Wheetsin

To all of you saying that you "failed" with the band - try to see it in a different light. Unless you knowingly ate too much or ate incorrectly, irped the food back up, then tried again until it stayed down, you didn't fail. Unless you opted to eat ice cream all day because it's what you wanted, then you didn't fail. Having a mechanical device that is supposed to give you fast satiety, but never does, is not failure. In reality, it's having gone through surgery with high hopes, and finding you still have to "diet" to maintain weight or lose weight. Having a band that maybe worked for a while, then failed, is also not you failing - it's you not having the ability or resolve to "do it on your own" but why would having had surgery change that? If we could do it on our own, we would have long before surgery... and definitely would have long before a second (or third, or fourth...) surgery. The sleeve cannot have the same issues as the band. The sleeve cannot slip (prolapse), it cannot erode through your esophagus, etc. It can limityour intake. You will still have to work at it. Since it is not (or maybe just lightly) a malabsorptive procedure, you will still have to own what you eat. If you cannot own what you eat, then frankly the sleeve might not be the best option. I'm pretty far post-op by band standards. I know a lot of people in the 5 - 7 years post-op range. Those who still have their bands, shouldn't, but are too afraid it will be removed to seek the medical care they need. It has let down a lot of people, and mentally is about a 30x magnification of the standard diet "failure" emotions we've all experienced more times than we care to count. I suspect I will spend the first 6 months with my sleeve "just waiting" for it to somehow fail. I mean, 100% of my bariatric experience tells me that eventually, it stops working, right? But try to focus on the fact that the band is not PERMANENT. Ok, in theory it's intended to be a permanent device. I'll give it that. I don't know anyone 5, 7, 10 years out who still has theirs, so it's not THAT permanent. Every sleeved person I know 5, 7, 10 years out still has their sleeve. I understand your fears, and I share them. We have "failed" at weightloss most of our lives. We "expect" failure again, it's what we've become conditioned to. But if you didn't at least have hope, you wouldn't be here, so run with it.

115 - 155 is going to be your "normal" BMI range. 135 puts you right in the middle of that. BMI really isn't the best gauge, but if you need a target to shoot for, it's a starting point. I'm a 5'11 Pear, so pics of me won't help, but a friend of mine about your height and shape weighs around 145 and wears a 6.

Sorry for the typos above, but I'm too lazy to go back and edit.

I don't think a private plan is going to be economically your best bet. Private pay plan premiums are really expensive. They get more expensive depending on your age, health, where you live, your salary, etc. It's hard to ballpark this, but I'll try. These are just really, really loose figures. A healthy "preferred" person on private insurance might pay $600 - $700 a month just for the premium. That does not include coinsurance. As soon as an underwriter sees something they don't like on your application or in your medical history (obesity, diabetes, high blood pressure... basically comorbidities) your rates are going to go up and that's if you're even considered insurable - they can easily say "we won't cover you." I would suspect rates in these instances (obese with comorbidities) could be around $850 - $1000 per month for premium only. If bariatrics aren't excluded on your policy, you're going to most likely have a 6 month supervised diet, possibly 12 month. That's $5700 - $11,400 just in premiums while you wait. That's a part of why the medically supervised diets are required. Popular notion is that it's to prove you can follow a diet, but don't be surprised if I say it's (at least partially) because the insurance company is a business and businesses need to make a profit, and they want some sort of "investment" from your end to ensure they aren't just going to lose money on you. There may also be an additional waiting period before your eligible for benefits like this, that would not usually count toward the time period of your medically supervised diet. Then your coinsurance, which is probably going to be at least 20% but should not exceed 50%. And your deductible (which could be per condition or per year - you'd probably be per year). When you see self-pay options ranging from about $4k to about $15k, it's easier to understand why most people pay it rather than pursuing insurance options such as the one you're considering. Now for greener pastures... Are you sure you don't have credit? Lots of things establish credit, which you might not be aware of. Car loans, student loans, mortgages, credit cards, etc. You can always check your credit for free, but you'll probably have to pay a small fee (I think about $5) to get your FICO or "credit score" - the number you hear talked about in all the commercials. If you have a surgeon/hospital in mind, call them and ask if they offer payment plans. There are also companies whose sole business is offering medical loans, and I've seen a lot of people in financially bad situations get approval. Interest rates are out the wazoo, and you really really won't want to miss a payment, but all things considered it really could be cheaper than the private insurance option. As for what companies - UHC and BCBS are the most "bariatric friendly" companies IME and in my research. HTH. Let me know if you have any questions.

