k_podski

Hi all, I cannot find any info on this site of anyone dealing with Harvard Pilgrim for this surgery, more specifically a band to sleeve revision.. My surgeon has approved me for this revision and said he is willing to help me fight to get it. I am no stranger to this site as I followed it over from lapbandtalk.com when I saw how many people were getting revisions and having beter success. The hunger with the band is killing me, and the constant fill/ unfill process is getting old. I am over the extremes of starving or sliming.. And always feeling hungry.. My doc feels as though the sleeve would be a better choice to address the hunger issues. I have lost 50lbs with the band since 3/19/08 (246lbs-195) and have maintained, which is considered average- but the surgeon thinks I could stand to lose another 50-60lbs.. At 5' 3.5", my personal goal is another 50, anything extra would be a bonus! Supposedly Harvard Pilgrim is one of the top insurance carriers now adays, and have always been great to deal with, and quick with descisions. The doc wants me back in 2 months to see what progress he's made with HP and for me to see the nutritionist every 2 weeks until then and get a print out from my gym of my visit dates to show a paper trail to help my case. He feels as though the sleeve will be the new band and that the band is already phasing out due to complications and lack of success. He also feels that now there is 5 year research out on the sleeve that more insurance company's will cover the surgery. As of now HarvardPilgrim.com states that it does not cover the sleeve, however when I called to inquire if I could get around it they suggested my surgeon call with more info and codes.. Any ideas or experiences with Harvard Pilgrim? Thanks in advance for any input, Kerri:)

Hi Christine and Penny, I've been lurking too.. For a long time now! I do get on here daily to see how things are going. I have been having some band issues lately that have me pretty frustrated. I've kept off the board for fear of bringing people down.. I am still trucking along, slowly but surely! ~Kerri

This what is covered as of 10/2008: • Bariatric surgeries, including gastric stapling, vertical banded gastroplasty, gastric lap banding for obesity, biliopancreatic diversion with duodenal switch, and gastric bypass surgeries with required prior authorization from Harvard Pilgrim.

Yes Elisabeth, that was really helpful! I guess I hadn't given my BMI much thought.. It is now 35. I am 197lbs and 5'3". Could this compromise the possibility of a revision?? I would like to lose another 60lbs or so. As for my surgeon and nutritionist, yah.. You got the idea lol I should have known better at the beginning when my surgeon asked me which surgery he did on me and whenhe had done it, when I was there for my final consult pre op. Then for my second fill he asked me if I had a fill yet and how much I had in my band. Yikes! What was I thinking:( Thanks again for your reply, I really appreciate it!! ~Kerri

I am having SOME issues that I've been dealing with mostly all along. My GERD is back as I suspected it would be. When my doc was in there he said my hiatal hernia "wasn't that bad" so he did not fix it. I was without reflux for almost a year, then in January it started up again. My reflux now makes me nauseous so I am on meds for both now. The nausea med makes me want to sleep all day. I have also had a sore port since day one. I had a revision in Nov last year, and it continues to bother. There is a dull ache all the time, although when I sit, stand, or bend, forget it, it feels like it's getting ripped out. When I went to my doc for this he asked "does it hurt when you touch it?" I said yes, to which he replied "then don't touch it and you will be fine..." Thanks. 'Preciate that. I also am hungry ALLLLLL the time. I've been working with my nutritionist every two weeks for god knows how long now. I'm sick of being hungry. I've been hungry all my life. That's why I'm fat. No it's not head hunger, no it's not poor food choices, no I'm not an emotional eater.. I'm effing hungry, can't you just hear me out??? I'm sick of cramming in 75 grams of Protein a day to prove to them it's not lack of protein. "Add another 5g-10g in, you should feel better then." Ugh. I spoke with the nurse from the bariatric center who also has a band. She suggested I look into the VSG originally because of a possible hunger hormone issue. She is getting a VSG in July. When I brought this up to my Doc he pretty much laughed in my face. I think that he thinks I'm not doing the right things. Granted I don't exercise as much as I should, but I do damn good, and am a different person than I was a year ago. I wish they could follow me around for a week to see what I go through:( So yah, sorry to let loose, I kind of needed to get that out. lol I guess I'm confused about pre op and post op stuff if Mexico is chosen for surgery too. Will I need to do post op here in the US with my current doc? Because EEEEK, I don't think that will work out well.. And how does the pre op stuff work? Is it all done once you get there?? Thanks again for your time and responses! Kerri

