Band_Groupie

This is from someone who hasn't been approved yet, so take this with that knowledge. The insurance person at my surgeon's office deals with the insurance co.'s every day. At my seminar she knew each person's insurance co. and gave us handouts on specific requirements. She knew which ones were easy to deal with and which ones aren't. If your gal works for the hospital, her job is to work to get you approved, if she's telling you she thinks you'll be denied, I'd take it as truth...I think she's just telling you like it is. Instead of asking why, maybe ask her what you would need to do to get approved...even if it takes a few more months/years...it's better than giving up completely.

Exactly...I love/hate my treadmill...TV and a remote make the time go fast, and a fan on you really helps (bought mine at costco with both of these built in, but less expensive models and these separate do the same thing). I'm not an outside walker as the weather is only perfect for this a few days of the year here, and the treadmill is much easier than pavement on your joints. I bought a few videos, but renting them at the library or online works great...it's nice to be able to change things up when you're bored. Tracking is my motivation too...the treadmill gives me time, calories, all that and I also enter it onto a website (using my fitness pal, but any will do). It's fun to graph your progress and can keep you accountable with others if you form friendships/fitness buddies online.

Great post...very inspirational. Good to know you kept going even with the leak/surgery...that says a lot for the help of the band. Thanks! -BG

You need to make a call to your ins. co. to ask your questions and to get a copy of your policy. I don't know if you need a weight history (some need 3 or 5 years), since I didn't, but I can share my experience with the 6 mo. diet. You need to be OVER the minimum 35 BMI, which you are. With every ins. co. that requires comorbids (some require one, some two) you need to have at least one of the 5 big comorbids: heart-obesity related, hypertension, high cholesterol, type II diabetes, or sleep apnea. For any of these 5 to count, you also have to show that you're being treated for them...ie. if you are on meds. for your high cholesterol then it will count (if you're not, I'd talk to your PCP about starting meds now), and if you only need one comorbid then you're golden. The rest of the minor things only 'help' your case, they won't get you approved....I have asthma, osteoarthritis with therapy for my lower back, etc., these won't get me approved though. As far as the 6 mo. diet, it usually has to be done with the PCP or your surgeon's office with a nutritionist. There need to be 6 CONSECUTIVE visits (I couldn't follow if you'd had 6 consecutive monthly visits?) and you can't miss a month or you need to start over (just saw someone denied for too many days between one visit). For most people this visit is not just a weigh in, it also has to include review of the exercise program/progress and education (exercise being left off the monthly form gets many denied, make sure the Dr. takes good notes on diet AND exercise and the Dr. need to code this as a weight loss visit-insurance will see the codes. In other words don't combine a sick visit with one of your monthly weigh ins...again, I saw someone denied for this, if you have to make two visits in one week if your sick then do that). This diet has to begin within 2 years of your SURGERY DATE...if it's beyond that it won't count. Now, that said, I've seen others have more lenient ins., and excepting peoples WWatchers log books...seems like CA mainly has more forgiving ins., or maybe that's just my perception. If you don't get definitive answers here, try the insurance Forum. Also call your co., as an insurance expert who was also a patient on one site told me...even if you find someone in the same state with your same insurance co. every company's policy can be different. Talk to your sugeon's ins. expert as well. Good luck! Oh, and welcome to LBT...lots of friendly helpful people here. Don't be afraid to post anything (I already asked all the 'dumb' questions and no one bit me!).

Hi Jenn! Just wanted to see how you are doing today...seen lot's of post where people are at their worst a few days 3-4 post-op (but usually not the day or two following). Hope all is going well...hang in there. -BG