What Rootman said is correct. The others are correct to various degrees. You may deduct only the amount by which your total medical care expenses for the year exceed 7.5% of your adjusted gross income (AGI). This is only applicable if you itemize deductions. Your AGI is all of your qualified income, minus your qualified deductions. To calculate your AGI total all money you made during the tax year. This includes W2 income, business incoe, alimony, unenmployment benefits, taxable SS benefits, taxable interest, etc. Then subtract qualified deductions which include things like alimony you paid to someone else, moving expenses, student loan interest, etc. That gives you your AGI. Let's say your AGI is $50,000. 7.5% of $50,000 is $3750. The portion of your expenses minus the first $3750 is what you can deduct. Your medical expenses were $10,000. $10,000 - $3750 = $6250 <- the amount you can deduct And THANK YOU Rootman, for differentiating between credit and deduction. So many people get confused by that. In my math above, wehat the deduction means is that you would not pay taxes on $6250 of your income. It does not mean you get $6250 extra tax refund. (I can't tell you how many people think that deducting their mortgage interest means they get back, dollar-for-dollar, what they paid in interest) Recap: Your income from all sources - your allowable deductions = AGI AGI * .075 = deduction threshhold (amount which expenses must exceed before they can be deducted) Medical expenses - deduction threshhold = allowable deduction Phew. Now I'm gonna sit back and I hope I didn't fat finger something in there and throw everything off.

Do you mean a personal policy, where you pay out of pocket, or do you mean selecting an insurance plan offered through your/spouse's employer? Some companies completely exclude certain bariatrics. The sleeve is becoming more allowed, but is not yet as widely allowed as the RNY or AGB. If you're talking about joining a group plan (through your employer, or a spouse's), you would need to see what the available coverage options were and contact the insurance companies to see if they had plan enforced exclusions for the sleeve. You would then need to contact your HR and see if there were any employer enforced exclusions for the specific procedure. Just because an insurance company considers the sleeve a covered procedure does not mean it's one of the options your employer has paid to have included in their coverage. Coveragte under a private/personal plan would have similar caveats. You'd have to qualify for the plan, for one - depending on your past medical record and current health this may be hard to do, and will almost guaranteeably be more expensive (e.g. b/c I've had bariatric surgery, I would be considered uninsurable by a lot of private plans, and a self-employed friend of mine who is in the super morbid obese category is uninsurable because of his weight.) You would still have to meet all the requirements. And you're looking at a very hefty premium, and probably a good chunk of coinsurance to boot. It's also fairly common to have waiting periods (that's my own term, not the technical term) -- periods of time, generally 3 - 6 months, that you have to wait while actively paying premiums before you're eligible to receive certain benefits. I'm going to bet that bariatrics are included in the procedures that require the waiting periods. IfPrince out a private plan, and find out if they require the waiting period. Then find out the cost for all the preliminary stuff you will need to do such as (most likely) supervised diet, nutrition classes, consultation, pre-op labs, etc. You might find that all those costs are more than the self-pay price of a sleeve (my US surgeon charges about $11k). This isn't a conversation about whether or not you should have health insurance, so I'm not factoring in things like coverage for complications. I'm just looking at the "for procedure" costs.

MissMichele, one of the things I hated most about my slipped band (I lived with it for about 3 years) was that there were times I could not drink when thirsty, could not take painkillers when I needed them, etc. My slip "bouts" lasted anywhere from several hours to several days. By "bout" I mean the time periods during which I couldn't really eat or drink anything without significant pain. I didn't bring things up very often at all, but I woild feel them for hours & hours & hours. I once had a bout that lasted 6 days. I could drink extremely cold drinks, like ICEE type drinks, and that's all I could get down. I never really was hungry with the band - that was one of the few exceptions. By day 6 I was very hungry, but knew I could not eat anything. "Head" hunger doesn't hurt. Actual hunger can be quite painful. That sucked.

