FatButNotHappy

I recently found out my insurance Aetna, will pay for bariatric surgery. However, it isnt cheap. I have an $1100 deductible and they will pay 80%. My max out of pocket is a whopping $4000 (on my husbands plan, i believe it is $1500 max and that $4000 is for our whole family--so, YOUCH!) So, my questions are: Does that $1100 deductible count in the $4000? Also, would 20% of the surgery equal up to $4000? could it potentially be less than the $4000 max-out-of-pocket or should I just assume that I will be paying $4000 for this surgery? OR--would it really be $5100 if the deductible isnt inlcuded in the $4000? Thanks a lot. Stacie

I am an Occupational Therapy Assistant and sometimes I have to transfer patients and may do a lot of stuff bent over BUT, a lot of my time is spent just doing activities with patients while seated at a table. Varies day to day, really. So my question is, how long would I be expected to stay off work. I just started my job and wont have much time off. I was only planning on a few days...like surgery on wed, go back to work on monday. Is this feasible? I had my gall bladder taken out in may on wed and returned on monday and was fine. Are the recovery times similar? Any idea? Stacie

Oh, the $4000 IS the individual max. Can you believe that? Pretty crappy, huh? I work for a big, nationwide corporation in the HEALTH CARE business. I would think my insurance would be better, especially after reading on here how great other's coverage was. A year ago, I was willing to figure out a way to self-pay. I decided I would wait to see where I landed my first job to see if the insurance would cover it and YAY...it does.

OH, i am on my plan by myself. I didnt add the rest of the family to the plan because the only reason I got it at all was for this surgery. So, my individual cap is $4000. Boo. I tried to find the info on Aetnas web page, but i can find anything about co-pays for each visit (nutritionist et al) but would those appts go into the OOP or the deductible? I am sooo confused. I have already called the insurance company and i am still confused. Do the co-pays (for the dr visits) go to the deductible and do those go to the OOP? The insurance lady at the surgeons office was confused too because she said i had a $1100 deductible, then i had to pay the next $4000 and only THEN would they pay 80%. Boy was i depressed after she told me that. I am glad i called Aetna and figured out she was wrong. :cool: After the $4000 they pay 100%. Another question is....if you go to an OUT of Network doctor, is the max OOP still the same? I know they only pay 60/40 instead of 80/20....but if the max OOP is the same, then i would really like to see Dr. Curry (cincy ohio) who is not in my network.

Hi. I have had health insurance through my husband for years, but none of them ever covered WLS. Well, I just graduated from college and started my first "real" job (at 40) and I am able to get insurance at my new job that WILL cover WLS. It is Aetna, by the way...and from reading around on here it looks like they do actually approve people! (YAY!!) I have decided to take my job's insurance for the sole reason of using it for lapband (if approved.) It went into effect on 1/1/09. From what I can tell, I will have to do the six month diet thing as well as jump through other hoops. I am about 5'5" and weigh...gasp...235. I believe that makes my BMI just around 39 or 40. I do not have any other co-morbs unless you count joint pain, back pain, foot pain and depression -- although I do believe I am having some sleep apnea issues because I have been waking up gasping for air a few times over the last couple of months. ANYWAY, I need to know what I do first. Do I go to my doctor and have her start tracking my weight? Do I call the insurance company? Do I go to the surgeons informational meeting? What should be my very first step (after researching lapband because I have been doing that for months.) ALSO, if I do this diet--and I lose weight will they refuse to do the surgery? I am right at their "limit" now--so if I lose weight my BMI wont be high enough (in their opinion.) Thanks a lot. Stacie

Does anyone know how much these doctors charge for lapband surgery? They are at Miami Valley Hospital. Premiere Bariatrics, I believe. I am self pay and just trying to get a ballpark price. I have a call into the office, but have not heard back yet. Any opinion on these two guys??? Thanks a lot

I am wondering if most people are happy with the results after having Lap Band surgery. If you had it to again, would you? Do you wish you would have done Gastric Bypass instead (or the sleeve, balloon or whatever)? Do you wish you had saved the money and done no surgery? Was it worth the money? I was talking to my aunt about this and she pointed out that a 1-2 pound loss a week is what a person would lose on just a normal "diet." I tried to explain to her that the biggest difference is that I would not gain all of the weight back and I would not be starving to death while losing the weight. That is a "reasonable" response, isn't it? She thought Gastric Bypass sounded better because it was much faster of a loss. HOWEVER, my mom had it and almost died, so I will never go that route.

Since you have had your lap band surgery, are you obsessed with food and what you are eating OR does it all become routine and you dont even have to think about it anymore? I am worried that the band may start to control my life and every thing I do. I want eating to be something I control--not something that controls me....if that make sense. I want it to be something I dont even think about...just eat good food and the amount of it I NEED, and not think about it too much. (after I learn what works and what doesnt....kwim?) and.... Were you obsessed with food BEFORE the surgery? Was your next bite always on your mind? Or you LAST bite, for that matter? Beating yourself over what you just ate? Ok, thats all!!! Thanks a lot. Stacie

I had heard doctor curry did, but I wrote them earlier and they said they wont take on any patients that had their surgery done anywhere else. What is up with that?