Today’s the day. I’m sad, I’m gloomy, and I need some comfort food, which is why we ate homemade lentil soup for lunch. I know, soup can no longer be the comfort food of choice post-band…slider and all that, but it’s perfect on a cold, snowy, bummer day like today. DD just left with DH to take her back to college. It’s been a fun three weeks of coloring hair, going to the movies, renting chick flicks, lunch out- just the girls, shopping, and yes, cooking. Now it’s all over…back to my ‘Boys Club’ here at home. Waaah! The only thing that always makes this parting easier is that she’s a ‘packing b***h’ like the generations of women in my family. We’re a little OCD and like everything ‘just so’ when we’re packing. We’re not the type who could even fathom just ‘throwing a few things in a suitcase’ and hour before leaving for the airport. Therefore, we get very stressed out when packing to leave for anywhere and it brings out the absolute worst side of us. I remember from the time I was tiny my Mom fighting with my Dad every time we left for a vacation. My Dad would always be sitting in the car with all of us honking the horn while my Mom was vacuuming her way out of the house. She would finally come out, angry, red faced, and with the last few items she’d thought of for Dad to fit in the already overstuffed car. Like me, a few minutes into the trip she was fine…I could hear her loud sigh and I knew everything was good. My Mom has always had everything we could possibly need when we arrived (usually for a camping trip-one huge canvas tent with all seven of us in it) and I marveled even then how organized she was…I guess with 5 kids you had to be. She always had everything we needed. I got the ‘packing b***h” gene…in spades. Even worse, I also got the gene from my Dad that compels me to write everything down and pigeon hole things to the nth degree (a deadly combination). Yes, my Dad danced a jig as he saw the birth of the sticky note! He has to have a certain kind of calendar every year, because it fits the tiny sticky notes perfectly…I’m not quite that bad, unless you count the fact that I have labels for every row of food in my walk-in food pantry…OK, I’m that bad (the Doc ought to have a feild day with me at my Psych pre-op tomorrow huh?). I’ve had a packing list on my computer since our first vacation; I update it, print it out for every trip, and check each item off as I start packing weeks before a trip (thanks Dad). I am a total grump, OK ‘packing b***h’, the day before and day we’re leaving (especially if we’re leaving somewhere I want to be)…DH now knows just to steer clear of me, keep the kids out of the way, and ask me if I need help every once in a while. My house is never so clean as when I leave for a trip (thanks Mom)…what if you died and company had to come to your house…would you want them to see how messy you left it?...Mom’s words. Yes, I am my mother. Like my Mom, I’m fine once we’re on the road…I let out that sigh and I’m instantly on my trip/vacation/whatever. Even better, once we’re there I AM Mary Poppins as my extended family has dubbed me. Ask me for anything, I dare you to, I’ll have it. Once we were sitting at one of those Japanese steakhouse places at WDW. My nephew put his hand on the grill in front of us even though they’d warned us 100x that it was hot. My sister, who didn't get either of these genes, asked if I had anything as she was planning a frantic trip across the park to the first aid station. Did I have anything?!!! I had tissues to dry his eyes, antibiotic wipes to clean it, I had antibiotic lotion WITH the pain anesthetic, I had bandages of every size, I had pain reliever pills for Jr. kids even…after the ice, I hooked him up and we were good to go…Mary Poppins! (thanks Mom & Dad) DD has definitely got the ‘packing b***h’ gene…I went in her room this morning to chat and started helping her put the clean laundry on hangars…I wasn’t doing it right…then I wasn’t sorting them right…when I turned off her TV to pack it up all he!! broke loose. Eventually I was asked to leave the room so she could ‘just get packed on my own’. ‘Packing B***h!’ It’s OK, in fact it makes the parting easier for her…she’s leaving us, I get it, I’ve been there. As she was giving me a long hug goodbye she whispered in my ear ‘I’m sorry I yelled at you earlier Mom.’ and then with a kiss it came…the sigh…it was all good…she was ready to get back to her life at school.

Today’s the day. I’m sad, I’m gloomy, and I need some comfort food, which is why we ate homemade lentil soup for lunch. I know, soup can no longer be the comfort food of choice post-band…slider and all that, but it’s perfect on a cold, snowy, bummer day like today. DD just left with DH to take her back to college. It’s been a fun three weeks of coloring hair, going to the movies, renting chick flicks, lunch out- just the girls, shopping, and yes, cooking. Now it’s all over…back to my ‘Boys Club’ here at home. Waaah! The only thing that always makes this parting easier is that she’s a ‘packing b***h’ like the generations of women in my family. We’re a little OCD and like everything ‘just so’ when we’re packing. We’re not the type who could even fathom just ‘throwing a few things in a suitcase’ and hour before leaving for the airport. Therefore, we get very stressed out when packing to leave for anywhere and it brings out the absolute worst side of us. I remember from the time I was tiny my Mom fighting with my Dad every time we left for a vacation. My Dad would always be sitting in the car with all of us honking the horn while my Mom was vacuuming her way out of the house. She would finally come out, angry, red faced, and with the last few items she’d thought of for Dad to fit in the already overstuffed car. Like me, a few minutes into the trip she was fine…I could hear her loud sigh and I knew everything was good. My Mom has always had everything we could possibly need when we arrived (usually for a camping trip-one huge canvas tent with all seven of us in it) and I marveled even then how organized she was…I guess with 5 kids you had to be. She always had everything we needed. I got the ‘packing b***h” gene…in spades. Even worse, I also got the gene from my Dad that compels me to write everything down and pigeon hole things to the nth degree (a deadly combination). Yes, my Dad danced a jig as he saw the birth of the sticky note! He has to have a certain kind of calendar every year, because it fits the tiny sticky notes perfectly…I’m not quite that bad, unless you count the fact that I have labels for every row of food in my walk-in food pantry…OK, I’m that bad (the Doc ought to have a feild day with me at my Psych pre-op tomorrow huh?). I’ve had a packing list on my computer since our first vacation; I update it, print it out for every trip, and check each item off as I start packing weeks before a trip (thanks Dad). I am a total grump, OK ‘packing b***h’, the day before and day we’re leaving (especially if we’re leaving somewhere I want to be)…DH now knows just to steer clear of me, keep the kids out of the way, and ask me if I need help every once in a while. My house is never so clean as when I leave for a trip (thanks Mom)…what if you died and company had to come to your house…would you want them to see how messy you left it?...Mom’s words. Yes, I am my mother. Like my Mom, I’m fine once we’re on the road…I let out that sigh and I’m instantly on my trip/vacation/whatever. Even better, once we’re there I AM Mary Poppins as my extended family has dubbed me. Ask me for anything, I dare you to, I’ll have it. Once we were sitting at one of those Japanese steakhouse places at WDW. My nephew put his hand on the grill in front of us even though they’d warned us 100x that it was hot. My sister, who didn't get either of these genes, asked if I had anything as she was planning a frantic trip across the park to the first aid station. Did I have anything?!!! I had tissues to dry his eyes, antibiotic wipes to clean it, I had antibiotic lotion WITH the pain anesthetic, I had bandages of every size, I had pain reliever pills for Jr. kids even…after the ice, I hooked him up and we were good to go…Mary Poppins! (thanks Mom & Dad) DD has definitely got the ‘packing b***h’ gene…I went in her room this morning to chat and started helping her put the clean laundry on hangars…I wasn’t doing it right…then I wasn’t sorting them right…when I turned off her TV to pack it up all he!! broke loose. Eventually I was asked to leave the room so she could ‘just get packed on my own’. ‘Packing B***h!’ It’s OK, in fact it makes the parting easier for her…she’s leaving us, I get it, I’ve been there. As she was giving me a long hug goodbye she whispered in my ear ‘I’m sorry I yelled at you earlier Mom.’ and then with a kiss it came…the sigh…it was all good…she was ready to get back to her life at school.

