JayinMA

Keep me posted on the pre op tests! I have mine on the 27th!

I start my pre-op diet this weekend, but mine consists mostly of carnation instant Breakfast, hopefully i like it. sorry yours isn't ideal, could you talk to your surgeon or nutritionist and see if there is an alternative? Or maybe gas-x strips might be able to combat some of the gas you experience

I do have those thoughts, and I go through my daily life just thinking "how am I going to do this after I have the band." Being at work and going to lunch was so easy, just get to the car, drive to some place with food and eat it. Soon it won't be so easy and I wonder if I'm up for that, or if it will be too hard. But then I stop and think about how being fat is too hard. Going to someone's house and wondering if the furniture will hold me, knowing I can't go on amusement park rides, hearing someone laugh behind me and always wondering "are they laughing at me" (I know they're probably not, but I always wonder)... that's hard. And it's not worth it. This will be hard, and it will be worth it. I think that's what makes the difference for me.

I just got back from the doctor's office and I was told my date would either be february 4th or the 11th. I honestly had no idea I'd be picking a date today! I went in for my weight check up (I had an Upper GI done earlier today too) and the doctor basically sat down said good job on the weight loss went over a few things and then nodded and said "Ok, go down the hall to my assistant and schedule a date" to which I said "What?" Guess I wasn't expecting that! I don't even have insurance approval yet! But I did as I was told and looks like I'll be getting it done in early february! I was honestly thinking march/april and this will sound dumb but actually picking out a date makes it seem so much more...real. It's quite... something, I'm not sure what it is, but it's something!

No one here can really answer that for you because it's a choice about you and your body and what you're capable of. Good luck in your decision making, it might just be the hardest part of the whole journey. No matter what avenue you choose, i wish you good luck in your weight loss.

I have mine on monday and I require 24 hours notice (and valium) if I have to take my clothes off. When you first met your surgeon did you have to?

Well since i'm a guy if they try to perform a vaginal exam on me I'm switching doctors!!

Thanks, that takes some of the nerves off! I hope a simple lift of the shirt will do.

Hi Green Eyed Lady I'm also in MA and I have my first consult with the doctor and nutritionist in mid november. I'm planning on having mine done at Brigham and Women's. Great to have you around!

Hi, i'm sorry, I should probably know this, but where do I start with all this? I have decided the Lap Band is the way I want to go about losing weight and I started my new job recently and my insurance just kicked in. I contacted member services about the procedure and this is what they wrote back to me: Thank you for your inquiry via the Harvard Pilgrim Health Care (HPHC) Secure Website regarding your coverage for bariatric surgeries such as the lap-band procedure. I would like to provide you with the following information. Bariatric surgeries are surgical procedures that are intended to assist morbidly obese patients in achieving medically significant long-term weight loss. Harvard Pilgrim covers bariatric surgeries that are Medically Necessary for morbidly obese members with documented history of failure to lose weight despite physician-supervised medical/dietary therapies. The following services are covered when specific medical necessity criteria are met. • Gastric Bypass (Roux-en-Y) • Gastric Stapling • Vertical Banded Gastroplasty (VBG) • Laparoscopic adjustable silicone gastric banding (Lap Band) • Laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) Comprehensive multi-disciplinary program including: • Pre-operative medical and behavioral health evaluation • Medically necessary surgery • Post-operative follow-up including nutritional and exercise counseling Prior authorization is required for all bariatric surgeries. Clinical information must be reviewed by HPHC before services are authorized. Your physician will need to contact HPHC to begin the authorization process and provide our Medical Management Unit with all of your clinical criteria so that it may be reviewed for Medical Necessity. If services are approved, per your schedule of benefits, member responsibility for Inpatient and Day Surgery services when performed at a facility recognized by Harvard Pilgrim as a Weight Loss Surgery Center of Excellence would be subject to a $300.00 copayment per admission when using a Participating Provider. Services must be performed at facility recognized by Harvard Pilgrim as a Weight Loss Surgery Center of Excellence in order to be covered. The following is a list of facilities recognized by HPHC as a Weight Loss Surgery Center of Excellence: Massachusetts • Baystate Medical Center • Berkshire Medical Center • Beth Israel Deaconess Medical Center (BIDMC) • Brigham and Women’s Hospital • Boston Medical Center • Caritas Norwood • Caritas St. Elizabeth’s Medical Center • Emerson Hospital • Faulkner Hospital • Lahey Clinic Medical Center • Lawrence Memorial Hospital • Lowell General Hospital • Massachusetts General Hospital • Mercy Hospital • Newton Wellesley Hospital • North Shore Medical Center – Salem Hospital • Southcoast Hospital Group – Tobey Hospital • Tufts – New England Medical Center • U Mass Medical Center • Winchester Hospital Maine • Eastern Maine Medical Center • Maine Medical Center Rhode Island • Roger Williams Medical Center New Hampshire • Portsmouth Regional Hospital Please note coverage for services is based on the patient’s eligibility and plan provisions in effect at the time services are rendered. Ok so that all sounds good, but now what? I don't have a primary care physician because I have a PPO instead of an HMO and I'm just confused as to what my next step is. Any help you can offer would be greatly appreciated.

