April410

Congrats to those who have their surgery dates for 2009!! After initial denial, my insurance gave their approval. It's been about 3 months since I saw the doctor and nutritionist so I made appointments to see them both again the first week of December.......so I hope I can be on the January surgery schedule.....if not, February. So glad to have my motivation back! (after the initial denial by insurance I went off the deep end and ate like a starving refugee!).......now back to healthy eating and feeling inspired once again. Good luck to all!:smile2:

Good morning all you wonderful people! I too have not checked the boards for the past few days.....work has been busy!.....but wow! so many things happening here..... First - to all who responded to my post about having doubts about the decision for LapBand.....Thank you all for your wonderful encouragement and wise advice! I am "back on the wagon" and eating healthy....doing the high protein and low carb diet to get the 5% weight off before I see the doctor again (Dec 9).....Making the solid commitment to myself (and you all) to stay positive and to continue to eat healthy. I hope to be able to get on to the doc's January schedule.....or at the latest February. Also made an appointment to see the nutritionist on Dec 2. Gypsy - thank you for sharing your story. Thank God that you and hubby survived that boating accident. I am sure it really has given you a whole new persepective on and appreciation for life. Every day is a gift. Every day we wake up is a new opportunity to live the life we were meant to live. Thanks for you most inspiring post. Orea - so sorry to hear about hubby's layoff. I hope he lines something else up soon! I'm not sure if it's the older people or the younger people who should worry about their jobs. Low man on the totem pole might be the one to go first......BUT......the higher up person (older one) also makes more money and can be replaced with two younger ones.....Scary times. My husband and I are lucky in that we have secure jobs....and I feel so sad for those who are not so fortunate. Katy - prayers to you that your recovery goes well. Sorry to say, but I think your Mum is a bit selfish......you need to take care of YOU, not her. Have a great day all.......:smile2:

good luck Poodles and all the other December bandsters! dseig - as for having "the last supper".....yep, I think it is definitely an emotional response to knowing that soon you will have to go without all your favorite foods. I learned in one of my support group meetings that some of us go through the "Kubler-Ross" stages of grief......about food! We actually grieve the loss of our favorite treats....and we go through the stages of denial, anger, grief etc.....and finally acceptance of how things have to be. Since I got my insurance approval I've been a little out of control food wise too....but with the help of some wonderful folks on these boards and my support group....and the support of a good husband.....I am pulling myself together. As one of you mentioned earlier, it is important to shrink the liver a bit before surgery, so we cannot eat mindlessly and hope for a good outcome. The time to start taking care of ourselves is NOW....today.......and quit playing games with our health.

hi everyone.....I just wanted to say thanks to all of you for your responses! I think as one you said, that I was just at a very low point when I wrote my post and of course when one is feeling that way, the negative posts will "speak" to you more strongly than the positive ones......so I think I was just letting all the wrong thoughts into my head. Believe me when I tell you that I WANT the LapBand....very much so. I guess what I was trying to say is that I am scared.........not of the surgery, but of failure. I think so many of us have been down the "diet" trail way too many times and have failed over and over again.....I guess I could not help thinking that I would fail again too..........I've done several diets but most recently Weight Watchers. In the past few years I lost 30lbs and gained it back. Lost 50lbs and gained it back. Lost 54lbs and gained it back.........you get the picture. I know only too well that the real work is done in the head and the LapBand is just a tool. So I guess I was just projecting (negatively) that I would indeed lose the weight again then go back to old habits and gain it back. Reading your responses really touched my heart. To read about wanting to ride horses or sit on the floor to play with a grandchild really reminds me it is about the simple things in life that others take for granted. Being able to take a walk or climb stairs or even ties your shoelaces without huffing and puffing is surely a bonus! I am 59.....will be 60 next spring. I have diabetes II, thyroid disease, high blood pressure, high cholesterol etc......and am really terrified of being in such bad shape that I have to rely on a walker etc......or falling and breaking my hip........or God forbid, getting Alzheimer's like my mother (and I know that things like cholesterol and diabetes etc can contribute to that). Thank you all again...........You have given me new inspiration and have helped me to stop making excuses and "git 'er done!" Tomorrow is a new day........I will begin my protein shakes for breakfast and lunch....a healthy dinner.....some salad and fruit. Hopefully in a few weeks I will be at the desired weight for surgery.....so I will be able to do this in January or February. One of you mentioned about crying before going to the OR.....I can well believe that it must have been with a huge sigh of relief that you finally felt like you had another chance to get to a healthy weight. I remember leaving my doctor's office (after my insurance turned me down the first time), clutching my medical records in my hands .....and sobbing and wretching when I got to my car! I felt so completely alone........and felt like no-one was going to help me. But then............I realized...........I am the only one who can help me. I hope to become a regular contributor here......one of the things I need is to feel connected to others who are going through the same thing. Thanks again to all.