Tonight I spent cooking. Yes, I said cooking. Stop laughing! I know you are tuned in by now to my dislike of cooking. I outed myself with my funny stories (HERE). And yes, like I’ve said, I CAN cook, I made a whole turkey dinner for Christmas with many side dishes and it was perfect. I just choose to not cook unless I have to. I think the only reason I love to bake is because the baked goods last longer than a day. I hate when you spend hours cooking a meal and then it’s gone…over and done with in mere minutes…sometimes to an appreciative audience, sometimes not. Maybe it’s the artist in me…when I create something, besides the enjoyment of the process, I’ll have to admit it’s the appreciation of all that hard work that makes it worthwhile, and in art that appreciation can last forever. Call me selfish, but I love a little appreciation. I want oooh’s and aaaah’s. There’s too little of that with cooking…lot’s of time, not much enjoyment of the process, little appreciation, non-lasting…that just doesn’t add up for me. So tonight when my daughter suddenly decided we had to cook something special for her last home cooked dinner before returning to college, I inwardly groaned. When she started looking up recipes online, the groans became a moan in my head…there was no way she’d pick something with ingredients I already have. That meant a trip to the grocery store, in the midst of a snow/sleet storm. We braved the slush and went out, returning to my ‘Boys Club + the boyfriend’ all enjoying football on the couch. DD had picked the recipes for her favorite meal at Olive Garden; Parmesan encrusted tilapia, steamed squash, and linguine with garlic butter. Yes, it could have been harder, ie. Lasagna, but since DH eats no seafood (his parents never had it at home, so he never developed a taste for it), we also had to make parmesan encrusted chicken breasts. Now get this, I actually had fun with the process! Yep, standing there being my daughter’s sous chef was actually fun. I poured the wine, tied the aprons, drank the wine, got the water boiling, drank the wine, chopped the squash, drank the wine, prepped the meats, drank the wine, poured more wine, and watched as she coated the meats. We had a good time, and a lovely meal. I love that my kids like to cook. Like, I’ve said before, my Mom hated us being in the kitchen. Who can blame her with five kids running around. As great a cook as Mom is, her 4 daughters and 1 son suck at it. Three of us hate cooking, my brother loves only grilling, and one sister is an OK cook, but only because she does cook all the time. Anyway, I’m not sure if my kids like to cook because I hate it so much they had to learn to fend some for themselves, or because I’m just a great mom and I let them dabble in the kitchen from a young age. I’m choosing to believe the latter. From the time they were little I always let them help with cooking, especially baking. I’ve ‘let them’ make their own lunches for school as they got old enough. Or maybe it was actually when they got embarressed by my lunches with those notes I always wrote on their napkins, and the puzzle cut PB&J sandwiches (like I’ve been saying, I have to be creative, no ‘cut in fourths’ sandwiches for MY kids). I did teach them, as has DH, all the basics of cooking. But I’m the one who passed on my love of fine dining and giving everything a try, at least once. I’m a foodie, or more accurately an eatie, because I love good food, but not the cooking part. Besides no seafood DH won’t eat anything on the bone (also passed down from his parents, I don’t get that one as they are a Dr. and a nurse so it can’t be gross to them, but maybe that makes it grosser to them…who knows?) and he also has some issues with textures of some foods. We also had to buy leather couches with no cording/piping because of that texture on his legs (try finding them, I dare you…about the 10th store I started calling him ‘the princess and the pea’), so I think he has lots of ‘texture issues’…it’s just weird. It’s fun as they get older, and my two oldest are becoming adults, to watch them do the things they enjoy. My kids love all kinds of food; they can all crack a crableg like nobody’s business. DS1 ordered the seafood platter in Normandy and I watched with interest and pride as he attacked about a dozen kinds of ‘critters’ including the usual crawfish, muscles, etc. and even a sea urchin. DS1 has also taken on my love of baking. I’ll randomly find him in the kitchen baking a cake or cookies to take to school to give out to all his friends (makes him a very popular friend). He would secretly love to go to culinary or pastry school, but after selecting engineering I consoled him with the fact that he can always take cooking classes for fun. In Paris I had set up his taking a pastry class at the Ritz Escoffier (better thought of than le Cordon Bleu to Parisians) for his 18th birthday…he had a personal translator and he loved every minute. DD loves to cook and proudly says she’s the best and healthiest food cook of any of the college girl she knows. DS1 is just starting out, but he’s gotten very good at eggs…he loves my mom’s sunny side up eggs and has gradually perfected her technique of the perfect temperature and slowly basting the yolk. He’s also working on my ‘Willie May’ scrambled eggs…she was the cook at my sorority house in college and I watched her closely every morning as I sat in the kitchen while she cooked her wonderful eggs; butter first, pour the hot butter into the eggs and mix in, more butter in the pan, then finally pouring the mixture into the frying pan to cook them up…what’s not to love with all that butter. I’ve promised next weekend to make my Mom’s famous egg casserole with him (sausage, bread crumbs, you get the picture). I hope their love of food doesn’t ever become a weight issue for them as it has for me (they’re all super thin). Hopefully, my getting thinner will be a good example of having a normal relationship with food, even good food. I think that’s why at this point, I don’t intend to be one of those who eats the rest of my life like I’m on a horrid diet. That doesn’t mean we won’t try to eat healthy, but I don’t intend to be one of those banders who’s eating mostly protein drinks three years later. I know that works for some, but I know that won’t work for me, it hasn’t in the past and I can’t live that way forever…and what kind of example is that for my kids…personally, I think that could cause them to have more food issues then seeing me fat. I’d rather eat way less of something good, then more of something awful. I want that normal relationship (albeit way smaller portions) with good, healthy food. I know with this banding process, it will be up to me to take the lead on healthier choices. I’ve already been collecting ‘bander’ recipes here and there. Like I said, it will be fun to watch what kind of cooks they become when they’re adults. Maybe I’ll be going to their homes for dinner…my Top (Healthy) Chefs.