Hi. My name is Stacie and I live in Ohio. I am almost 39. I have three daughters, one is 19 and the twins are 10. I was always a pretty chunky kid and slimmed down as a teen. Of course, I thought i was a cow. I remember gaining weight again in 1994 and I have been gaining ever since. It was 1994 that I bought a size 12 pair of pants...and I am now in an 18W. Ugh. About four years ago, I lost 40 pounds, but I have since gained 50 back. I weigh 35 pounds more now that I did when I had my twins in 1997. That is sooo sad. I am going to college to be an Occupational Therapy Assistant and I will start doing clinicals full-time in March and I will graduate in June. This is why I decided I need to get this weight thing under control. I have been doing 8 hour clinicals once a week and I am about to die. My back is killing me, my ankles are killing me and I am ready to cut my feet OFF. By the time I walk out to my car, I want to cry. How can I do that 40 hours a week? I was first introduced to Occupational Therapy after my mom almost died from having Gastric Bypass Surgery. (seriously) After she got out of her "almost" dead state, she went to a nursing home and that is where I saw OT for the first time. They had to re-teach her everything. I saw what a great job they did with her, and I knew that is what I had to do with my life. Get people better and healthy again. BUT, how can I do that when I can hardly walk because my joints hurt too bad? Obviously, I am NOT going the gastric bypass route. So, I am thinking the lap band may be the best direction for me. I am sure my insurance wont pay for it. They hardly cover anything. So, I am going to be a self pay...I have been doing NOTHING but research for a week and I don't know what to do. I am broke (full-time student) but, I do not want to end up with the problems like my mom has (brain damaged, and more.) Any suggestions? That is all for my introduction, I guess.

I have tried to do a search to find this but I am coming up short. Can someone tell me how much he charges for his fills if you have the surgery done somewhere else? Either Colorado (Dr. K) or Mexico? Does that make a difference as to how much he charges? Thank you very much!

Ok, if my insurance refuses to pay for the Lap Band....but WILL pay for gall bladder surgery (which I do need.) Can they both be done at the same time, and insurance pay for at least PART of it? When I was looking at the sites of the doctors in Mexico, they said they will do gall bladder removal for free if it needed to be done. So, I thought MAYBE this would be one way to have insurance at least cover a portion of it. That said, CAN bariatric surgeons remove gall bladders? Thanks again! Stacie

Can someone answer this? I am a comfort/emotional (over) eater. Is the band a good choice for me? I mean...I honestly did NOT get fat by "looking" at food. I really really LIKE food, and I like EATING it. I also like every thing that is bad for me. BUT, I also really love healthy food too but, it is easier to eat junk. Anyway, my question is this.... Will the desire/need to eat crap go away? My thinking was--if i over-eat or eat bad thing--I will throw it up...and who wants to do that? SO, I look at is as though I am conditioning my brain to tell me body to "stop eating crap!" Obviously I get that I have to have some control and I have to want this and I have to follow the rules....but, seriously....isnt that why I am where I am now? Because I don't follow the rules, I know hot fudge is bad for me but I still eat it? Does the desire to eat go away? Is it like "forced will power?" Is there anyone else out there that really LOVES to eat BAD food? How do you not eat it now??? Do you miss it? Thanks again.

Thanks for your input....it has made a lot of sense. I did south beach and LOVED it. I never felt better. I never felt hungry. I never craved any junk and really I didnt cheat (they say that once you do---it is hard to stop wanting it.) Well, on Labor Day I had a brownie. The next day ice cream...then a candy bar....then, forty pounds back to my butt! I could never start it up again....I couldnt get passed the two week detox. I was like an addict, for real. I never felt DEPRIVED while I was on SB--but, as soon as I slipped up, it was all over. I kept half of it off for a while, but I have officially gained it ALL back now--plus 10 pounds. It has been three years. Fifty pounds in three years? That is nuts. Oh, and while I was losing weight, I LOVED going to the gym...I became addicted to that instead of eating, I guess. Although, it could have been because I tanned while I was there and I was really addicted to the tan?????

Ok, so I just got done with my super-long introduction....and now I figure I will ask you all a few questions that I am sure has been asked a million times. If you are a self-pay patient: Did anyone self pay in Ohio? Or anywhere around Ohio..Indy, Mich, Ky, WV? I read about the guy in Colorado, but if you have to pay for fills...it maybe better to stick with a more local doc that doesn't charge an arm and a leg for them. He only charges $15 but it would be costly to go there very often. Dr. Curry's fills? I read on here he will do other surgeons fills-anyone know how much he charges? Does anyone give family discounts??? My aunt would like to do this too. How long does it take to get the ball rolling? Once I schedule my initial appointment, how long before I can actually get the surgery? I have two weeks off before I start my clinicals between the end of march and the first of April. Could I get it done in that time frame? Would two weeks off be enough time to recovery and get back into action? I guess that is is all. I am sure that I will think of more soon... Thank you very much.

You arent discouraging...that is why i was asking...to get truthful answers! thank you!

Yes, it needs to come out. I have had a few (what we think are) gallbladder attacks in the last year, and my family doc says it will probably need to come out if the pain continues. However, since my insurance is so bad, I have never had anything done about it.