I hope to be a January or February bandster.....I have my insurance approval (after being denied initially)....but as one of you mentioned before, my work schedule too will not make the surgery possible till after the New Year..... The problem I'm having now is trying to maintain my focus and get back the energy and determination I had last summer......With so much time to wait, I am playing "head games" ... and almost trying to talk myself out of it. But I think I've come too far to quit now...........so I hope to see all of you in 2009 - sharing your success stories! Good luck to all!

I've been reading many of your posts over the past month or so.....I've even posted a few comments myself, though not on any regular basis. I started the "journey" last summer - going to the seminar, getting all the tests done etc.....I felt so gung-ho and ready to have the surgery. I was scheduled for August 27th. I felt excited and nervous at the same time, but had such determination to make this change. Then my insurance company turned me down. I felt like all my energy just drained out of me.....I was devastated, angry, frustrated etc. Well what do "fat chicks" (to use Indigo's words) do when we are frustrated and angry? I ate. I ate so much that I regained the 5% that I was required to lose before surgery. In fact I've gained a few more! A few weeks ago my doctor's office called to say that they had won the appeal and my insurance company reversed their decision......I have approval! With my work schedule it will not be possible to get time off till January......so here I am .....kind of in limbo. I think knowing I have (had) two months to lose the weight again just made me lazy......I'm a procrastinator by nature...........so I have still not pulled myself together to get the weight off. I promise myself every day to start fresh. Sorry for the long post............but the problem I am having now is not knowing if I still want to do the LapBand. How can something I wanted so badly, now seem like something I really don't want anymore? I read about the challenges and struggles some of you are having post LapBand.......and your advice and suggestions to one another are wonderful .....and I am sure so helpful......but I can't help thinking to myself that if I will still have "head hunger" and cravings after the surgery, then why put myself through that? If I knew how to maintain portion control I wouldn't be in the spot I'm in. I really wonder if as some of you say, the LapBand does not help to prevent you from eating too much ..... then why do it? I have heard too many stories - both here and from friends I know - of people gaining the weight back...... Forgive me for sounding so negative......Please believe me that I am delighted for those of you who have had so much success with the LapBand.......I guess I am just really trying to reach out and have someone convince me that LapBand WILL help me...... One day I feel like "yes" I want to go ahead with this.....and the next day I say "who am I kidding?"......I will always want things like ice cream or cookies.....and again if I can use willpower to stay away from those things, then why not just go back to Weight Watchers?

Congratulations!! My insurance initially denied me but they finally gave approval after an appeal......I have too many work related things to take care of right now so I can't think about surgery till January......problem is trying to stick to healthy, low carb eating in the meanwhile. I guess I won't really get serious until I have a definite surgery date.......good luck to you!!