Tonight I spent cooking. Yes, I said cooking. Stop laughing! I know you are tuned in by now to my dislike of cooking. I outed myself with my funny stories (HERE). And yes, like I’ve said, I CAN cook, I made a whole turkey dinner for Christmas with many side dishes and it was perfect. I just choose to not cook unless I have to. I think the only reason I love to bake is because the baked goods last longer than a day. I hate when you spend hours cooking a meal and then it’s gone…over and done with in mere minutes…sometimes to an appreciative audience, sometimes not. Maybe it’s the artist in me…when I create something, besides the enjoyment of the process, I’ll have to admit it’s the appreciation of all that hard work that makes it worthwhile, and in art that appreciation can last forever. Call me selfish, but I love a little appreciation. I want oooh’s and aaaah’s. There’s too little of that with cooking…lot’s of time, not much enjoyment of the process, little appreciation, non-lasting…that just doesn’t add up for me. So tonight when my daughter suddenly decided we had to cook something special for her last home cooked dinner before returning to college, I inwardly groaned. When she started looking up recipes online, the groans became a moan in my head…there was no way she’d pick something with ingredients I already have. That meant a trip to the grocery store, in the midst of a snow/sleet storm. We braved the slush and went out, returning to my ‘Boys Club + the boyfriend’ all enjoying football on the couch. DD had picked the recipes for her favorite meal at Olive Garden; Parmesan encrusted tilapia, steamed squash, and linguine with garlic butter. Yes, it could have been harder, ie. Lasagna, but since DH eats no seafood (his parents never had it at home, so he never developed a taste for it), we also had to make parmesan encrusted chicken breasts. Now get this, I actually had fun with the process! Yep, standing there being my daughter’s sous chef was actually fun. I poured the wine, tied the aprons, drank the wine, got the water boiling, drank the wine, chopped the squash, drank the wine, prepped the meats, drank the wine, poured more wine, and watched as she coated the meats. We had a good time, and a lovely meal. I love that my kids like to cook. Like, I’ve said before, my Mom hated us being in the kitchen. Who can blame her with five kids running around. As great a cook as Mom is, her 4 daughters and 1 son suck at it. Three of us hate cooking, my brother loves only grilling, and one sister is an OK cook, but only because she does cook all the time. Anyway, I’m not sure if my kids like to cook because I hate it so much they had to learn to fend some for themselves, or because I’m just a great mom and I let them dabble in the kitchen from a young age. I’m choosing to believe the latter. From the time they were little I always let them help with cooking, especially baking. I’ve ‘let them’ make their own lunches for school as they got old enough. Or maybe it was actually when they got embarressed by my lunches with those notes I always wrote on their napkins, and the puzzle cut PB&J sandwiches (like I’ve been saying, I have to be creative, no ‘cut in fourths’ sandwiches for MY kids). I did teach them, as has DH, all the basics of cooking. But I’m the one who passed on my love of fine dining and giving everything a try, at least once. I’m a foodie, or more accurately an eatie, because I love good food, but not the cooking part. Besides no seafood DH won’t eat anything on the bone (also passed down from his parents, I don’t get that one as they are a Dr. and a nurse so it can’t be gross to them, but maybe that makes it grosser to them…who knows?) and he also has some issues with textures of some foods. We also had to buy leather couches with no cording/piping because of that texture on his legs (try finding them, I dare you…about the 10th store I started calling him ‘the princess and the pea’), so I think he has lots of ‘texture issues’…it’s just weird. It’s fun as they get older, and my two oldest are becoming adults, to watch them do the things they enjoy. My kids love all kinds of food; they can all crack a crableg like nobody’s business. DS1 ordered the seafood platter in Normandy and I watched with interest and pride as he attacked about a dozen kinds of ‘critters’ including the usual crawfish, muscles, etc. and even a sea urchin. DS1 has also taken on my love of baking. I’ll randomly find him in the kitchen baking a cake or cookies to take to school to give out to all his friends (makes him a very popular friend). He would secretly love to go to culinary or pastry school, but after selecting engineering I consoled him with the fact that he can always take cooking classes for fun. In Paris I had set up his taking a pastry class at the Ritz Escoffier (better thought of than le Cordon Bleu to Parisians) for his 18th birthday…he had a personal translator and he loved every minute. DD loves to cook and proudly says she’s the best and healthiest food cook of any of the college girl she knows. DS1 is just starting out, but he’s gotten very good at eggs…he loves my mom’s sunny side up eggs and has gradually perfected her technique of the perfect temperature and slowly basting the yolk. He’s also working on my ‘Willie May’ scrambled eggs…she was the cook at my sorority house in college and I watched her closely every morning as I sat in the kitchen while she cooked her wonderful eggs; butter first, pour the hot butter into the eggs and mix in, more butter in the pan, then finally pouring the mixture into the frying pan to cook them up…what’s not to love with all that butter. I’ve promised next weekend to make my Mom’s famous egg casserole with him (sausage, bread crumbs, you get the picture). I hope their love of food doesn’t ever become a weight issue for them as it has for me (they’re all super thin). Hopefully, my getting thinner will be a good example of having a normal relationship with food, even good food. I think that’s why at this point, I don’t intend to be one of those who eats the rest of my life like I’m on a horrid diet. That doesn’t mean we won’t try to eat healthy, but I don’t intend to be one of those banders who’s eating mostly protein drinks three years later. I know that works for some, but I know that won’t work for me, it hasn’t in the past and I can’t live that way forever…and what kind of example is that for my kids…personally, I think that could cause them to have more food issues then seeing me fat. I’d rather eat way less of something good, then more of something awful. I want that normal relationship (albeit way smaller portions) with good, healthy food. I know with this banding process, it will be up to me to take the lead on healthier choices. I’ve already been collecting ‘bander’ recipes here and there. Like I said, it will be fun to watch what kind of cooks they become when they’re adults. Maybe I’ll be going to their homes for dinner…my Top (Healthy) Chefs.

