My Life Back

Although I am not banded yet, I have found a TON of things that make you go hmmmmmmm on the post called something like "What have you eaten today?" I have found reading what others are eating has helped me to be able to plan what I am going to be packing for lunch (since I am not telling my co-workers about WLS). I will be using the individual cottage cheese, individual fruit cups, Dannon Lite & Fit yogurts, hard boiled eggs, Egg salad, Slim Fast, Weight Control instant oatmeal, etc. I also plan to use Protein shakes - homemade and store bought. Hope this helps you guys. Good Luck to all of you.

What kind of input did you GYN have towards your surgery? My GYN is an absolute dream of a Dr. and he would do ANYTHING that would support me in this process. We even discussed my weight at my last visit, and he was very excited for me when I told him about trying to get banded. Therefore, this topic has peaked my interest greatly. Please share.

Hi Denise - I was wondering if it was possible that you could send me a copy of the information that you submitted regarding the National Institute of Health. I haven't been denied or accepted yet. I am still going back and forth with my PC to get the "proper" referral letter :confused2:. But I would like to be prepared in case they do hand down a denial. I would greatly appreciate it. Thanks so much in advance. Becky

Just a quick history on myself - I was born and raised in Texas in the country and on the farm - and have now lived on my farm in Florida for the last 13 years. As much as I wanted to, I never got to rodeo. :cool: I read what Kat wrote and LOVED every word of it - it sure made me homesick, so I decided that I would add my 2 cents worth and take it a bit deeper, but Kat was right on with everything she said - Rockies are cut for VERY thin girls with NO shape or curves what-so-ever. I was never too fond of them cuz they ride right on up where they don't need to be!!! :eek: I think the size ranges from 00 like Kat said, to 00.5! :crying: As far as the Ropers - those are the BEST boots in the world! They look good and are comfortable too! And yes, I had them in several colors!! There is an entire "attitude" when you put on your Wranglers and boots!! It is hard to explain, but you definately feel it when you get dressed. Now as far as the belt buckle goes, I have personally always just loved a man dressed to the hilt in his tight Wranglers, cowboy boots, a nice starched button up shirt and a cowboy hat. I don't care what hel looks like, ANY man is TOTALLY HOT dressed like this!!! :thumbup: This is the surest way to get my attention!!! I too have heard the comparison to the bigger the belt buckle, the smaller the "member". But from where I was from, you just didn't say it, joke about it, or even imply you had heard it before. HOWEVER, when I read what Kat wrote about them being called Tombstones - I just about fell out of my chair laughing hysterically! I had NEVER heard that one before, but now that I think back, most of the time it is SOOOO TRUE!!! :tt2: The things I miss the most about Texas is the 2-steppin'! Here in Florida men only know how to dance in circles - they can't count to 2!! :rose: The BBQ is another well missed item, as well as the Mexican food. Man-o-man do I miss that food!! :drool: Green, I hope you make it to NM to try BBQ and see some of these "cowboys" that we are referring to. It can be somewhat dreamy to see the Marlboro man riding by :tt1: Anyway - sorry this was so long, but I just HAD to comment - it was quite a trip down memory lane. Thanks again Kat.

Wow!!! I like the way you read things :myscared: I can only pray that the person responsible for my approval has an understanding of the coverage as you do. That whole thing about it being more cost efficient in the long run to pay for surgery vs. all the health problems is EXACTLY what I was thinking. I think that on top of all the medical bills they will be paying for BOTH me and my DH, it would be better to cough up the surgery for both of us than to have to pay out for all the medical bills AND the huge life insurance policy that I took out on us, should one of us drop dead (god forbid!) from our health problems. :smile: I appreciate all you have done for me thus far!! You have brought a whole new light to the topic for me. I was very down and depressed thinking that we were not going to get surgery at all....and now I can see it from the point of view that your giving me and that gives me hope again that we can get our surgery and finally get healthy!! I was telling my DH earlier that I didn't think I would take the reimbursement until I got denied 2 or 3 times....ya know, when I thought it was really NOT going to happen....lol. I can also see that the first hurdle we will have will be the supervised diet. I don't know if or how we can get around that.....we may just have to go with it....and that kinda sucks. But after that, we will have all the info she told me I needed to send in and then some. I would love your help writing an appeal letter - hopefully it won't be necessary. I plan on calling the surgeons office on Monday to move forward with the appt. They should already have our blood work (although I am sure they don't) and hopefully they will have the psych evals by then too!! Then I believe all I need is the referral from my PC and I get an appt with the surgeon!! Wooo hooo!! Thanks sooooo much for giving me hope again!!! :redface:

