insurance options but by the time I finished the 6 month diet I would have only had 3 weeks of coverage left. Even if I could have gotten the surgery approved, scheduled and performed in those 3 weeks (unlikely), I'd still be on my own for the $150k (and counting) in complications that I experienced. Make sure you know when your coverage will terminate if you go this route, and get it in writing from the company.

Hello Phewforaminutethere, I totally sympathize - I lost four years of my life to UHC's WLS exclusions. Unforatunately you're dealing with a heartless, amoral company that doesn't think twice about ruining people's lives. You have a couple of options: You can try to convince your employer to switch insurers or buy a rider, though UHC wouldn't even price one for my company. Put differently, it wasn't willing to sell my employer WLS coverage for ANY price, not even $1 trillion/year. Switching plans for one employee was a no-go for my HR department. You can TRY the healthcare.gov marketplace, but since Texas chose not to require WLS benefits for its citizens, it's very unlikely that you'll be able to purchase a policy with this coverage. Typically when companies aren't required to offer this option, none of them do. During my four years of hell, I found that I was unable to buy a policy on the "open" market for any price. Companies that cover the surgery typically won't sell to people who are fat enough to need it. So this is probably not a good option either. Your best shot if you live near a border with another state (one that offers bariatric coverage to its citizens) is to consider moving across state lines. Otherwise, you might start looking for another job, though I changed jobs 5 times and never did get WLS coverage. Because of where you live, it's extremely unlikely that you'll be able to ditch your employer's plan and take your dollars to a company that does cover surgery, as those companies won't want to sell you a policy. Your only remaining option is to pay out of pocket, maybe in Mexico if the US is too expensive. However, as someone who almost went to Mexico, waited until I had insurance coverage at one the best WLS surgery centers in the country, then had a life-threatening surgical complication despite having no risk factors, I can't stress enough how careful you need to be. I required weeks of tube feeding, several EGDs and a six-hour revision surgery that cost ~$136,000 before insurance discounts ($76k afterward). My good friend needed 8 corrective surgeries and was on daily TPN (IV nutrition) for 11 months. As a result, my feeling is that you need to think through the non-trivial possibility that you could have to file for bankruptcy if you self-pay and have a serious complication. Good luck and sorry there isn't happier news.

Lisacaron, I think the comparisons in your post fail. Gaining weight is not the same as needing mouth-to-mouth resuscitation, for instance; the first is a personal choice (and that person's responsibility, not yours), while the latter is a medical emergency. I don't know where this tendency to equate fatness with imminent death comes from, but I view it as pretty harmful... the vast majority of fat people won't die in this decade or the next (hence my point that it's NOT a medical emergency, though lord knows being fat can feel that way), though their lives will be diminished by their disease. But your conviction that other people shouldn't make your mistakes (and your urgent, self-righteous need to share it with them) it about you, not them. The best thing to do in these situations is look inside yourself and ask what kinds of emotions you're projecting onto the other person. Most likely it's displaced regret that you didn't have surgery sooner, or that someone didn't "save" you by having one of these conversations much earlier in your life. But part of recovering from obesity is learning some personal humility and how to set appropriate interpersonal boundaries, and these threads always make me think that the desire to "intervene" has so much more to do with the posters' need for everyone to be onboard with their new lifestyle than with actual concern for the person gaining weight. I can see how the two emotions could become conflated, but I'm encouraging you to dig deep within yourself here. Lisacaron, I'd like to answer two of your points specifically: I allow my doctor to talk with me about these things because I've entrusted her with my health, and because it would be unprofessional for her not to note the damage I'm doing to my body by being obese. I know going into an office visit that I've given implicit consent for thse types of issues to be broached, and I'm prepared for it. But I accept this kind of imposition from no one else unless I solicit it because it's none of their business and because there's such a narrow margin of error for these conversations if they're going to be done right. What makes you think that you'll fall within that margin, as opposed to alienating the person further? To answer a specific comparison you made, about a coughing person putting a cigarette to his lips, no I wouldn't say something to that individual. Smoking is a disgusting, detestable habit, and if it were up to me it would be banned both in public and in private homes. My father is a heavy smoker, and at 80 it's hard for him to finish a sentence without coughing. But years of me haranguing him, begging him, bribing him to quit, flushing his cigarettes down the toilet, etc. have done nothing for his habit, and they've only damaged our relationship. Also, it's not like he doesn't know he should quit; what good would it do to point his out? I now approach him with a renewed sense of appropriate boundaries, and I understand that he has the personal right to make poor choices, even when I'm making better ones. I can love the things I love about him while also understanding that his smoking isn't about me, and it can't effect me unless I let it. I can, however, ask that he not smoke in my home or car (which I pay for), and enjoy the look of irritation that comes across his face every time he can't light up in my kitchen. No one owes you healthy choices, and no one deserves to have your judgment subsituted for theirs.