Sounds like you're doing great JA!

Great blog! I've been saying the same thing...I think we have a distorted view of ourselves. Just 8 years ago I had dieted down (again) to 160 for my sister's wedding. I felt exactly the same way then as I do about my body and now I'm 86 pounds heavier. How in Gds name could I possibly look the same? I know it's not true, but even looking at photos I feel the same. It was helpful for me to read your blog and see that you're changing your self-image. I hope that happens for me as well. I want health most, but a better self-image would be a bonus! -BG

Oh, and always write down Date, Time, and Name of the insurance rep. and what they told you. You may need it later if there's a problem.

I don't know if this will be any help, but I called my insurance yesterday so I can tell you what mine is (as someone else said, call yours again and if you're getting confusing answers ask to speak to the reps. supervisor). I have Highmark PPO Blue (BCBS). I have no co-pay, my deductable is $250 per individual and $500 per family. All my Dr. visits go toward this deductable (PCP, Psych, NUT, surgery, etc.), so my first few visits each year, no matter who they are with I get huge bills until I've reached that $250. After that I pay 10% of everything (again no matter who I'm visiting, up to my max which is $1000 per individual and $2000 per family (the $250 deductable IS included in my $1000 max). After I reach $1000, I'm covered 100% up until 2 mil. So the bottom line for me is I'll reach my $250 deductable with other Dr. visits long before my surgery. Let's say I only reach that and haven't done any 10% visits...so now I've got $750 left toward my max. My surgery will be way more than $7,500, so I know that paying my 10% I'll definitely reach the $1000 max. Perscriptions-Keep in mind the prescription part of my insurance policy is totally different, so you'll have to plan this into your costs as well (even if all you need is pain killers to go home with). Copay- In the past I've had plans like Aetna with a co-pay and in those plans the co-pay would also go to my deductable/max. Out of network- on the plan I'm on now, if I go out-of-network ALL the rules change, my deductable, my percentage, my max, everything...I would end up with most of the costs. I've read people have gotten pre-approval to go out-of network from their insurance co. (usually because there is not a doc in their area), but be really careful with this if you try it and make sure you have pre-approval for both the Surgeon AND the hospital bills as these are totally seperate (I've seen people have pre-approval for the surgeon and then get stuck with the huge hospital bills). Again, write down what you think you know and call your insurance co. again. If you can supply them with estimated bills (ie. "My surgeon will charge $$$ and the hospital billing person told me to estimate $$$$") then the insurance rep. should be able to tell you exactly what your costs will be. I hate insurance...good luck!

