ANKPTA

Hey guys, I was banded in 2008...never any problems with vomiting or reflux. Also, never lost past the first month after surgery. Began having sternal pain radiating down in to both left and right rib areas in 2012. Surgeon decided it was my gallbladder so out it went. During the gallbladder surgery the surgeon checked the band and cleaned up some scar tissue. Did well with no pain until Nov 2016. I had the lovely gastro virus and vomited 5x and since then have been having the same sternal and rib pain again. I had also had acute reflux and difficulty swallowing my meds in the morning and they felt like they were just sitting there all day. Went to my surgeon and he unfilled the band. Checked under fleuro with everything looking ok with the exception of a slight "backing up" of the barium before it continued on through the band. He told me to take Pepcid complete and return back in a month. He also doesn't perform the sleeve but I spoke with him about going elsewhere for a revision. Fast forward and he sent an inquiry to insurance to have the band removed due to my issues for a later revision to the sleeve. In the meantime I had a consult with a new surgeon who performs all of the procedures and he wants the band out as soon as possible to allow healing before the revision and thinks I will do well with it. Well, right after I had the consult I received a denial letter from Anthem (from my original surgeons inquiry) stating that it was not medically necessary and there was no evidence that the band was the cause of the issues and basically that I suck because I only lost 35lbs with the band and have since gained it back. A week later I get another denial from Anthem from my new surgeons request for approval. This letter was slightly more positive but still a denial stating basically they need more info to prove the band needs to come out. Insurance lady, the bariatric nurse and the Dr plan to have a meeting to discuss where to go next with me and will let me know soon what's up. So here I sit in limbo not knowing if this will happen or if I have to keep this ticking time bomb in me causing me pain all of the time until something life threatening happens to it. Does anyone have any advice on where to go next? I did start taking Prilosec and plan to document the pain daily but what else can I do or suggest be done through the Dr? Sent from my iPhone using the BariatricPal App

Here are 2 of my favorites, the first is a little over your calories, but it does have 18g Protein. ATKINS ADVANTAGE chocolate Peanut Butter BAR: 18g Protein 1g Sugar 240 Calories Only 2g Net Carbs ATKINS ADVANTAGE PEANUT FUDGE GRANOLA BAR: 16g Protein 1g Sugar 200 Calories Only 2g Net Carbs

Debbie, have you checked to see how much it would be to see your surgeon w/out insurance? They may be able to discount you some since your new insurance won't cover...or they may at least let you pay payments? Sounds to me like you really need to get in there to see him. Keep us updated. That has always been a fear of mine that our insurance would change and not pay for further visits. I know the agency I work for will usually prorate and write off some of the cost for people who don't have insurance. Would be worth a try.

I am glad I am not the only one. I am still at around 40 pounds lost since surgery. I had my last fill 6 months ago and had to beg for it...I was so irritated with my Dr. I shouldn't have to do that when I was still not losing and still hungry. Anyway, he said he would see me in 6mths...which landed me at this past Friday. I was dreading it because I had lost a whole pound in that 6 mths. When I went in he said, "huh, you seem to be at a standstill...lets do an adjustment" no questions asked. I was wondering what the heck got into him lol. I had prepared myself for the fact that I wouldnt get a fill because I hadnt lost anything. Of course you would think it should be the other way around if you arent losing you should get a fill! Anyway, I was so tickled this morning I got on the scale and have lost 4 pounds since last week. Yippee, so nice to finally see the scale move again. I had scrambled egg this morning (1 egg). I was berely able to get the whole thing down...which is huge for me! Last week I was able to eat 2 eggs and 3 slices of turkey bacon!! So hopefully it continues...this time I am to see him in 2 months and he is going to do the fill under fleuro. Good luck guys, I am hoping that things are finally back on track. I was beginning to think that I had made the wrong decision or that I had horrible willpower after listening to everyones success.

I usually put cinnamon and a little honey in mine...really good!

You guys are so encouraging...I am planning on starting tomorrow with the pouch test. The last two days I have been trying to limit my carbs so that Mon and Tues may not be so bad. Yep, have the "carb withdrawl headache today" not fun!! I have an appoint with my surgeon on Tues hoping to get a fill, but no guarantee. I have had only 3 fills and had my surgery Sept of 08. I was kind of hoping to have some good restriction by now, kinda getting discouraged. So far I haven't had good restriction since the swelling went down from surgery. He almost didn't give me a fill last time and I only had 2.6cc (in a 10cc band) in the band at that time (3.5cc now). The last time I had a fill I had good restriction for about 2 weeks them not much again. He only schedules me every three months...I have been VERY hungry lately! Anyway, I am thinking that if he does give me a fill then I am on a good start (since I have 48 hours of liquids after anyway) and if I don't get the fill maybe I can start re-training myself. I am open for any advice you guys have!

Nikki, if you have Bob Evans near you...they have alot of mushy friendly items on their menu.

sonipez, I have two insurances mine & hubby's...I had asked the receptionist at the weight loss center (when I started) if she needed both insurance cards (because we knew that mine doesn't cover the surgery at all) and she said no. Well the business office at the hospital said that since mine is primary we needed to submit to them first and get a refusal (even though we already knew that it doesn't cover) and then submit to my husbands. That didn't happen because they didn't take the info from mine to begin with (their fault because I asked if they needed it.) Anyway, the lady at the business office said that they were going to try and submit it all again...sending my insurance through first. I actually got an email the other day that my insurance paid $6000 of it...haven't heard anything else. I am taking no news as good news...

Hey guys, just updating on what I found out from the hospital business office. When I first went to the weight loss center I asked the secretary if they needed my insurance card (from my employer/promary insurance) and she said no since they know it doesn't cover the surgery. The business office is now saying that since we didn't get pre-certed from through my insurance since it is my primary (even though we know that it doesn't cover it) that my husbands insurance may refuse to pay for it even though I was approved and pre-certed through hubby's insurance. She told me for right now not to worry about it (yea right) and that they would keep me updated. To me though that is their fault for not taking all my information in the first place especially since I asked if they needed it. So I may end up having to pay $21,000, don't know how...it just makes me mad cause the whole thing could have been avoided in the first place. Oh well, hopefully it will all work out...thanks for the suggestion Teri I think I just needed some other people to sound off to.

Hey guys, has anyone had trouble (or heard of someone that had) with their insurance not wanting to cover your surgery after you have had it done? I got a call from the Hospital today on my answering machine that they were having trouble with my insurance company and to call them. I also received a letter a month or so ago from the insurance company saying that I am responsible for $21,000 and that they are responsible for $0. If anyone has had (or heard of it) this problem how was it resolved? I am just geting really nervous tonight cause I don't have that kind of miney and really don't want to have to finance that much. If I would have known ahead of time that there would be a possibility that I would have to pay out of pocket I probably would have waited to have it done and saved up for it. Please pray for me that this will all be figured out. Thanks for any info.

Has anyone had trouble with their insurance not wanting to cover your surgery after you have had it done? I got a call from the Hospital today on my answering machine that they were having trouble with my insurance company and to call them. I also received a letter a month or so ago from the insurance company saying that I am responsible for $21,000 and that they are responsible for $0. If anyone has has this problem how was it resolved? Thanks for any info.