Dumping can happen, it does not happen to everyone. This is a really common misconception (that you don't dump with the sleeve). I tend two see two approaches to bariatric lifestyles. 1. Avoid bad foods, they're what made you fat. 2. Don't avoid, just moderate. When I had my band I only avoided the foods I knew I physically could not eat, like slimey fruits. They wouldn't go down without pain, so I just stopped eating them. I stopped eating red meat because I could not get it to chew up well enough. And so on. I suspect I will have the same approach, as much as I'm able, with the sleeve. #2 is a holisitcally healthier approach, IMO. Part of the great thing about restrictive procedures is that you're still able to eat (for the most part) what you want. You just have a little bit of enforced will power.

carbgrl - I had a band for about 5.5 years. I am scheduled for sleeve surgery next month. The information below is what I have seen, read, and been told. It is not my personal experience. As I'm sure you're aware, everyone experiences things different and what you experienced with the band also depending on your ability/inability to achieve good restriction. Seems the sensations of fullness are comparable (pressure somewhere prior to "full" sensation, soft stops seem about as frequent and similar). Band patients perhaps have a stronger "full" feeling than sleeve patients (referring to that "just ate Thanksgiving dinner" sensation). Seems band patients experience significantly more discomfort when food cannot pass (with the sleeve, it would be food cannot fit, I guess, excepting a complication). Sleevers seem to avoid the minutes-hours of discomfort/pain we had while the body tried to get the food through the stoma, and that the food is much more likely to "just come up" with the sleeve. HTH

^ as long as it's not plan nor employer excluded.

FXD, someone above said your insurance company cannot have a pre-existing condition "argument" for your band removal. Unfortunately they can. (I worked for a major insurance company for many years). There is an exception to the pre-existing rule but it's pretty specific around previous group health covering. I don't know if they've been changed for 2012, but for 2011 it was: Pre-existing = anything that a person sought medical advice or treatment for in a set period before the new health insurance policy took effect. The insurance company will go back at least 12 months, usually more, to determine this. If you were previously covered by an employer health plan for a minimum of 12 months and you have not had a lapse in coverage of more than 63 days, you don’t have to serve a waiting period under a new employer health plan. Any claims relating to the weight loss surgery would be covered under the provisions of the plan.

The only thing about the procedure that would matter is maybe the rate of weight loss, if at all. As my surgeon puts it, "It is a matter fact. If you lose 150 pounds from an elastic organ such as skin, you’re going to have saggy skin." When I had my band I lost a total of 185 - 200 lbs. At my lowest, I was within maybe 40 lbs of goal, so I can't speak to the state of my skin AT goal... but I didn't have much sagging until I was about 115 - 130 lbs down. Then I started sagging big time. Your skin has two major factors: history and heredity. History includes factors like lifestyle, skin care regimen, etc. Heredity is your genetic factors like race, family skin history, etc. How overweight you got (how much your skin had to stretch), how long you were overweight, what years of your life (age) you were overweight, whether or not you smoke or are around smoke, ethnicity, ease with which you develop stretch marks, number of stretch marks you have; and type, exercise routine, health of skin (damage, e.g. sun damage)... and lots more are all factors. My general motto is that if you're fat enough to need WLS, you're gonna have saggy skin.

I don't know if the pain is worse, but the risk for complications goes WAY up. Lots of true revision surgeons won't do them at the same time (but lots of surgeons who haven't done many revisions will). Should be getting my sleeve in the next few weeks so maybe I can help with the actual question then.