Today I called my insurance company for the first time in order to confirm/ask for clarification on my benefits. I spent some time gathering information and preparing for this call here, and on other sites. Let’s just say I wish the insurance people were half as prepared. I really only had a few questions; 1) I wanted to confirm my policy hadn’t changed this year. 2) When exactly can I apply for approval, so what exactly is 6 months/diet (is it a certain no. of days? Is it 6 weigh-ins or 7? I’ve heard all these answers on the web.). 3) What will my costs be- deductable, percentages, maximums? And how are fills covered? 4) Do I need to remain above the minimum 35 BMI until approval? Is it too much to ask for some clarification? In a world such as insurance where everything is supposed to be black and white, why is there so much gray? I play fair (OK, except the bulk up)…I get that they need minimum BMI’s and can’t just arbitrarily approve people…I won’t whine about the rules. I’m a girl; I don’t mind reading the directions, but, for example, what the heck is up with just listing examples of some comorbidities, etc., dot, dot, dot. Why not just list the specific list of ones that will gain you approval so you know if you should apply or not? Why do I have to decipher after many hours on the internet that only 5 of the obesity related comorbidities really count at all toward approval? If there are specific rules why the @%&* aren’t the rules to this ‘game’ spelled out clearly? It’s like trying to play a game that your kids made up and the rules just keep changing. I was sweet as pie on the phone…we weren’t making any headway until I told the rep. that I had a copy of last year’s policy…OK, there we go #1 down…no changes. Then came the 6 mo. question and I explained it further. She put me on hold as she asked her supervisor. When she came back she told me it all depended on whether I’m outpatient or inpatient as different departments handle these. OK, I’m in, so WHAT DOES 6 MO. MEAN? I know you’re all screaming at me, better safe then sorry, just do the extra mo., but this is a major difference in BG-land. My kids are both graduating the next mo. so that will be dicey with ceremonies, company and parties. We skipped to costs and they were what I expected ($1000 max), but she had no idea what a fill even was. At that point she transferred me to the pre-authorization department. The rep. that answered was immediately p.o.’d when she found out I wasn’t a Drs. office and all she would tell me was my Dr. would fax the papers to them for approval…she couldn’t answer anything else. Frustration. I took a deep breath (sigh) and decided not to sweat it as I have my surgeon’s consult next Tuesday. I’ll be meeting with the insurance expert from the surgeon’s office as well as the surgeon. She seemed to be very aware of my insurance co., so I’m hoping she has my answers. OK, here’s my real rant…My last job being in business process improvement, this part burns me…I’m not mad at the rules, I’m mad that if there are rules, no one gave all of them to me and this is plain stupid. How can this not lead to more costs for insurance? I get that by being vague they might be able to deny a few more people at the end, but weigh that against all those who wouldn’t have ever embarked upon this process if they knew they didn’t meet the qualifications…how much money is lost on them? How many people go through months of PCP visits, pre-op visits with psych, NUT, etc. (how much does that cost?) only to get denied for something the insurance co. should have spelled out to begin with. As difficult as diets have been for me in the past, it doesn’t begin to compare to this insurance maze. I just don’t get the game, or even more, why there’s even a game to begin with…and I’m just starting.

Today I called my insurance company for the first time in order to confirm/ask for clarification on my benefits. I spent some time gathering information and preparing for this call here, and on other sites. Let’s just say I wish the insurance people were half as prepared. I really only had a few questions; 1) I wanted to confirm my policy hadn’t changed this year. 2) When exactly can I apply for approval, so what exactly is 6 months/diet (is it a certain no. of days? Is it 6 weigh-ins or 7? I’ve heard all these answers on the web.). 3) What will my costs be- deductable, percentages, maximums? And how are fills covered? 4) Do I need to remain above the minimum 35 BMI until approval? Is it too much to ask for some clarification? In a world such as insurance where everything is supposed to be black and white, why is there so much gray? I play fair (OK, except the bulk up)…I get that they need minimum BMI’s and can’t just arbitrarily approve people…I won’t whine about the rules. I’m a girl; I don’t mind reading the directions, but, for example, what the heck is up with just listing examples of some comorbidities, etc., dot, dot, dot. Why not just list the specific list of ones that will gain you approval so you know if you should apply or not? Why do I have to decipher after many hours on the internet that only 5 of the obesity related comorbidities really count at all toward approval? If there are specific rules why the @%&* aren’t the rules to this ‘game’ spelled out clearly? It’s like trying to play a game that your kids made up and the rules just keep changing. I was sweet as pie on the phone…we weren’t making any headway until I told the rep. that I had a copy of last year’s policy…OK, there we go #1 down…no changes. Then came the 6 mo. question and I explained it further. She put me on hold as she asked her supervisor. When she came back she told me it all depended on whether I’m outpatient or inpatient as different departments handle these. OK, I’m in, so WHAT DOES 6 MO. MEAN? I know you’re all screaming at me, better safe then sorry, just do the extra mo., but this is a major difference in BG-land. My kids are both graduating the next mo. so that will be dicey with ceremonies, company and parties. We skipped to costs and they were what I expected ($1000 max), but she had no idea what a fill even was. At that point she transferred me to the pre-authorization department. The rep. that answered was immediately p.o.’d when she found out I wasn’t a Drs. office and all she would tell me was my Dr. would fax the papers to them for approval…she couldn’t answer anything else. Frustration. I took a deep breath (sigh) and decided not to sweat it as I have my surgeon’s consult next Tuesday. I’ll be meeting with the insurance expert from the surgeon’s office as well as the surgeon. She seemed to be very aware of my insurance co., so I’m hoping she has my answers. OK, here’s my real rant…My last job being in business process improvement, this part burns me…I’m not mad at the rules, I’m mad that if there are rules, no one gave all of them to me and this is plain stupid. How can this not lead to more costs for insurance? I get that by being vague they might be able to deny a few more people at the end, but weigh that against all those who wouldn’t have ever embarked upon this process if they knew they didn’t meet the qualifications…how much money is lost on them? How many people go through months of PCP visits, pre-op visits with psych, NUT, etc. (how much does that cost?) only to get denied for something the insurance co. should have spelled out to begin with. As difficult as diets have been for me in the past, it doesn’t begin to compare to this insurance maze. I just don’t get the game, or even more, why there’s even a game to begin with…and I’m just starting.