I have to agree with one of the previous posters who said that insurance companies are not in the business of helping us.....they are in the business of making money......(and not spending it!)..... I don't know anything about Kaiser.....but I am sure they are not the only insurance company who will initially deny a request for lapband or bypass surgery. A lot of companies prefer that you try to diet and lose weight naturally (of course MY insurance did not pay for the nutritionist!!!! Cost me $500).....It is also not uncommon to be turned down the first time around. I was. My doctor's office filed an appeal and I finally got approved last week...and hope to have surgery in late December or early January. I have also heard from friends that their PCP's or regular MD's are just not educated on the benefits and success of LapBand.....and they haul out the same old story.....diet, exercise etc........As if we haven't tried that 100 times already! (what kills me is these doctors are usually Doogie Housers who are like 12! .... and probably weigh 120lbs soaking wet. Those of us who have been around a few years and have tried all the diets and have had successes and failures along the way know that dieting alone is not enough. I know that LapBand is not a "magic bullet"......I still have to put effort into eating healthy and getting some exercise, but what I need is a tool to help me.....something that will "force" me to eat less....and hopefully allow me to feel less hungry all the time. By all means.....appeal! The more noise you make, the better chance you have of getting approval. With your weight/height I would say you definitely qualify! Good luck!

Hi all..... Like one of you mentioned before about finally getting insurance approval, I finally got the ok for surgery from insurance last week. I was originally scheduled for surgery in August, but insurance denied my request as my BMI was not high enough and they thought my co-morbidities (diabetes, thyroid disease etc) were not severe enough. They also said that the lapband surgery was not a proven, effective procedure. After going through all the pre-op tests and procedures and psych evaluation etc., I was totally crushed by their denial! Fortunately my doctor's office filed an appeal and sent all kinds of documentation on the success of lapband surgery.....and the insurance's decision was reversed! Yay! Of course, after being denied in early September, I went off the deep end and just started eating again, so I regained the 5% I was required to lose before surgery. I am in the process of losing that again....just about 8lbs to go. Now with my work schedule, I can't get the surgery until late December or early January. I figure I might as well wait till the holidays are over, not because of the food (since I have to keep the weight steady or my doctor will not let me have the surgery)...but because of the post-surgery stuff......I don't want to take the chance of possibly not feeling well, or whatever during the holidays. Anyway..........I have to get back to talk to the nutritionist and get my surgery date re-scheduled...... Good luck to all of the December bandsters!

oh....and as far as "experimental".....the LapBand procedure has a CPT code 43770 which means "laparoscopy, surgical, gastric restrictive procedure, placement of adjustable restrictive device".... When my insurance initially denied me, it was for two reasons: 1) BMI was not high enough and co-morbidities were not severe enough. 2) the procedure was "not proven effective" My doctor's office sent them all kinds of info on the LapBand and just how effective and successful it really is!!! Also, I said get as many doctor reports as you can to show how your weight has climbed....or gone up and down over the years....how many attempts you have made to lose weight, etc. If you have been to Weight Watchers etc....try to get dates, how much money you spent.....etc.... As I said, write a powerful letter........not angry, but firm.....and demand that they make your insurance pay for the procedure. I would even mention being left with no alternative but to go to Mexico - and perhaps putting your life in danger by going to an unknown doctor and hospital. Hopefully you will be able to appeal to their sense of right and wrong.