QTKidsmom - The coverage that they are now saying is valid is: "Treatment for MORBID OBESITY only if the covered person is twice his/her ideal weight or greater than 100 lbs overweight and suffers from documented seperate conditions (i.e., severe diabetes, mellitus, hypertension, cardiovascular complications, obstructive sleep apnea, hypertriglyceridemia, amenorrhea, hypercholesterolemia, degenerative joint disease, & athralgia of other weight bearing joints which are aggravated by morbid obesity). This must be documented by objective evidence provided by the physician who is treating the covered person for the condition that is aggravated by morbid obesity. Note the term "treatment" does not include any surgical procedures - see General Limitation, item #17." General Limitation #17 reads - No payment will be made under this Plan for expenses incurred by a Covered Person: for instruction or activities for weight reduction or weight control, including charges for Vitamins, diet supplements, or physical fitness programs even if the services are performed or prescribed by a Physician; for any surgery performed for the purpose of weight reduction. Can you still decipher that it will be covered? I am seeing that it says there is no coverage for ANY surgical procedures. (The last sentence) You have given me hope :myscared: - but I am not sure if you read the right coverage paragraph from below....I am praying that you are right, but I am soooo skeptical. I just keep waiting for my balloon to be busted into many little pieces. :redface: Thanks so much for helping out.:smile:

This was so funny that i had tears!!!! My DH has asked me to help "seperate" the unibrow. So he lays his head in my lap and I pluck them - I laugh so hard sometimes that I can't continue. :smile: Ok, maybe that is a little sadistic and mean, but I just think it is so freakin' funny because he has made fun of me for having my eyebrows waxed and tearing up. :myscared:

Has anyone been required to do the 6 month supervised and lost enough weight that disqualifies them for surgery? Has anyone "thrown" their supervised diet to still maintain qualification for surgery? I understand the idea of the diet is to prove that you can follow a restricted diet, but what if you lose too much to still qualify to have surgery?? Personally, I am just over the qualifying mark - so to lose 20 or 30 lbs may put me under all the requirements....how scary is that???

Has anyone been required to do the 6 month supervised and lost enough weight that disqualifies them for surgery? Has anyone "thrown" their supervised diet to still maintain qualification for surgery? I understand the idea of the diet is to prove that you can follow a restricted diet, but what if you lose too much to still qualify to have surgery?? Personally, I am just over the qualifying mark - so to lose 20 or 30 lbs may put me under all the requirements....how scary is that???

I just noticed that the JUST the last sentence has changed, but they took the first word of the definition that says "surgery" or treatment....... now it just starts off saying: "Treatment for Morbid Obesity....." Thanks for the insight Minpinmom - I also thought about throwing a fit, cuz in my gut I feel like that is the case. I feel like they know that if I throw a fit, they will have to cover it. It was strange bcuz all this went down on Tuesday and yesterday, the same HR girl, saw me in the coffee room and asked me about my receipts. Then made sure she let me know that she had discussed it with her boss (the director of HR) and that she agreed that they would reimburse me. I felt like that was her way of trying to convince me that there is no one that I can talk to to argue about it with. nursekathy2u - THanks for the info. I just called and this is what the lady told me: "Still move forward with having your Dr. send in the pre-determination paperwork....especially if you still have a copy of the so-called "wrong" coverage." So to me she is telling me that if I fight it, I still may be able to have it covered. That is a bright spot for me, however, I was not looking forward with fighting the insurance company. Now if my company is Self-funded, does that mean there is some kind of medical review board within my company that goes over this stuff. I would be totally humiliated to know that my bosses knew when I am thinking I am doing this on the down-low. Anyway - Thanks for the posts ladies. I appreciate it. I just wish I knew a lawyer to tell me if I had a leg to stand on with this before I go and fight about it. Being new to the company, I don't really want to rock the place, but I WANT THIS SURGERY!!!!

I think it is great what you are all doing. Here is a helpful link: http://www.aa.org/en_pdfs/p-55_twelvestepsillustrated.pdf I too have had experience with the first 4 steps. Those were the only ones that I completed - and that was like 20 years ago. Good Luck - it is not an easy journey. It was always emotionally draining to me. Step 4 was familiar to me, but I couldn't remember it - so I went in search of. I found a website that offers the actual worksheets with instructional pages. This was pretty good - I almost forgot that I was posting here....lol. :wink: 12Step.org for Sobriety, Strength and Serenity - Tools Enjoy - I hope this help for some of you. Good luck!