Moonlitestarbrite, I definitely see where you're coming from, and clearly your actions come from a place of deep concern. But my response to you and to the OP, Shazam, is that this is just none of your business, even if you mean well. With a very limited number of exceptions (i.e., minor children who need their parents' guidance and who should be encouraged by all means available to avoid a lifetime of obesity; close intimates who have expressed a willingness to confront their weight problem and asked for your help), it is no one's place to confront, intervene on or otherwise evangalize fat people, and just because we've lost weight post-WLS doesn't give us a license to insinuate ourselves into other people's struggles. This is true even if they'd be better off making the same choice we did. For one thing, these "interventions" almost never benefit the person being targeted; they tend to be more about the person initiating the conversation's feelings (which have apparently been hurt by the target's weight gain), rather than offering concrete help. Are you prepared to go to this person's house every week and help him/her cook healthful foods? Are you offering him/her a gym membership? Even if you are, obesity is a terrible disease with all sorts of underpinnings, and I think you'd be better off dealing with your feelings of disgust and alarm over other people's weight choices. Not all fat people are going to die this month or this year or this decade, and people can choose to be fat in this life. Also, I can tell you from my experience that conversations about my weight were deeply, deeply embarrassing to me for most of the time I was morbidly obese. This was a combination of 1.) yes I know I've gained weight, thank you and 2.) my feelings of total helplessness over how to change. These things were solved only when I made the conscious adult decision to change my life and pursue WLS, and the four or five "interventions" that various people in my life tried before then probably delayed this decision by an entire year or two. These discussions were never effective, served only to plunge me deeper into denial, and were among the most offensive and traumatic experiences of my life. I would look at this situation as a chance to continue healing by repairing your own interpersonal boundaries, which are askew if another person's weight gain is having this kind of impact on you.

Hello Ortega07, I just converted from a sleeve to a bypass this past week, on June 2. A few words about my situation: I was originally sleeved on March 14, 2014, and had two weeks of *perfect* recovery. I went back to work on day 4 post-op, had absolutely no pain, and went straight from the hospital to a support group I enjoyed because I wanted to see all my friends. On day 15, I threw up 13 times. Though I didn't know it at the time, I'd developed a mechanical obstruction in my sleeve, which had folded over on itself and was preventing food and even liquids from going through. Every day since, I threw up between 4 and 12 times and I lost 93 lbs in 2.5 months due to, well, starvation. I also developed severe acid reflux, which kept me from sleeping most nights. I had to be tube-fed and barely held onto my job during the 10 weeks of hell that followed. In my case, the decision to convert to bypass was relatively straightforward. I wanted a sleeve, not a bypass and was afraid of malabsorption. But the chances that the obstruction would return were relatively high with an exploratory surgery to save my sleeve and after so much suffering I was ready for anything that would help me rejoin the land of the living. Bypass was the much better bet. What I wanted to share with you was the other part of my conversation with the surgeon. He kept emphasizing how much more weight I would lose with the bypass, and said that where the sleeve would have left me around 200 lbs, while the bypass would take me down to 175 or lower (I started at 330 lbs, which was a BMI of ~50). On a 5'7" frame, that's a big difference - 200 vs. 175 is the gap between a pretty "normal" silhouette and someone who still heads to the plus size department. (Not that I'm knocking someone who loses 130 lbs and gets down to that weight - both are a massive improvement over life at 330.) Although this didn't influence my medical decision to go with the bypass, it was interesting and acted as a sort of "bonus." Given the situation you've described, it sounds like you need the additional "boost" of malabsorption the bypass provides to get closer to your goal weight. If your insurance will pay for the bypass, you'll have a lot more support post-surgery... and either option does involve an operation with risks and benefits. The other thing I can say on the other side of the surgery is that you do re-start the "honeymoon" phase of low appetite, basically no food intake during your hospital stay (and ok with it), etc. The last thing I have to add is that you do NOT want a feeding tube placed during a conversion surgery (whether to bypass or a resleeve). I have one and it is so uncomfortable that I don't know how I'll stand the next 2 weeks until I can get it removed. But somehow life goes on, even when you're hurting.