Hi....I am so sorry you have to go through this trauma! I don't know how tall you are, but 245lbs is not a healthy weight for the "average" woman. I am around the same weight, at 5' 8"..... I think just based on the fact that your TWIN sister died of a heart attack you should be allowed the chance to get yourself to a healthy weight. Shame on Cigna!!!!! (my son in law has that insurance and after he fell from a roof, breaking his elbow and shoulder he should have had months of therapy following surgery and those cheap s.o.b.'s only allowed him 16 therapy sessions....at 2 or 3 a week, he obviously only got a few weeks of therapy and to this day his arm is permanently bent)..... Anyway, I see you live in New York. Have you taken your appeal to the New York State Department of Insurance yet? I think you should sit down and write a very detailed letter of your weight, the problems it has caused you, the effect on your self esteem etc....and any comorbidities such as diabetes, high blood pressure etc. Get as many doctor reports as you can lay your hands on....everything from PCP, to Gyn, to endocrinologiest to heart specialist that you have seen. It just sounds to me like your insurance is just being cheap and not thinking of your welfare. When I spoke with my doctor's office (after I was turned down by my insurance) I asked them if it seemed better for the insurance to pay for surgery to cut my feet off once my diabetes got too out of control.......rather than pay for LapBand so that I can avoid further complications of type II diabetes???? I was so angry!!!!! Luckily my doctor and staff appealed the insurance decison and I am now approved for surgery.....hopefully for early January. (my work schedule is too busy to take time off right now)..... Keep fighting!!!! Remember the squeaky wheel gets the oil!

Good morning Annie, I don't have your insurance plan. I have United Healthcare (NY State plan) and Blue Cross for the hospital portion of my plan. However I waited over three weeks for an answer from my insurance and I can certainly relate to your feelings of anxiety while waiting. One day you feel sure they will say yes and the next day you are sure they will say no. My BMI was around 37......and I have type II diabetes, thyroid disease, high cholesterol and blood pressure (controlled with meds) etc. I went through all the tests and I guess the good news is that my heart is healthy and the only other thing they found was that I have GERD. I also gave them proof of 20 years of diet plans including Atkins, Weight Watchers, Nutri System etc. Even so, insurance turned me down. My surgery date was cancelled. (August) They said my BMI was not high enough and my co-morbidities were not severe enough. Needless to say I was devastated! I didn't post here for over a month because I just felt so defeated and I just couldn't read everyone else's success stories while I was sitting here with feeling like I was stuck being fat forever. My doctor's office appealed the decision and just a couple of days ago I got the approval. I tell you this just to let you know that insurance companies sometimes turn you down the first time around......but if you are willing to fight hard enough (or if you have an excellent doctor and staff to fight for you) then you WILL get approval. I do hope your plan says yes.........but keep the faith and keep fighting if they say no. Good luck!!

Hang in there JulieAnn.....glad to know someone feels the way I do. SeaSide....so glad this makes you smile, although there is nothing funny about this battle.

I don't know the answer but I think it's a fair guess to say that losing 70lbs has definitely affected your whole system, especially your metabolism. Not just the weight loss itself, but the fact that you are probably eating healthier foods and less carbs and junk food. I have Hashimoto's thyroiditis which is an auto-immune disease of the thyroid. Basically your body attacks the thyroid as if it was a foreign agent! The result is a low or non-functioning thyroid gland.....and the thyroid is what controls your metabolism. That explains why hypothyroid patients gain weight while hyper (over active) thryoid patients lose weight. I would definitely suggest discussing with your endocrinologist.....you may need a reduction of your Synthroid.... Congrats on the weight loss!!

So far the only ones I have told are my husband (of course), my daughter, one friend/co-worker who I know can keep her mouth shut and my boss (just in case I need some extra recovery time)... I think, at least speaking for myself, that it has been such a rough journey over the past 20 years of losing and gaining weight over and over again....I've had a few successes (lost 30lbs; lost 50lbs - twice!).....but I gain it back again twice as fast I lost it. I've done everything from Nutri System to Slim Fast to Atkins to Richard Simmons to South Beach to Diabetic Exchanges to Weighht Watchers...... I guess part of me is just terrified that I will make a big (fat) fool out of myself and fail again .... and I just can't stand the thought of people knowing it! LapBand and other gastric bypass procedures are such a last hope kind of thing.....and I just can't stand the thought of having to admit that to anyone. I guess I also don't want people saying I am taking the "easy" way......Anyone who has gone to the LapBand seminars, gone through all the psychological tests, hospital tests and procedures can tell you it is anything BUT easy! I know that I will be on a liquid diet and/or pureed food for 4-6 weeks.....what's easy about that? I know I won't be physically hungry so I am not worried about that.....I guess it's the "head hunger" that daunts me.....and I just hope I can get my head straight and apply all the knowledge of healthy portion size, nutrition, calorie, fat and carb counts etc.....to finally achieving successful weight loss AND a new way of eating for the rest of my life. Any diet will work, but the hunger just gets to you after awhile....so I am hoping the LapBand will be that one tool I can use to finally conquer the physical hunger.

