toribug1

I have a low BMI. I weigh 207 give or take. My doctor doesn't want me to lose too much beacuse I will go under the BMI. Like a lot of people I have lost weight before but then gained it back. Last year I lost 20lbs and was down to 186 and it felt so good. I even got to stop taking my blood pressure meds, and had energy to have fun, exercise and my self esteem was so high. I had surgery in fall 2007 and got a staph infection and had to go in for surgery again and then gained 25LBS!! This weight gain this time has taken a toll on my knees and I have little energy. I hate this 6 month diet and wish I had enough money to self-pay. When I am thinner I feel good, I exercise, get out and swim, etc. My insurance is bad too I have to pay HALF . I feel like I am doing okay at work, but I do have a hard time at home with the diet. I saw things on here about having to give up bread, what other things beside soda should I go ahead and give up and did anyone else have problems witht the diet. I am afraid of cutting everything out and exercising too much because of the low BMI. What do you all think, thanks and I have learned a lot on this.

Does anyone know where I can work part time that has insurance that covers lapband that I can get soon after hire? I have insurance but it is horrible. It only covers 50% or up to 5,000.00 lifetime after my deductible. I had breast reduction and it covered it all after my deductible. I think this is decrimation toward fat people, some lawyer should sue insurance companies. If they cover other surgerys 100% should be totally covered if it is nessary to improve your health.

Can anyone help me. I live in Louisville and I have to do The 6 months with a doc but my PCP doesnt think I need lapband. Does anyone know who I can see just for the six month diet??

I am just starting and I have Humana. I have to do 6 months seeing a Dr. every month, weigh in, etc. I can have any exercise program as long as the doctor has the records to go along with it. If you ask me a waste of my time, the Dr. time and money. My PCP won't consider lapband so any notes from her is out. I can call and get my records for the last 10yrs but I do not normally see her every month. I tried to do the pills with a doctor but they were making me sick and his staff was no help so I stopped going. From what I understand they want to know that you can lose some weight. BIG WASTE OF TIME...I have lost a lot of weight and then I gain it back again.If I was a success I wouldn't be doing this. I guess I won't get to be banded till at least March of 2009, seems like a long time of waiting.

I am going to St. Mary's next week to see about the whole process. I have to do my six months :thumbup:. A friend of mine said her mother went there and they were very helpful with all the 6 month appts and psch appt and just the entire process. I will be paying a lot of of pocket due to my insurance so maybe the six months is a good thing. Currently I have a 40 BMI and I cannot have lower than 35 for the surgery. Can anyone tell me about the six month process and what to expect. I am tired of being overweight and I am ready to take the step. I lost 25 pounds last year and gained over 35 back. I am 37 and want to enjoy life and time with my kids and just feel healthy again. I would do this tommorow if I could pay it all out of pocket. I just wish I had insurance like some of you guys do that pays it all, I would even go work somewhere part time just for the insurance if they covered it.

I am so sorry to hear this. It's not right but things never are in the insurance field. The only thing I can tell you is to keep copies of everything and names, dates, and times of the people at the hospital and ins co. you talk to. Depending on your ins co. you don't have to have a certain paper for an appeal. You just need all the facts and copies of everything!!! Copy and date them and even send them cert. mail so someone has to sign for it. Send that to them and it can take 30 days. And it really may not be the ins co, it could be that the hospital or Dr office failed to submit the doc's correctly. You need to know from the ins co what doc they are missing,if its a ICD code or did the hospital fail to pre auth, all these things can be done again with no problem. They just have to decide who made the mistake and correct it. Hospital billing offices are well aware of insurance related issues,you just keep them informed and let them know you are waiting on it. Since you were approved prior to surgery it is most likely paperwork that needs to be corrected. You have a one up since you have all the pre-approval doc's. DON'T LOSE THOSE, it's your word against them but if they pre-approved based on the hospital finishing some paperwork you need to know. Call the insurance company and talk directly to a claims mgr, don't take no, and don't talk to a sup, you want a mgr, sups can't do a lot. You want to know what the hospital failed to send in so YOU can get it corrected. Then you contact the hospital and same thing you talk to a mgr not billing, because it may be ICD codes that need corrected. These claims and pre-approvals go thru a lot of hands so anybody could have made the mistake but since the ins co approved it, they should eat it, if it should not have been approved. Hope this helps.

congrats, wish I had ins to cover it. Mine only pays up to 5,000.00 with a 2500.00 ded. I too am just starting my 6 months. Good luck to ya

I work for Humana and they only pay up to 5,000.00 lifetime max after the 2500.00 deductible. I live in Louisville and I am going to St.Mary's for the seminar. I am trying to find the best Dr.'s to go to and the cheapest. I have to do 6months before anything happens. Hopefully my husband will get insurance in the fall and it will cover it. Anybody else work for Humana and know an est for my out of pocket?

I work for Humana and we have a $5000.00 lifetime max after our deductible. I want the surgery but I have no idea how much it will cost me out of pocket. I think this is wrong and it should be changed. I had breast reduction and I only had to pay my deductible. I would think the Lapband would be better for my health in the long run. I am also having a problem with my PCP, she doesn't believe in it and I need her to write my history up, Good luck