Thank you so much for all your help! I have a BMI of 46 and I think i'm going to have a sleep apnea study done. I will look into getting a "usual" doctor and I think i'm going to sign up for an info session

Yes you are correct I don't have a doctor. I just recently got insurance after five years of being a "contract" employee which meant I didn't have to paid benefits and so I wasn't.

This is what I received as a response, I'm so new to insurance things however, that I'm not sure what it really means. Thank you for your inquiry via the Harvard Pilgrim Health Care (HPHC) Secure Website regarding your coverage for bariatric surgeries such as the lap-band procedure. I would like to provide you with the following information. Bariatric surgeries are surgical procedures that are intended to assist morbidly obese patients in achieving medically significant long-term weight loss. Harvard Pilgrim covers bariatric surgeries that are Medically Necessary for morbidly obese members with documented history of failure to lose weight despite physician-supervised medical/dietary therapies. The following services are covered when specific medical necessity criteria are met. • Gastric Bypass (Roux-en-Y) • Gastric Stapling • Vertical Banded Gastroplasty (VBG) • Laparoscopic adjustable silicone gastric banding (Lap Band) • Laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) Comprehensive multi-disciplinary program including: • Pre-operative medical and behavioral health evaluation • Medically necessary surgery • Post-operative follow-up including nutritional and exercise counseling Prior authorization is required for all bariatric surgeries. Clinical information must be reviewed by HPHC before services are authorized. Your physician will need to contact HPHC to begin the authorization process and provide our Medical Management Unit with all of your clinical criteria so that it may be reviewed for Medical Necessity. If services are approved, per your schedule of benefits, member responsibility for Inpatient and Day Surgery services when performed at a facility recognized by Harvard Pilgrim as a Weight Loss Surgery Center of Excellence would be subject to a $300.00 copayment per admission when using a Participating Provider. Services must be performed at facility recognized by Harvard Pilgrim as a Weight Loss Surgery Center of Excellence in order to be covered. The following is a list of facilities recognized by HPHC as a Weight Loss Surgery Center of Excellence: Massachusetts • Baystate Medical Center • Berkshire Medical Center • Beth Israel Deaconess Medical Center (BIDMC) • Brigham and Women’s Hospital • Boston Medical Center • Caritas Norwood • Caritas St. Elizabeth’s Medical Center • Emerson Hospital • Faulkner Hospital • Lahey Clinic Medical Center • Lawrence Memorial Hospital • Lowell General Hospital • Massachusetts General Hospital • Mercy Hospital • Newton Wellesley Hospital • North Shore Medical Center – Salem Hospital • Southcoast Hospital Group – Tobey Hospital • Tufts – New England Medical Center • U Mass Medical Center • Winchester Hospital Maine • Eastern Maine Medical Center • Maine Medical Center Rhode Island • Roger Williams Medical Center New Hampshire • Portsmouth Regional Hospital Please note coverage for services is based on the patient’s eligibility and plan provisions in effect at the time services are rendered.

Thanks, I was confused because the plan does offer a discount on weight watchers registration so it seemed contradictory but the e-mail has been sent and it was incredibly easy to find a list of weight loss surgery locations. So hopefully that'll be a good sign.

Thank you so much, I will send them an e-mail and ask if they cover it!

Congrats!!

That's awesome! Good luck and let us know how it goes! I hope Harvard Pilgrim covers it!

Can I ask what kind of insurance you have? If you're going through insurance that is. I have Harvard Pilgrim and I hope it goes pretty smoothly

Hi Mrs. Mitch. I'm a little south of boston and just starting my lap band process, I just got my new insurance card this weekend, so hopefully I can start the process asap! Good Luck!! and if you have any tips on doctors to go through in MA i'd be happy to hear them!

Hi everyone. My username gives away most of the information one would typically put here, but Hi, i'm Jay, age 25, and living in MA. I'm completely new to this whole thing and am taking the initial steps (right now i'm looking over insurance companies [any suggestions?] as I just started a new job) and hoping to be another success story!

Thanks for all your answers, everyone! I'm hoping insurance will cover it but it's nice to know that there are options just in case it doesn't.

Hi all, I'm new and recently got a new job, which means, new insurance. Two of the plans offered to me are in my price range, seem to have similar co-pays on almost everything and I was wondering if one was more helpful with the lapband process as far as approvals and any other things that may come up. I don't know if it makes a difference but they are both PPO's not HMO's. one is Tufts Navigator www.tuftshealthplan.com/gic and the other is harvard Pilgrim Independence Plan www.harvardpilgrim.org/gic anyone have any suggestions between these two plans or providers? Any info you could give me would be greatly appreciated! Thanks!

Self Pay? Would it be rude of me to ask what that ball park figure looks like if you do self pay? I'm sure it changes from hospital to hospital and surgeon to surgeon but it would be nice to know if the insurance thing doesn't work out I would like to have a plan B so i'm just not devastated.