Hello to a fellow Brit! Actually I was born in Scotland and emigrated to the States when I was 16.....so I am pretty Americanized! I am pre-surgery..... I hope to have the LapBand done in January. My insurance finally approved me for surgery just a few days ago, after having been turned down. They said my BMI was not high enough (at that time it was 36.7 I think).....I have had type II diabetes for over 5 years, Hypothyroid disease (had the thyroid gland surgically removed a few years ago), high blood pressure, high cholesterol etc etc etc.....but insurance didn't think any of those conditions was severe enough to qualify for LapBand.....oh how I long for the good old National Health System!!! LOL!!! Kidding! Anyway.....I have a fabulous doctor and staff who went forward with the appeals process and we got the insurance to reverse their decision. Now, I have to wait till January due to my work schedule. I had been hoping to have the surgery last August and had my vacation time all figured out to cover the time off.........but since they turned me down I simply used the time for an actual holiday. My work schedule is so busy for the next two months.....and it would be impossible to get time off before the end of the year. Well, at least it gives me time to lose 10-15lbs prior to the surgery.....and hopefully shrink the liver a bit. I've also invested in some exercise equipment, hypnosis CD's etc....so that I will hopefully begin to get myself fit. My problem is that I don't feel particularly motivated just yet.... I think it's because I know I have two months! :-) I am sure that if I was scheduled for surgery in, say two weeks, I would be working my behind off and starving myself to get those few pounds off! I guess it's that stupid kind of mentality that I have to get in as much as I can before "D" day......(*sigh*) I would love to correspond with you......and perhaps you can help to get me motivated to do this. I think that I had been so completely charged up and I was running on adrenaline while going through all the pre-testing etc.....and when the insurance company said "No" it was like hitting a brick wall! I was just crushed......and I gave up hope......and just stopped caring what I ate. So.........now the journey back to where I was mentally and emotionally in August begins.............

Congratulations Danlee.....I too have been lurking for a couple of months. I went through all the doctor visits, tests, bloodwork, nuclear stress test and etc....only to be turned down by insurance. I guess like some of you, my insurance is in two parts....one for doctors (major medical) and one for hospital.....both turned me down. One said I didn't meet the BMI requirement and my diabetes and other health conditions were not deemed severe enough. The other part of the insurance said that the LapBand procedure was not a proven, effective measure for obesity. I went into a tailspin....got so depressed and upset.....ate like a demon.....and just gave up hope. Well lo and behold, my insurance called last week to say they had reversed their decision based on my doctor's letter of appeal!!!!!!! I have been approved! I just hope that means BOTH parts of the insurance! It's all very well that they will pay the surgeon and anesthesiologist, but I want to be sure the hospital will get paid too. Anyway....I am a lot more optimistic than I was before! Now I just have to get head back to where I was.....motivated and determined to do this for my health and well being. Good luck to all who are still waiting!