Have fun at WDW! Your eyes will be glowing soon (LOL)!

I need to start doing a food tracking journal. I'd also like to have the ability to track exercise. I don't intend to do this the rest of my life, but when I do want to, I'd like to be able to track as much as possible; fiber, fat, water, etc. I want to use one of the free online sites and I'm wondering which one is best and why? I've heard FitDay and MyDailyPlate mentioned here. Anyone compare the sites available before you selected one to use? Thanks!

January seems to be the time for all kinds of cutbacks…cutbacks of the calorie kind and now, in this economy, corporate cutbacks. Like many of you, we’ve also been hit by that fear. DH knew that the company he works for wouldn’t be immune and changes were coming soon. He’s in a key position so we’re hopeful, but we also know to plan. We talked through all the possible implications for us and yes, I worried silently, and perhaps selfishly (yes, this is the new selfish me, I’m finally ready to put me first this year, and yes, that’s still guilt you hear), that we won’t have the same great insurance when it comes time for my surgery this Spring. All my plans may be for naught. I’ve been trying to keep the stress levels at home at a minimum, but with 3 teens, that’s sometimes easier said than done. DH's company announced yesterday that MAJOR cutbacks are planned and we’re talking MAJOR, not many details, but the amount of $$$ that will be coming out of this is huge…fear is reality. He’s been talking about what a grim atmosphere it is at work. I can relate to what he’s experiencing. I made it through a period of major layoffs about 15 years ago while working for a Fortune 500…at company headquarters where employees families had all worked there for many generations going way back…layoffs for people like that was more than grim, they felt betrayed; like their family was turning them out…it was painful. I also know that change is inevitable and life brings tests for us sometimes and ‘what doesn’t kill us only makes us stronger’. You see, DH was laid off once before, shortly after we were married. I worked two full time jobs for over a year while he looked for work and worked part time. It was hard, but we made it through. DH reinvented himself in the world of business, as did I (from teacher), and he worked hard to get his MBA over 8 years at night. Like I said, tests can make you stronger…so no matter what is to come, we’ll make it through. Now DH is obviously thin as are my kids, so relating to my level of desperation that has led me to WLS is hard for him to truly understand. He’s seen me lose the weight and gain it back, more times than I can count…he’s seen my struggle. I’ve shared with him as much as I can about my journey and I know he understands how important this is to me, but other than coming to meetings, he’s had a hard time knowing how to support me in this. Well, he came home tonight and told me of the latest updates at work…we should know what will happen with jobs in February...He had gathered all the information on the severance package (just in case) and we talked through all the details…but do you know what came next? All I can say is support comes in all kinds of packages..and I love my DH. He had also looked into what would happen with our insurance…he announced that no matter what happens we’ll still have our same insurance when it’s time for my surgery…my new-oh-so-selfish side was so happy!

January seems to be the time for all kinds of cutbacks…cutbacks of the calorie kind and now, in this economy, corporate cutbacks. Like many of you, we’ve also been hit by that fear. DH knew that the company he works for wouldn’t be immune and changes were coming soon. He’s in a key position so we’re hopeful, but we also know to plan. We talked through all the possible implications for us and yes, I worried silently, and perhaps selfishly (yes, this is the new selfish me, I’m finally ready to put me first this year, and yes, that’s still guilt you hear), that we won’t have the same great insurance when it comes time for my surgery this Spring. All my plans may be for naught. I’ve been trying to keep the stress levels at home at a minimum, but with 3 teens, that’s sometimes easier said than done. DH's company announced yesterday that MAJOR cutbacks are planned and we’re talking MAJOR, not many details, but the amount of $$$ that will be coming out of this is huge…fear is reality. He’s been talking about what a grim atmosphere it is at work. I can relate to what he’s experiencing. I made it through a period of major layoffs about 15 years ago while working for a Fortune 500…at company headquarters where employees families had all worked there for many generations going way back…layoffs for people like that was more than grim, they felt betrayed; like their family was turning them out…it was painful. I also know that change is inevitable and life brings tests for us sometimes and ‘what doesn’t kill us only makes us stronger’. You see, DH was laid off once before, shortly after we were married. I worked two full time jobs for over a year while he looked for work and worked part time. It was hard, but we made it through. DH reinvented himself in the world of business, as did I (from teacher), and he worked hard to get his MBA over 8 years at night. Like I said, tests can make you stronger…so no matter what is to come, we’ll make it through. Now DH is obviously thin as are my kids, so relating to my level of desperation that has led me to WLS is hard for him to truly understand. He’s seen me lose the weight and gain it back, more times than I can count…he’s seen my struggle. I’ve shared with him as much as I can about my journey and I know he understands how important this is to me, but other than coming to meetings, he’s had a hard time knowing how to support me in this. Well, he came home tonight and told me of the latest updates at work…we should know what will happen with jobs in February...He had gathered all the information on the severance package (just in case) and we talked through all the details…but do you know what came next? All I can say is support comes in all kinds of packages..and I love my DH. He had also looked into what would happen with our insurance…he announced that no matter what happens we’ll still have our same insurance when it’s time for my surgery…my new-oh-so-selfish side was so happy!

Read HERE for my gain tatics.