I’m a longtime lurker on this forum and this is my first stab at actually participating. Today marks seven days since I was sleeved and I’m feeling fabulous. I am so grateful for the support and information you all provide, and hope I can return the favor by being a resource for some of you. As great as I’m doing, I am starting to understand what you all mean by the phrase “head hunger" (alas). I’m not sure if someone who hasn’t had weight-loss surgery can really conceptualize what this is, and though mine hasn’t been a huge deal so far, there is a certain novelty in finally “getting” it. Appropriately enough, I heard a perceptive analogy about head hunger today that I wanted to share with the group. It happened while speaking with a neighbor who is an amputee. She noted that her foot and lower leg had been removed due to a chronic condition that caused debilitating pain, and she described her post-amputation life as vastly improved despite the need for a prosthetic limb. As I explained the sleeve to her, I observed that although I have absolutely no appetite right now, I do find myself occasionally preoccupied with food. It’s not exactly a feeling of being hungry for the food, and it doesn’t seem to be related to how long it's been since I last ate. Rather, it’s closer to a sense of being fascinated by a food item. Even if I couldn't swallow it (which of course I can’t right now), I would want smell it, touch it, be close to it. Sometimes I find myself thinking how much I want to buy the food and cook it for someone else, or more often I’ll fantasize in minute detail about how it’s going to feel in my mouth after I’m back on solids. It’s the kind of feeling that might have put me in danger of having a binge episode in my life before, except that it’s not accompanied by a feeling of emptiness or “hunger” in my stomach… which makes the sensation especially bizarre and unexpected. This is head hunger. She seemed to understand completely. What she said next took me aback: According to my neighbor, the pain in her diseased foot actually had two sources. The first was obviously her foot, where pinched nerves and misshapen bones fired off distress signals day and night. But the second site of the pain was inside her brain, and its role in her suffering turned out to be non-trivial. She said she only fully understood this after the amputation, when she continued to require prescription pain medication for discomfort in a foot that no longer existed. She could see that the foot wasn’t there and her “thinking brain” knew that it had been removed even when she wasn’t looking at her leg, yet she continued to feel that awful ache for years after surgery. I found the end of her story especially interesting: My neighbor said that although the pain has not gone away, eventually it diminished significantly. I asked how she deals with the lingering discomfort. She replied that she made it a smaller part of her life. I didn’t understand at first - I mean, pain is pain, how do you just ignore it? She said she uses cognitive-behavioral therapy techniques, which have trained her to think of the pain as a cognitive distortion formed by years of suffering with the pre-amputation foot, as if those neural pathways became so well used that her brain can’t turn them back off. She also practices of mindfulness. She pauses each morning to record her level of pain and how her stump feels in a medical record book, but otherwise she resists letting her thoughts drift in this direction. Instead, she focuses on savoring what she’s doing, or she may change her environment when she feels the pain intensifying by (mindfully) smelling a special scent or reading a book of quotes. This helps make the sensation bearable until it recedes again. I have no idea how scientifically sound this narrative is and it may be an over-simplification, but I thought it might appeal to members of this crowd. I definitely buy the idea that my brain has been permanently changed by 28 years of cognitive distortions related to obesity and binge eating, and it makes some sense that these thoughts might not just “turn off” with the removal of most of my stomach. However, it seems equally possible that by filling my life with healthier thoughts and continuing to root out cognitive distortions, I can take steps to minimize head hunger’s interference with my recovery. [indeed, I just realized every time I’ve felt this way has been late at night, which is when I tend to be alone with my brain.] This helps me feel more confident that when (not if) head hunger-type feelings do recur, I can learn to “make them a smaller part of my life” rather than suffering with them or giving in. What do you guys think? Thanks again for all you do - I couldn't have gotten to this point without you!

I want to echo what others have said above - please be kind to yourself and don't underestimate how much trauma your body has been through in one week. I am also seven days post-op (I had surgery on the 14th) and the difficulty of staying hydrated and lack of variety have definitely gotten to me a couple of times. Especially since you've had to be readmitted to the hospital twice, I would strongly recommend leaning on your surgeon's support team for help (you should be able to get emergency appointments with nutrition, psych and the surgeon himself - why not ask for both a pain consult and a session to figure out why you're having such a hard time with fluids?). I don't mean this in a bragging way at all, but I haven't had anything stronger than a Tylenol since post-op day 4 and have been off pain meds entirely for over 48 hours... your pain could be entirely normal, but it could also be a sign that you need some follow up medical attention. Make sure it's not the latter, even if they make you feel like you're wasting their time or being a hypochondriac. If there isn't anything medically wrong, please have faith that you will feel very differently about the surgery in a week or a month when you're X lbs lighter and feeling healthy again. Our minds can't be trusted this soon after invasive surgery (not to mention tons of huge changes to what and how we eat), so try to think of your brain as a trickster and resist its attempts to get one over on you when you're vulnerable. I'm wishing you a positive and hopeful recovery from Ohio!