CTerry.......I feel your pain! I just went through 2 months of doctors' appointments (some weeks I had 2 or 3), tests, psyche evaluation, diet to lose 5% etc.....only to be turned down by insurance. My BMI does not meet the 40 they require......BUT.....I was told that a BMI of 35+ with at least one co-morbidity would qualify me.....Well, they said no anyway! I have type II diabetes, thyroid disease, mild sleep apnea, mild neuropathy (from diabetes) GERD, Barretts Esophagus (pre-cancer), small hiatal hernia, high cholesterol and high blood pressure.......... I am also post menopausal. Insurance company seems to think my medical issues are not that severe. All of these health issues have contibuted to weight gain and they also contribute to an inability to maintain any weight loss. My endocrinologist basically said that it would take me TWICE as long to lose HALF as much as a "normal" person........ There is no justice in this world. I too just want a chance. I have spent the past week feeling depressed, angry, hopeless etc........but you can be sure that I WILL fight back! Unfortunately, I am a stress eater so of course the day the denial letter arrived, I went on a junk food frenzy..... Seems stupid to hurt myself because I am angry with them! Good luck to you. Let's keep on fighting for our rights.

Did the insurance say they would cover the LapBand if the doctor WAS in network? Or are they turning you down whether he is or not? I wish I could help you but I am fighting the depression of having been turned down by my insurance. I've spent the past two months going from doctor to doctor, having all the required tests, dieting to lose 5% etc.....only to be told my BMI is not high enough.....so the answer is no. I feel so upset about this........I was told by the bariatrics office staff that with a BMI of 36.8 (and not the 40 the insurance requires) that I would probably be a good candidate because I have type II diabetes, thyroid disease, GERD, Barretts Esophagus, elevated blood pressure and cholesterol and mild neuropathy (due to the diabetes)..........Wrong! Now I have to see if I can appeal their decision but right now I am feeling pretty discouraged. Good luck with yours.

Hello all, I hope you don't mind if this "old gal" joins in to this thread. So nice to find people of similar age and with so many things in common. I just joined a week ago and have enjoyed reading all the thread but just "found" this one today. I'm waiting to hear from insurance if I will be approved for LapBand....This waiting is horrible! I keep running all the scenarios through my head.....One minute thinking I will be turned down and the next feeling so sure I will be approved. Needless to say it doesn't do me much good as my usual source of comfort when stressed is food. Ugh! I am doing my best to maintain the 5% weight loss required by my surgeon before the procedure.....Surgery date is Aug 27th if the insurance ever gets around to reviewing my paperwork! Nice to "meet" everyone!

Hi Connie....First of all, my condolences on the loss of your husband. It certainly can't have been easy to go through such a loss and I'm sure that all you did was lose focus on YOU during that time. I haven't had my surgery yet, so I can't really give advice other than the same advice I would give to someone who is dieting and has lost her way......Just take things one day at a time. Forgive your slips/mistakes. Don't beat yourself up because you gained. I think the important thing is to remember to be kind to yourself and accept that you are human and have made some mistakes.....BUT.......try to remember all that you went through to have the surgery and to lose the weight (great job by the way!).....and just try to get back to that place where you felt strong and motivated. I wish you all the good luck in the world....I'm sure you can do this. "When God leads you to the edge of the cliff, trust Him fully and let go. Only one of two things will happen. Either He will catch you when you fall, or He will teach you to fly!"

Welcome Julie! I'm a newbie too....Just joined last week. It's so good to know that so many others are going through the same thing. All the doubts and anxiety as well as the happiness and contentment in knowing that we are doing something good for ourselves. I'm still waiting to hear from the insurance (and each day I get more nervous they will deny me!).....but I am tentatively scheduled for Aug. 27.....

Pumpkin.....I was given the EMMI link and pin number when I attended the LapBand seminar at my surgeon's office. I am not sure how else you would get that......but it's a very informative video/tutorial. Maybe you could ask your surgeon about it? Or go online to EMMI .... there might be a way to see the tutorial on LapBand......not sure

Wonderful! Glad to hear that all went well. Give yourself some TLC for the next few days and take it easy. Keep us posted on your progress.

Hi Pumpkin86, Did your doctor's office give you the info on EMMI so that you can go online and learn all about LapBand, pre and post surgery? You can give your Mom your PIN number and she can view the EMMI video herself and will get a better understanding of what you will be doing. Good luck with surgery and it's great that Mom will be there for you!