ShellieB73

What's up with the "AND" stuff.......really......that is extremely frustrating!!!!!!!!!!

Is there some concern that if the policy changes that it won't take effect until January 1, 2011. Is the general feeling that the policy will be changed? Lord have mercy........

Wellmark - BCBS in Iowa isn't covering yet either, but they are due to revise their policy this month.....I am patiently (not) waiting.....and stalking the website daily!!!!!

I'm holding my breath for a revision to Wellmark's policy sometime soon....I am in IA and I hear about surrounding states getting approval for the sleeve through BCBS.

Anyone have any inside info?

Thanks.....

Many congrats and thanks for the information....I am waiting for the traditional Wellmark of Iowa policies to be updated as well. I have been contemplating submitting and then asking for an independent medical review if denied, but I have a feeling it will be soon!!! I guess I am trying to be optimistic Meanwhile...I continue to be frustrated with myself after removal of my band.....argh!!!!

I'm so hoping that Wellmark BCBS of Iowa will hurry up!!!!!! My patience is wearing thin!!!!!

When I had my lap band done I got a huge bill from the hospital despite getting pre authorization....

I called the hospital and asked for an itemized bill and found that they had billed for two actual lap bands.

I kindly informed them that I did not have multiple stomachs like a cow and the problem was fixed with in about 6 weeks.

Sometimes if the charges are over what seems to be customary, they will kick out the claim.

What if you had the lap band done under another insurance, they paid to take it out (due to slippage) and now you have new insurance (Wellmark). What's the chances of having to meet the criteria for weight loss surgery all over again? UGH!!! I did that once and now have to jump all through the hoops again to get a revision. ARGH!!!!!

This is so frustrating!!!!!!!

I just received a return call from Wellmark on Friday...the gal was really nice, but no real helpful information.

I know the current policy was revised in Sept 2009. The gal told me that they typically do revisions on policies every couple of years OR if they receive literature or information from surgeons, etc that would warrant changing it sooner.

I say barrage them with reliable studies that support VSG and see if that persuades them to update their policy sooner than later!!!!

SpringerLink - Journal Article

Just thought I would share a link to a an abstract for an article published recently.

I thought the results were pretty promising, and although the sample size was small, at least it is favorable for weight loss stability at 5 years and plasma ghrelin levels staying low.

Now if we can get insurance to make some changes!!!

Just wanted to share....

Shell

I think I asked this same question when I was researching the band.....

Is there anyone on here that has personal experiences to share after being "sleeved" for several years?

The band seemed like the thing to do Feb 2008....not a lot of complaints or problems (or none that I distinctly remember). Now pretty much everyone you talk to who has had a band for greater than 1 1/2 or 2 years is having some sort of nuisance issues or had removal, etc.

I am seriously considering the sleeve, but I dread getting 2-3 years out and having issues that can't really be reversed. (I had my band removed in March due to slippage and have no problems resulting from my 2 years being banded.)

Anybody's thoughts are appreciated....shellieb

Anyone know anything about Wellmark/BCBS in Iowa and where they are as far as covering the sleeve? I heard that it was in committee. It seems that BCBS in other states is covering.....

I can't believe that some companies will say one WLS per lifetime....that seems so discriminatory. We are people trying to get healthier!!!!

Is this going to become the standard? I have a hard time believing that because of a mechanical failure (slippage) in a tool that worked at the time, it would completely disqualify a patient from another procedure.

What is health care coming to?

I can so relate to the initial post here.....

I was banded in Feb 2008....did absolutely wonderful until November 2009. I had a slip that was discovered on a routine UGI. Looking back I did have some sypmtoms, but overall had lost 80 pounds and was maintaining without any difficulty.

I had my band removed in March of this year....after the roller coaster insurance battle. The technically can't deny removal of the band as it could potentially be life threatening (rare, but possible to have part of your stomach become necrotic). The refused to replace the band because I was no longer "morbidly obese". My surgeon was about as frustrated as I was!!!

Now....after gaining since November....I am pretty close to the BMI of 40.....frustrated, mad, depressed....blah blah blah!!!!

My dilemma now is that I live in Iowa and the sleeve is not commonly done here. My surgeon is doing them, but insurance coverage is spotty. Due to a job change, I am getting a Wellmark/BCBS product beginning May 1st....

Does anyone have any information about Wellmark in Iowa covering the sleeve any time soon? Honestly, I don't see why they don't....it would be much better from an insurance standpoint. No fills, no frequent appointments....it is a much better surgery, I believe.

thanks for letting me rant....

shellie

I'll try to make this brief....

I had Lap band surgery 2.2008...lost about 70 pounds very easily. Had a slip 11.2009....removal 3.2010. My insurance at the time would not pay for a replacement of the band because I was no longer "morbidly obese"....even though I didn't get to goal.

My surgeon talked to me about the sleeve and I have been seriously considering it since November. Also, I have gained back nearly 30 pounds since November.

I am getting new insurance due to a job change May 1st. I am praying that they will cover WLS for me and specifically the sleeve. My problem is that my surgeon does not operate at a "participating facility", so my options are to pay a 40% copay and the non participating facility or find a new surgeon.

Is the 40% figured on the allowable charges or on the billed charges? We all know that insurance doesn't pay the entire billed charges, but usually cash pay patients do unless there is a prompt pay discount or something similar. Has anyone had any of these similar issues? I wish I could find some more concrete literature on the long term success with the sleeve. Specifically, are there any issues with ulcers, strictures etc.