Hi! Just a suggestion...you'll get an answer if you post this question under the "Forum" tab at the top and then in the subcategory "Doctors & Hospitals" or even "USA" then "California". Not many folks here read all the blogs as they're for journaling not usually for asking specific questions...good luck.

Don't give up on yourself, not ever. You're way too young to be talking that way. Find out what you don't know... Will the insurance cover the surgery at different hospital...it sounds like there are others that are cheaper? Will they cover this in Mexico? Do they have better coverage on other WLS, like RnY? Are there hospital 'studies' you could get into? If you've exausted everything else on WLS then get help with the coverage you have...have the Dr's. checked your thyroid? Can they at least put you on a supervised exercise and diet plan? If you really believe what you said above then that's exactly what you'll get. I know this seems like Mt. Everest right now, and I have no idea how I'll react if I get denied, but don't you ever give up on you. Love yourself enough to get healthy again.

As per my PCP's request I've started my food and exercise log today. I do see the benefit in this short term. In the past keeping logs has helped me with accountablity and you also learn a lot along the way. I plan to keep this up until I'm on the other side of the band and feel comfortable with what I'm allowed to eat. My goal is not to have to do this long term though. As I've said before I find tracking every calorie, for me, becomes just trading one kind of food obsession for another. There's no way for me to not feel like I'm on a diet and being deprived some how while I'm doing this time consuming task of measuring every bite, writing it down, and entering it in. My food goal is to be on a new lifestyle change NOT ANOTHER DIET, to eat mainly what my family is eating with a few tweaks, minus the bad carbs and sweets, and obviously a whole lot less. I'm hoping that with my previous experiences with calorie counting that the learning curve post band will be easier (I'm talking just calorie counting and categories of foods not all those other things I'll need to learn). I know I'll need to go back to tracking anytime I'm not getting the results I want...it's always helpful then. So today I signed up for My Fitness Pal; nice site very easy to navigate and people answered my questions within minutes (thanks V-Queen from LBT). It was even easy to add extra things (beyond the default) I want to track like fiber, sugar and some additional body measurements. OK, stop right there. Sure, I know I'm a 'scale whore', yep even when I'm fat I look, but who the heck tracks their measurements as they're gaining weight? NOT ME! I think I was in college fitness class the last time I took my measurements...and I was pencil thin and teaching aerobics classes at the time...Let me just say standing there in my underwear with the measuring tape trying to figure out where to measure my waist was a humbling experience. I'm not one who carries the majority of my weight out front (now the rear is another story), but there is no longer a waist...Do you measure right under the boob line where I'm smallest, the belly button line, just above where I still have a little indent of what little remains of my waist on the sides? In the spirit of getting this over with as soon as possible I picked the largest spot and moved on. I'm pretty sure my current thigh measurement is about the same as my waist measurment in college...great. My new computer cord came and it doesn't work...so no access to my computer still. I've been waiting for this to load my new pedometer software. Oh well. Tomorrow I'll look at the exercise tracker on Fitness Pal. Wonder what I'll have to measure for that one? Stride? Yes, I can handle that.

As per my PCP's request I've started my food and exercise log today. I do see the benefit in this short term. In the past keeping logs has helped me with accountablity and you also learn a lot along the way. I plan to keep this up until I'm on the other side of the band and feel comfortable with what I'm allowed to eat. My goal is not to have to do this long term though. As I've said before I find tracking every calorie, for me, becomes just trading one kind of food obsession for another. There's no way for me to not feel like I'm on a diet and being deprived some how while I'm doing this time consuming task of measuring every bite, writing it down, and entering it in. My food goal is to be on a new lifestyle change NOT ANOTHER DIET, to eat mainly what my family is eating with a few tweaks, minus the bad carbs and sweets, and obviously a whole lot less. I'm hoping that with my previous experiences with calorie counting that the learning curve post band will be easier (I'm talking just calorie counting and categories of foods not all those other things I'll need to learn). I know I'll need to go back to tracking anytime I'm not getting the results I want...it's always helpful then. So today I signed up for My Fitness Pal; nice site very easy to navigate and people answered my questions within minutes (thanks V-Queen from LBT). It was even easy to add extra things (beyond the default) I want to track like fiber, sugar and some additional body measurements. OK, stop right there. Sure, I know I'm a 'scale whore', yep even when I'm fat I look, but who the heck tracks their measurements as they're gaining weight? NOT ME! I think I was in college fitness class the last time I took my measurements...and I was pencil thin and teaching aerobics classes at the time...Let me just say standing there in my underwear with the measuring tape trying to figure out where to measure my waist was a humbling experience. I'm not one who carries the majority of my weight out front (now the rear is another story), but there is no longer a waist...Do you measure right under the boob line where I'm smallest, the belly button line, just above where I still have a little indent of what little remains of my waist on the sides? In the spirit of getting this over with as soon as possible I picked the largest spot and moved on. I'm pretty sure my current thigh measurement is about the same as my waist measurment in college...great. My new computer cord came and it doesn't work...so no access to my computer still. I've been waiting for this to load my new pedometer software. Oh well. Tomorrow I'll look at the exercise tracker on Fitness Pal. Wonder what I'll have to measure for that one? Stride? Yes, I can handle that.

Read my SECOND start of the diet/weigh in Here. You can laugh at my methods of bulking up...I did (I was 1 POUND short the first time!!!!).