It is relative to each patient. The best he could give you would be averages, and I don't think a lot of surgeons are yet tracking AGB - VSG revisions yet. It would be nice if he had some current data to give you. There are also a lot of variables. For example, length of time banded may play a role, as does success while banded, and reasons for that success (e.g. did you actually change behaviors in a positive way, or did you just irp up everything you tried to shove down as though you were eating pre-op). The statistics also vary for AGB -> VSG "all in one" procedures (removal and revision at the same time) compared to requiring a waiting period (so do the rates for complications). My surgeon's statistics are currently about 80% EWL with a virgin sleeve. 70% - 80% EWL with his mandated waiting period between revision procedures. 60% - 75% EWL simultaneous procedures. (Complication rates from simultaneous procedures to stayed procedures ran about 20% less, respectively). I know it's been beat to death, but remember it really is a tool. Weight loss will happen if you work with your tool. Weight loss will not be automatic. Not with this procedure, anyway.

Vicki068 - I was banded in 2006 and had my band removed in September last year. I lost in the area of 185 lbs with my band. I suspect it slipped in 2008 (whem symptoms first occured) but I "tolerated" my slip and was even given the option of leaving it in until if/when symptoms worsened. I opted to have it taken the heck out. I was kind of supposed to have revision to a sleeve in November of last year, my surgeon requires 2 mos between procedures. Long story short, I just got my approval this week and should be scheduled for surgery some time around March 1. March 1 of this year would've been my 6 year "bandiversary" so there's something a little poetic in that. When I had my band, surgery was like 7am and I was outta there like 2pm. My surgeon requires overnight observation with sleeve, discharge the next morning if you're all clear. With the band, I slept the night I had surgery, but the next night I went shopping - I can't stand laying around doing nothing... but I leaned havily on the cart. I took 1 week off of work and was fine to return - probably could have returned sooner. For the sleeve my surgeon has advised me to take 2 weeks but plan on 4. I'm going to set up my STD claim as 4 weeks initially. When I had my band out I took 2 weeks. One of my incisions became infected. Otherwise I would've been fine a lot sooner. HTH

If you guys had/are having insurance pay for your surgeries, I would encourage you to call your provider and ask them about the fees. When a procedure is covered, there are legal restrictions in place that forbid your surgeon/healthcare provider from charging you for anything beyond the contracted rate. Even if the surgeon's office discloses the fee up front, or requires it in advance, call and ask. The sequence of things isn't as important as the comprehehnsiveness of the negotiated rate. I'm not guaranteeing it will make a difference, but insurance companies are very steadfast in their agreements that the patient does not pay beyond the negotiated rates, and that patients are not billed anything above & beyond.

Paying for the lapband yourself isn't a reason to deny coverage on a sleeve, in and of itself. You would still have to prove the revision is medically necessary (your insurance company will have the criteria that must be met), would still have to be fully covered for the procedure, etc. I'm trying to get approval for a revision, but my insurance company paid for the band. I'm with a new provider now, trying to figure out how the heck I can prove necessaity when they won't tell me what consitutes adequate proof. It's like, "Guess, and then we'll let you know how you did."

It's going to vary drastically by surgeon, and even by hospital/facility (for surgeons who do procedures at more than one location.) For example, my surgeon's self-pay cost is $12,000 for lapband or sleeve. That's start to finish. Compare that to about $38,000 they charged my insurance company (for my lapband - different procedures, but let's assume comparable costs). When my father had his lapband I think insurance was billed about $43,000. A friend of mine who had one had a complication and her bills topped about $100,000. VERY VERY VERY few plans around today would require you to pay 10% of $100k. Some surgeons use PAs, some don't. Different surgeons have different surgeon fees (and hospitals, and anesthesiologists, and...) Some keep patients overnight, some do not. Most procedures go smoothly, some do not. Etc. That's all going to impact cost. In addition to your deductible and coinsurance, you should have an "out of pocket maximum". Do you know what yours is? You should not have to pay 10% coinsurance of any amout, sky's the limit. E.g. if your plan has a 2k OOP maximum, you would not pay the $2600 you've estimated above, you'd pay no more than $2k total. You also need to determine if your premiums count toward OOP. Usually they do not, but I have seen some plans where they do. That makes a big difference. From your numbers above I'm guessing yours does not, but call your provider and check.

Do you mean to pay out of pocket?

The state of your skin is determined by your lifestyle and your genetics. Which I think is a very abbreviated version of what Diva said. The skin is an elastic organ. When stretched significantly for an extended period of time, it will become loose. Or from the surgeon directly, “It is a matter of fact: If you lose 150 pounds from an elastic organ such as skin, you're going to have saggy skin.” There's not a whole lot you can do on an acute basis to help. Your skin's either going to have some spring back, or it won't. Tiny lady carries twins for 9 months - her stomach may go back to flat. Obese person carries 200 lbs around for 40 years, they're going to be a hot mess.

Coinsurance is the same as a percentage plan. E.g. 80/20 where your plan pays 80% of the costs and you pay the remaining 20%. This only applies after your deductible is met. So if your deductible is $1000 and you have a $5000 procedure: You pay deductible (assuming it's not already met): $1000 Plan pays 80% of remaining charges ($4000): $3200 You pay 20% of remaining charges ($4000): $800 (assuming that's below your out of pocket maximum). That assumes you haven't yet paid against your OOP maxmum. On major medical there's usually a coinsurance cap, after which the plan pays 100%. As for individual vs. family, what type of plan do you have? This is quicker than me putting it in my own words: HTH

A quick background - I had a lapband slip diagnosed in June. EGD confirmation in July. Band removed in September. And last week my insurance denied my revision to a sleeve. I have a background in the insurance industry so I'm not completely at a loss, but... My surgeon had a wonderful lady who knew the revision process inside and out, who quit just a few weeks ago. Their new lady is, well... new... and I'm her first revision case. Uh oh. So I'm kind of having to be my own advocate, because she just doesn't know. The reasons for my denial were: Failure to submit proof of a mechanical failure Failure to document proof of adherence to the prescribed diet and exercise requirements. The revision is covered, otherwise. I don't have to worry about exclusions. But I need to figure out how to prove those two points. Mechanical failure - my insurance company (Cigna) does include a slip in their definition of mechanical failure, and both my x-ray and EGD report were provided. Does anyone have any other ideas how we can document or prove mechanical failure other than those two things? I'm not sure what else I can give them, unless I have the surgeon himself write a letter confirming it. First, lap-band doesn't have a prescribed diet. It's a restrictive procedure. I'm not sure I can prove compliance with a prescribed diet when there really isn't one. I have no way to document portion enforcement. The best I can think of is to gather medical records from doctor's visits (other than my surgeon's office), that demonstrate a steady loss or maintenance until when I had my daughter (I gained in my last trimester, then lost all but about 10, then gained about 20 - right around the time I started showing symptoms of what ended up being a slip). But even with a slipped band/lack of major restriction, I maintained for about 2 years. My surgeon's office wasn't sure these records would do the trick. I know I have OB records that will weigh me in at least 150 lbs down from when I first had the lapband put in. Anyone experienced denial on these same two provisions? Would you mind sharing what types of information & documentation you provided? Thanks all... I'm an instant gratification kind of girl, and this blows.

Hello troubled bandsters! I was just diagnosed with a slipped band. I was banded March of 2006, and I know that my band was fine in 2008. I know it's futile to try and pinpoint a cause, but all of my problems seem to be associated with a pregnancy in 2008. In fact, I have neen researching the band + pregnancy since about 2007 and the more I read, the more I found it almost common for slips or other complications after childbirth. My slip is a bit atypical. I wasn't particularly symptomatic except for a "new" band sensation that I didn't have previously, which would lead to nighttime reflux. All night long. And sometimes the next night too. I didn't have crazy restriction, I was not a frequent PBer (in the last 3 years I've probably had 2 PBs), I didn't have a sudden change in restriction, etc. And I don't fall into your typical "high risk for a slip" cartegory -- again, infrequent PBs, I maintained conservative restriction for most of my banded time - was only too tight once and I got an unfill the next day, I followed the rules that worked for me (not meaning I followed them selectively, but sometimes I had my own more restrictive rules... e.g. I was never able to tolerate a.m. foods/drink so I didn't try), etc. I'm not surprised I have a slip because something about such significant changes in my band (the "new" sensation I mention earlier was pretty significant) this far out certainly didn't seem normal. I also sort of went into this expecting to have a complication of some sort some day. And now that more data is available than when I was banded, and I see the increasing rates of complications, I just sort sort of expected it. (In other words, I went into this knowing it was a forever comittment, but also knowing that forever might be cut short). I've been given 3 options: Since my only presenting symptom is occasional reflux (maybe once every month or two), and even completely unfilled I still have some restriction, I can ride it out and see what happens. This may well work, but I have concerns about dysmotility consequences... and while I'm maintaining my weight, and have since my daughter was born in 2008, I'm not losing. That's not a good thing. I can go in for repositioning or rebanding, which I know tends to have lower and lower success rates as more long term data becomes available. I've had a band for a while - long enough to develop a love/hate relationship with it, and I'm hesitant to sigh up for another procedure that may or may not work properly. I can submit for revision to another procedure. My surgeon recommended the vertical sleeve. I've always been hesittant to do anything that permanently removes part of my stomach because, if it doesn't work, what then? Guess I have some thinking to do, but figured I'd say hi to y'all. BTW, I was 380 lbs when banded. About 215 when I got preggers. About 280 at delivery, and about 265 today. That's with a goal weight of 180.

First - I'm not posting this to scare anyone, I promise! I'm curious about band complications specifically in banded mothers, and there's surprisingly little documented information out there. I'm curious to see what the trend here has been. I'm guessing this is one of the best concentrations of pregnant/formerly pregnant bandsters out there. I'm really curious to see if I'm coincidentally seeing a correlation between pregnancy and band complications, or if there's more to this that surgeons aren't yet educating us about (because they don't know about it). While pregnant I did quite a bit of reading stories here & on other support boards about what to expect. The number trends I saw for women who, during or after pregnancy, lose and are subsequently unable to re-obtain their "sweet spot"; and women who experience slipped bands during or within about 18 months after delivery; were dismally high. (I was finally diagnosed with a slip yesterday, and with 20/20 hindsight probably started seeing symptoms of it while pregnant - which escalated about 5 months after giving birth). If there isn't an option that covers your situation, please feel free to post specs. I'd really like to see how prevalent this is.

Hi stagegirl, with my 20/20 hindsight, the best piece of advice I can give you is to call your surgeon. I believe I know when my band slipped - roughly. Things had been going fine for a few years and then I had a fairly sudden change in the way things worked. Part of it was prolonged discomfort with stuck food. My previous "routine" had been to feel icky (and actually for me, stuck food was very painful) but bring it up within about 45 minutes, and once it was up I would have complete/immediate relief. One of the (then unrecognized) earliest (likely) indicators was that even after I brought food up, I no longer had the immediate relief I used to have. I would still hurt for a while, though it wouldn't be as bad. I would also feel nausea, and also had an incident where I could taste acid in what came up. That had NEVER happened before with my band. Also after food would come up (or when it would be stuck, but not need to come up yet) I would slowly develop an increasingly intense pain in my left side that would last sometimes 2 - 4 days. During that time, I could swallow saliva, but could not comfortably eat or drink, or burp, and would "gurgle" quite a bit. This didn't last very long, but when it sort of went away, there was another change. This is all pretty hard to describe, especially with any sense of coherence or chronology. See my message (#32) here: http://www.lapbandta...82#entry1583482 That may help. My points "A" and "B", and the last paragraph in that post, pretty much encompass what ended up being the physical symptoms of my slip, I just didn't see them as such at the time. I had been through a few pretty drastic changes in band routines, so at the time I was grouping those symptoms into "another change" because they weren't adding up to what I was expecting to experience with a slip, or what I had been to watch out for, or what most people seem to experience (e.g. the "gold standard" symptoms like slips... the reflux is, but since it was so intermittent (at the time, it definitely got more and more frequent, and more severe) I didn't really piece it together for a while). Hope this helps.