So I have been in contact with my insurance, Harvard Pilgrim. As I suspected, they currently do not cover VSG. However.. The woman that I spoke with said that between her and I (?!) she believed it was in the process of being a covered surgery as long as it's medically neccesary, well documented history, blah, blah, blah.. But she wasn't sure about a revision?? Is it possible for her to know this info?? And if the insurance company covers the surgery why is a revision considered a different procedure? I have thought a little about financing the surgery myself and heading to Mexico.. I'm not so sure I could afford what the payments might look like? Does anyone know what a finance plan looks like through Dr. A's office? I know they offer through a few different companys, but I'm curious if it's even worth looking into? Generally anything like that through an office offers an extremely high APR and outrageous payments. If I do a personal loan I'm sure it would be a high APR as well.. Maybe I should wait on Harvard Pilgrim and see what happens??? Even if they did end up covering the surgery, I wouldn't know where to start in the US with a surgeon as I'm sure that no one in Maine does VSG... (Although I believe there is someone in Boston?) So yah, a whole lot of questions here. Hopefully you guys can understand my thought process here, I'm working on negative sleep and lots of coffee today:) Thanks in advance for your responses! Kerri:)

aJoneen.........................+1 75 pounds lost! Bandana....................... 0 92 lbs lost BrandNewLisa............0 80pounds LOST forever!!! evelas5000...................0 50 pounds Lost Desdemona...................0 Fenton...........................0 100 POUNDS LOST !! HarleyGirl....................0 85 pounds LOST! Hopeinapril................. .0 55 pounds lost! Kpodski......................... -4 Lynnt1215.....................0 NurseNiki......................0 Nycm00........................0 OUCH Potatie............................0 132 POUNDS LOST!! Scrappy_Friend........-3 160 POUNDS LOST!!!! SpecialK........................0 102 GONE forever! Sugarbean....................0 117 POUNDS LOST !!! Sharona.........................0 stellabella......................0 75 POUNDS LOST! Tess415..........................0 Thin2bme....................0 100 POUNDS LOST !! WestCoastMom............0 Wishin4...........................0 78pounds gone!! Back to onederland again! Down 13lbs of the 18 I gained while quitting smoking!

So... I have been lurking here on the VSG thread now for a while. You guys have posted so much useful information, and have definately struck some curiosity in me! I was banded just over a year ago, and have a love hate relationship with my band. I have had several fills and unfills trying to get to the right spot for me. I think I am about there now, although I am still hungry. As I always have been. I am at the point where I mostly eat mushy types of foods. Not many types of normal foods agree to go down. In the morning I am usually so tight I can't eat. Breakfast is usually coffee, which sometimes, even that gets stuck. By mid morning I can usually eat breakfast very carefully. I am currently working closely with the nutritionist from the bariatric center where I had my surgery. I feel like there is no happy medium for my restriction. Either I am loose, starving, and can eat a cow, or I am tight, starving, and can barely drink. Either way I am HUNGRY. All the time. I have done so well with keeping on track, logging food, and making good choices. I admit I slack on "exercise" but I am a fairly active person, always go go go, out and about. I feel stuck in a rut. I think I need something other than the band... I may have the option of getting the sleeve if I look more into the financing, but I am still unsure about the process. I also question my insurance. I have been told several times that Harvard Pilgrim is one of the quickest and easiest companies to work with. As of last October they said they do not cover VSG. Is it possible to challenge them? Or bring info to their attention? Also I'm curious with the VSG if things get "stuck". I've read posts about still having to chew chew chew.. I am so over being stuck and spending hours in pain, in the bathroom, waiting for things to come up or go down! I guess that's enough for now, sorry about writing a book on here! I've been curious for a long time, and just finally got the nerve to ask some of my many questions. Thanks in advance for your time and knowledge, Kerri

Very interesting! I will definately have to try this.. I have never heard of it.. My doc suggested doing this after banding to help the gas move from the shoulders.. I wish I would've know this when I was ohhhh soo stuck last night on a banana. Ugh! I was up until 1:30 waiting for that sucker to come up or go down! Thanks for the info:)

Hi Amanda, I was just looking up some info for my sister this morning about how to deal with a plateau. How frustrating! I found a couple interesting sites that I shared with her, so I figured I'd post the link here too:) Hopefully it can be of use to you?? This first one says to eat "something bad".. I'm curious how true this is? I've heard them say it several times on Biggest Loser.. Weight Loss Plateau - How to Deal with a Weight Loss Plateau I'm not sure how much I understand this one.. It suggests eating even less calories and exercising more. What happens when you go back to normal intake and reglar exercise? Sounded interesting anyway.. SmartShape.com.au - How to break a weight loss plateau And the last.. 5 Ways to Break a Weight Loss Plateau Hope these can be of help to you:) Kerri

aJoneen........................0 75 pounds LOST! Bandana....................... 0 92 lbs lost BrandNewLisa............0 80pounds LOST forever!!! evelas5000...................0 50 pounds Lost Desdemona...................0 Fenton...........................0 100 POUNDS LOST !! HarleyGirl..................0 85 pounds LOST! Hopeinapril................. 0 50 pounds lost! Kpodski........................- 4 Lynnt1215.................0 NurseNiki...................0 Nycm00.......................0 Potatie..........................0 100 POUNDS LOST!! Scrappy_Friend......0 150 POUNDS LOST!!!! SpecialK.....................-5 97 lbs and closing in on 100! Sugarbean..................-2 112 POUNDS LOST !!! Sharona.......................0 stellabella...................0 HALFWAY TO GOAL! Tess415......................0 Thin2bme................. 0 100 POUNDS LOST !! WestCoastMom........0 Wishin4......................0 73 pounds gone!! After gaining a pound on vaca, then coming home to gain 3 more, THEN, eluding the scale, I decided to get my butt back in gear. 2lbs to go to be under 200 again!! Have a great week all! :smile2: