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Hi Group, Any bandsters from NE Ohio lurking on this board? I live outside of Akron near Kent and am hoping for insurance approval in the next few weeks. My claim was submitted to Aetna 2 days ago. My surgery will be at Summa Akron City by Dr. Z.

Stevee, Sorry to hear of your personal experience. Glad you are back to give it another try. Your post reminds me how vigilant we must be with weight loss. The Lapband was not a solution but a tool. Along your journey you had challenges that you could not overcome at the time. I think it sounds like you are in a new state of mind and ready to move forward. I think you need to make some personal commitments to assure your success. Here’s my take on what they are. Surgeon/Nutritionist - Go back to your surgeon and nutritionist. Actively involve yourself in their decisions and directions. Don’t be afraid to call them if a fill feels wrong or you are in pain. You are paying the surgeon and have the right to question him/her. Some surgeons just shove people thru hte process. Don't let this happen again. Make sure your diet fits your lifestyle and is doable. Keep in touch with these folks regularly to help guide you along the way. Diet - Be vigilant on your diet and what you are eating. It’s more about a lifestyle change than about a diet. Add those calories for your first months and get that protein up. Make yourself accountable to you. That is what is important. Exercise – I know that’s a bad word for many. For me, it was what really transformed my life. It does not have to be a hard gym workout. Start with walking and regularly do this. Again, make yourself accountable to exercise. As the weight drops, you will be able to do more. Once you get into that exercise mode, it becomes a habit. Support – Use support mechanisms to the max. Join your local support group and attend. These folks helped me immensely. On-line communities like this one are also great. I don’t chat here a lot. I like the www.obesityhelp.com GLBT forum the best. It is a very active board with great folks. I know these may not be new to you. To me they are what made my loss a success. Tom PS: I was 273 at my highest in 2007. 258 when I started the process in Feb 2008. I am 186 today.

Group, My partner Brett and I have started a bariatric recipe blog, Blog.beariatric.com. Please check it out and leave us some feedback on your visit. We are interested in knowing how we are doing. I am new to the band. He is a very successful roux-en-y patient. We are relying on our personal experiences and knowledge. Your comments will help us make the blog better. Thanks, Tom and Brett

Jennifer, I will make the assumption that the basic Aetna diet and exercise requirement applies to your policy. So, you should see your primary care physician and have him start you on a 3 month diet and exercise plan. Have monthly visits and be sure he notes the diet and exercise discussion in his office notes. This is what Aetna wants to see. If you end up having to do 6 months, you will have 3 under your belt. If only 3, then you have that part done. Good Luck! Tom

Amy, I actually gained a pound in my 3 month diet and exercise program. The reason we are having this surgery is because we can't consistently lose and keep it off. I also thought that insurance looked at this as a way to see if you could follow a regimented plan. I was worried. My doctor submitted and I was approved in a week. My BMI going in was 41.3. I am now on my 5th week of a six week pre-op-op diet. I am to have surgery next Wednesday. I am down 25 pounds and have a BMI of 37.8. It's hard to predict what insurance will do. Just be sure you document everything! Make sure your surgeon's office is checking the documentation. I have heard of so many people being denied or delayed because their documentation was not complete. I just wanted to let you know that I was a person who did not lose on the 3 month supervised diet. Best to luck! Tom from Ohio

Hey All, I haven't posted in awhile. My surgery is approved and scheduled for 07/16. On Tuesday I start a 6 week Optifast diet. It really intimidates me. That is such a long time to not have any solid food. My surgeon initially told me that I would have 2 weeks. He then upped it to 4 weeks. Finally, at my last appointment he decided that 6 weeks would be best. I am 5'7" 255. He says my goal will most likely be 185. With the 6 weeks diet, he expects me to lose 45 pounds. That puts me over 1/2 the way to goal. How does all this sound to others on this thread? Is this goal weight realistic, conservative or liberal? Tom from Ohio

This friday I meet with my bariatric clinic's dietition. My surgeon starts me on a 6 week Optifast liquid diet the following Tuesday. It seem excessive from what I have read. I am 54 5'7" 260. My target weight is 185. According to the surgeon, I will lose 40-45 pounds during these 6 weeks. How many weeks of pre-op diet did you have to do?

I was approved by Aetna today! Yeah! It took 8 days ftom when the surgeon's office submitted it. I have a pre-op information and scheduling appt. this Friday with my surgeon.

Drew, I am pre-op. My insurance is coving all the tests at 80%. My surgeon has a $1600 admin fee that Aetna wil lnot pay. My flexible spending account will cover most of it. I did my diet through my PCP and only paid the $20 office visit copay 4 times. I think I have maybe $400 out of pocket so far. My surgeon requires 4 weeks of Optifast. That will cost me $116/week. I think I added everything up and with the surgery and all I will most likely have $5,000 out of pocket total. Tom

The insurance approval process is such a game. It seems so twisted as compared to approval for other procedures and surgeries. I have read through this document numerous times and almost always say "I meet almost all of these". The issue is that there are little clauses everywhere that can be interpreted many ways. In other words, you can end up not qualifying because of one of these. I do believe that insurance companies use this as a delay tactic to thin out the herd. In other words, you can get the surgery if you persist. That seems counter to Aetna's claim to be a health care partner and managing the health of the whole individual. It's good marketing material but not good for the bottom line. So, keep up the fight. I intend to. Tom from Ohio

I am almost on the same timeline as you. My claim was submitted Tuesday. I hope to hear good news this week.

Beth, I am now in the insurance review and approval/denisl phase. How are you doing on the loss? I am having my band done by Dr. Z. at Akron City.

I just completed a 3 month supervised diet and exercise program. My claim was submitted to Aetna 2 days ago. What was the response time for others covered by Aetna? I understand that they assign a nurse to do the review. My surgeon's office says it is typically 7-10 days. I have high hopes since i have 4 comorbidities, 12 year history of weight from my PCP and a BMI of 41.

I have Aetna. I am just now finishing the 3 month diet and exercise program. I've completed all of the pre-op testing. I believe my surgeon is going to file paperwork in early May after my final doctor visit. I have 4 of the comorbidities and a BMI of 41. I am curious of how responsive they will be. I hate seeing stories like yours. -- Tom from Ohio

Hi all. I had my initial consult on Thursday and am now looking forward to my journey. I am having surgery done by Dr., Z. at Summa in Akron, Ohio. The estimate I have been given is a three month supervised weight loss and exercise program, followed by insurance approval, pre-op tests and liquid diet. They tell me that my operation will most likely be in the early-mid July time-frame. I hope that it goes that smoothly given some of the posts I've read in these forums. My partner of 18 years had a gastric bypass 18 months ago and his pre-op stuff took about a year from his first visit. We'll see if I can beat that time. .. Tom from Akron

wow... amazing results... congrats just going for initial consult next week... hope i get approved and banded have u exercised more since surgery to get these results?

Nice to hear! Good luck on the rest of your journey.

Bigunc... We almost have identical med history and age. I am close to going to my initial eval. I actually posted earlier today about Aetna and the process. I am curious to follow your progress. I haven't heard the exercise requirement but of course i am very new. I am assembling a series of questions for my surgeon's visit in 2 weeks. I'll be sure to add this. Tom from Ohio

I am preparing for my initial evaluation in a couple of weeks with a gastric surgeon. I’ve been filling out the pre-exam paperwork and getting copies of my paperwork from my primary care doctor and cardiologist. I have been reading the posts on this site. It’s very helpful. I believe that I am a good candidate for surgery. I’m 53, 250… about 95 pounds overweight. My BMI is 40.2. I have coronary heart disease and had a triple bypass 2 years ago. I have had high cholesterol and high blood pressure for 20 years. I also have severe sleep apnea and type 2 diabetes. All are currently under control and under treatment. From what I have read, I hit most of the main qualifications for surgery. My fear is being jerked around by insurance. I have Aetna. I wonder if folks with stats similar to mine can talk a little about their experience with insurance. With heart disease, diabetes, high blood pressure, high cholesterol and my obesity, I think this should be a no-brainer for insurance. I’m curious what they will put me through. I figure a diet is a must but wonder how long. What can I expect? Maybe I am overreacting from filling out forms and doing research on the web.

How did your surgery go? Any details to share? I am from Brimfield, pretty close to you. Hope your are in good health and things went as expected.

Today I scheduled my initial eval with Dr. Z for the end of January. I have met him before. He did my partner's gastric bypass 15 months ago. He seems very knowledgeable and skilled. My parter only has good things to says about him.

Hey, Glad I found htis tread. I am a gay bear just starting this journey. My bf had bypass and went from 365 to 180 in 18 months. He motivatred me. I spoke to my dr. and he thinks this is best option for me. We'll see how it goes. I worry about approval from insurance. Talk to you all later. Tom

Hey gang! It's my first visit and post to this forum. I have been fascinated by weight loss surgery over the years. My partner had gastric bypass 14 months ago and lost 185 pounds! I've seen his progress and great results. I talked to my doctor about this surgery. He recommended the lap band for me as opposed to the bypass. 2 years ago I had a heart attack and triple bypass. I had many complications and do not look forward to surgery. From what I can tell, lap banding is less evasive and a shorter, easier recovery. I am not sure where I am going with this... even if I follow through. I am set to attend a gastric and lap band seminar next week. I am exploring my options. So, I'll be snooping around here in the coming weeks. Hopefully, I'll become a regular. Hello from Ohio!