I just started my new job a little over 90 days ago. My company is huge (over 4,000 employees in 130 countries). They are a Self-funded Insurance with a third party administrator. We use MultiPlan as our provider and Allied Benefit as the administrator. (At least I think this is how it goes....lol) In my Offer Package was a copy of the "Medical Benefits Plan Schedule of Covered Expenses". On this sheet, the coverage reads: "Surgery or treatment for MORBID OBESITY only if the covered person is twice his/her ideal weight or greater than 100 lbs overweight and suffers from documented seperate conditions (i.e., severe diabetes, mellitus, hypertension, cardiovascular complications, obstructive sleep apnea, hypertriglyceridemia, amenorrhea, hypercholesterolemia, degenerative joint disease, & athralgia of other weight bearing joints which are aggravated by morbid obesity). This must be documented by objective evidence provided by the physician who is treating the covered person for the condition that is aggravated by morbid obesity. This does not include gastric bypass surgery (i.e., "stomach stapling")." In-Network: 100% ($25 co-pay if outpatient) :tongue: Well, I recieved another copy of this stated coverage in my New Employee Orientation....so I ASSUMED that Lap Band would be covered. So I started my journey. (Now keep in mind, this is all x2 since my DH was planning on having surgery with me.) I began researching the area doctors, and found this site. I saw my PC and told him I wanted the surgery - he agreed and approves of the procedure and sends out the referral. $25 I asked him for current blood work - he sent me. $?? I sought out a psychiatrist for the Evaluation - found one, had her 3 required visits and "passed" the evaluation. $75 Now I have completed the "hoops" for the surgeon and was waiting for my appt. with him. So, now I am sitting at work daydreaming about the surgery and think that I will be nice and try to keep the ball rolling at the unbelievable pace that it is and send a note over to the surgeons office (as I was told I could do to help expedite the paperwork) that says my insurance doesn't require the diet history/supervised diet. :wink: I decide to send a copy of this "Schedule of Covered Expenses" along with the letter. I go to the website the website that I can print my coverage info from and print a copy of the schedule that is posted on their website and get the shock of my life when I re-read it and find out the VERY LAST SENTENCE in the coverage has changed!!!! Instead of reading that gastric bypass is the only thing not covered, it now reads: "Note the term "treatment" does not include any surgical procedures - see General Limitation, item #17". #17 - This policy does not pay for instruction or activities for weight reduction or weight control, including charges for Vitamins, diet supplements, or physical fitness programs even if the services are performed or prescribed by a Physician; for any surgery performed for the purpose of weight reduction. WOW!!! What a shocker!!! The page that says no surgery is covered says Revised 1/06 on the bottom - the other pages I have don't have anything written on the bottom! So, first things first - I head straight to my HR department. They have no idea, so I am walking them through the details step by step. They tell me they will get back with me. :wink: She comes back a little while later and tells me that she called someone (within the company) and was told that they would reimburse me for my costs of preparing for the surgery, but that surgery isn't covered. The page printed from the internet is correct :eek:!!!! I called the insurance company and talked to a lady who was very helpful - she told me that I could send a letter to the medical review board and that I needed: 1 - Letter from surgeon 2 - Current and reccomended weight 3 - CPT codes and the fee for each procedure 4 - 6 month supervised diet They didn't even ask about BMI, co-morbidities, etc. My head is just spinning!! Is this a positive sign or a so-called death sentence?? I don't know what to do. I don't want to take the reimbursement and then them say "well, since we reimbursed you, it was like you agreeing that there is no surgery" or something screwed up like that. Sorry for making this so long, but I am just on a roller coaster about all this. Any input would be greatly appreciated. I don't even know if I should try. :frown:

I don't really want to tell anyone at work at this point. I have told a handful of my closest friends, but my DH has told almost ALL of his friends....lol. He is excited about it and wants to talk about it to others and almost "brag" to a couple of his friends. I think men see it as the bigger and better "toys"....lol. I however, have only told the wives of his friends (who are my best friends), who would have found out anyway....lol. I don't want to feel like everyone at work is 'hawking' me everytime I eat, drink, or don't eat. I don't need that pressure - I feel like they all stare at me already for eating too much. I am just taking 1 week vacation off and, like someone else said, it is my time off, I will do with it what I want. I may change my mind later, but right now, I feel like I will be judged for having surgery. It is almost like admitting failure or defeat. I am not mentally ready to deal with it right now....I need a little more time on that topic. I have gotten support from all our friends (and wives) and I will probably be more open with them about it, but I am still pretty new at work and don't want to go into great details just yet. I probably will by the time I return to work, but just not now! Good luck to everyone who does tell and I hope you get the support that you want/need. To those who don't want to tell anyone - don't. If you don't feel comfortable telling about it - then keep it your secret. You have no moral obligation to tell ANYONE that you don't want to!! To those who had someone else blab about it - I am so sorry you had to go through that. That just sucks! I am not telling my family (other than my 2 kids and MIL) because my family wouldn't understand any of it. I had a mini tummy tuck about 6 yrs ago and my brother thinks I had my "stomach stapled"....rotflmao!!!