Guess that wasn't real brief, but I'm really feeling desperate due to my weight gain. It is so discouraging and I physically feel lousy!!!!

Thanks....shell

Hi all, I was banded by Dr. Eibes on February 25. Everything went great!!! I couldn't believe how easily my surgery was approved!! My husband has really good insurance. I have nothing but great things to say about their staff, program and everything. Haven't had my first fill yet, but I am losing and feeling great!!! I have lost about 13 pounds since surgery. It is amazing what a difference just 13 pounds makes. My husband and I went out to eat tonight...that was a moment...I was having a hard time having to just eat off of his plate...I had some grilled salmon and the tops off of some steamed broccoli. All is well...got my tea in a to go cup. I was just mad that I couldn't order my own...but I sure didn't need a whole entire meal that's for sure!!!!

Good luck to everyone planning surgery!!!!

I'm glad to not be the only one....I was banded 2/25 and was on full liquids for one week then purees/mushies. I lost 8 pounds right off the bat and then have been stuck for a week. It is driving me crazy!!! I get on the scale every morning (no obsession or anything) and it is the same every day. UGH!!! I really am not eating much and certainly very little carbs like I was previously.

My dr. had me on a full liquid diet for one week and then purees for two weeks and then to soft. They don't really specify what puree is...suck through a straw or run off a spoon or what. One section of my diet handbook listed things like cottage cheese, oatmeal, cooked veggies mashed with a fork, mashed potatoes etc. as puree. It is a bit confusing to me. I hope that I am not eating to thick of things....the diet that was full liquids included cream Soups, yogurt, pudding and such. To me the puree diet I am recommened is more like the mashies you all are describing. What do you all think...I hope that I am not hurting my band. I am not uncomfortable, gassy or anything. I only eat about a half cup at a time. HMMMM!!!!

Good luck to everyone tomorrow!!!! I am a bit nervous, but I am sure that everything will be just fine. I have been on 4 Protein Shakes each day and the few select foods that they allow for yesterday and today. I am amazed that I really am not that hungry. I guess the Protein really keeps you satisfied. That gives me hope for the weeks to come. I have to be at the hospital at 8am...I assume the surgery is around 10am. Hoping to be home by 5pm. I'm really most nervous about nause and vomiting, but hopefully they will give me good drugs!!! Also hoping I dont' puke that barium stuff!!!!!!! Praying for successful surgeries and quick recoveries for all!!!!!!!!!

Hi all,

I am scheduled for the 25th as well. Just had my preop visit with the surgeon today. I will likely be the second on for monday. I would be lying if I said I wasn't nervous, but I know it will all be good. He said I would probably be home early to mid afternoon. WOW!!!! Good luck to you all!!!!

Michelle

IA

Well, I think that because my surgery date was so soon I wasn't mentally prepared for the low cal....I am doing much better...I am drinking the Isopure chocolate Protein Shake twice daily and I am amazed at how that curbs my hunger. And you are totally right, boredom is my worst enemy...that and nerves. I am finding myself wanting to eat and then looking at the trigger. Then I ask myself if I am really hungry!!! I have lost 5 pounds in the past 3 days. Don't you think that most of the time we eat for all the wrong reasons!!!!!!

Hi all...I am scheduled for my band on 2/25...yeah....things actually went very smoothly and quickly for me. I was a bit surprised last Friday when I got the call and was able to schedule my surgery. I have to see the surgeon on the 21st and then after that will be on pretty much a liquid diet. Right now I am following a 1200 calorie diet, but I am having a tough time. Can anyone tell me why the 1200 call for two weeks and has anyone else had trouble sticking with it? I have made huge changes...no pop, eating only three times per day....no snacks....smaller portions. Has anyone failed and gotten "in trouble" by their surgeon? I am not doing horribly, but it is really hard. Thanks everyone!!!

Hi Irene,

Our stories are nearly identical...I too gained most of my weight after high school and into my early adult life. I am married with three small children and think that ten pounds a year or per child has quickly caught up with me. My max was 264 and I am at 250 most days now. I am hypertensive and also in my 30's. I went to the class on October 12 and met with my internist on Nov 9. I was petrified to talk to her about it. I had nonchalantly mentioned banding to her in the summer, but she brushed me off. I have been doing a ton of research and finally decided that I would make an appoinment to specifically talk to her about it. I really wanted her honest opinion. To my surprise, she was very supportive. My appointment with the surgeon was Nov 29, mandatory support group meeting Jan 5, psych eval Jan10. I have been seeing a dietician since October....for my insurance I have to see one monthly for 6 months...ugh. She really isn't much help and is very judgemental. So all that being said...I am hoping for a February surgery date. The surgeon said he thought my three months on Weight Watchers this summer would count towards my dietician supervised diet. I am not really sure. Keep me posted about your progress...GOOD LUCK!!!

Dr. Eibes is in Des Moines and operates at Iowa Methodist. He actually used to practice in Grinnell. Seems like a very comprehensive program. I am a bit frustrated to have to wait 6 more months for the medically supervised diet.....as if we all haven't been on a "lifetime diet". Oh well....One big question I have is How are people doing 5+ or more years down the road with lap banding. It seems that there isn't a lot of research out there. I don't want a fix for the moment....I want this to be an adjunct to help me for a very long time. Anybody with any other info?

I am planning surgery with IA Health's program...Dr. Eibes...just starting the process. They have a fairly new program...just wondering if there was anyone out there that has had a Lap Band by Dr. Eibes. Doesn't seem like there are a lot of central IA "groupies" on the site yet.

Michelle