Band_Groupie

Wow...didn't think THAT would be my title today! This morning I had in mind..."1st day of the Diet" or something else really benign (my insurance requires a 6 month PCP supervised diet/exercise history). OK on with the story. I spent the weekend wildly researching and typing up stuff in anticipation of my PCP appointment today. I put together a form for the Dr. to easily fill in each time. I also put together my family history...wow, was that an eye opener! I woke up nervous...let me back up... I'd been to the PCP last month for my physical follow up. I had just lost 25 lbs. on another low fat diet/fat absorbing pills, so my weight was down some, but I was still Obese (I wanted to make the best case I could to my PCP). My PCP came in and we talked, she supported my looking into the LAP-BAND®® and gave me names of surgeons and I picked up the diet plan to review. Then I went to seminars at two hospitals that are 'Centers of Excellence' for bariatric surgery in town (with my skinny DH) and found out what this was all about...I wasn't certain that I'd be approved by insurance...it's like an evil game. The seminars stated I needed to show I was a diet 'failure', so I quit the diet pills until my official start. I know, this all seems counter-intuitive since I'd just lost some weight, but it's not like I haven't just been a lot heavier, I'm an expert now an yo-yoing...I hate insurance and I'm just starting this (don't they know yo-yoers that are obese have even more health risks?). By the end of the month I was only up a few pounds more (less fast than I normally gain). So I'm back to where I began...I woke up nervous today...weighed myself...quite a few pounds over 35 BMI...but, what if their scale was way different than mine?!...No! I can't be too close to the 35 BMI when I start!!! OK, calm down, I know I've read some things online about this...ankle weights some suggest?...nope, my ethics won't let me go there, sorry...Next-eat a lot before you go...and drink a lot...OK, I can do that...bowls of cereal later I was ready to burst...Next-It's snowing for the first time...layers are good! OK, I need to time the water just right. I had incontinence surgery 3 yrs. ago (hysterectomy and the sling)...let's just say I was back to the Urologist last week and he told me "You're the first patient I've had where the procedure failed! You'll have to use the back door to leave here so my other patients can't see you, Ha Ha!" Lucky me!...I'm not laughing...because if I do...I'LL PEE! Now back to drinking water...water bottle in hand, I get in the car...the Drs. office is 1/2 hr. away...no problem. I'm dancing by the time I get there (the pee dance)! 15 min. wait...I get to the room with the Nurse and she pulls the digital scale to the middle of the open door "I need you on the scale" she yells from outside the room. What?!! Was the scale too close to the cabinet that my fat hips couldn't get on where it was...no?!!! Could we maybe close the door...no?!!! I glance wildly side to side to see who heard and if there was any patient coming down the hall who might be scarred by this site. Right, Left, no one...I can do this. I take off my coat and then she says it..."My you have a lot of layers on!"...."Yeah, it's cold outside." I manage to squeak out. On the scale I go...uh oh...my evil plan worked...too well! AHHH!!! I'm 5 pounds above where I thought I was...my scale at home is too light...I've gained weight (as usual, but are they going to be mad and not support me getting the LAP-BAND®®?)!!! Oh no!!! She flips through my charts. I try to distract her "I feel like I'm back at weigh in's at the group diet meetings-this is so embarressing!" (what did I just say?) Her head doesn't come up from the file...she notices! Are they're going to throw me out in the cold?? She asks me to sit for my Blood Pressure check (it's been high about a year now and they keep talking about putting me on meds.). "Are you nervous?" she asks. "No!" I SCREAM! "Why? Is something wrong?" I blurt! She looks frightened now..."No, your blood pressure is just really high 158/110!" Wild eyes staring into hers I say "Oh, maybe I'm more nervous about the surgery than I think?" She hustles out and closes the door. Oh no! What's going to happen? What's the doc going to say about my weight gain!!!! She's so nice..."Oh, so this will be your first supervised diet/exercise program visit?" she smiles...my heart is starting to calm...No!...she's flipping through the charts!!!...then it happens...I PEE MY PANTS...and once I start it's so hard to stop...SQUEEZE...How many gallons did I need to drink anyway?...SQUEEZE!!! I'd almost forgotten how badly I had to go in all the excitement...she's now talking and looking through my alarming family history...I vaguely remember her talking about hypertension...she's looking through my charts again...NO!...she mentions how long I've had High Blood Pressure...I feel her taking my blood pressure again...then pulling up my pant leg and checking my legs for swelling...NO Ankle weights here!!! (thank God for my ethics)...all I can think about is DO NOT PEE!...next thing I know she's standing at the door beconing me with papers...My mind races...what if I get up and there's a puddle on the table?...darn that evil paper they put on the tables...what to do?...with a smile she waves the form I brought at me...I smile and slowly get up...I turn...I can't believe it...and I say a silent prayer in heaven for the woman (you know it was) who invented the Super-Dooper-Almost-a-Diaper-Pad I'm wearing (which is know hanging heavily low in the crotch of my oh-so-dry pants!). She is walking me back to the reception desk and then presses another paper into my hand...what's this?...a perscription "for your hypertension"....I smile and thank her...(I found out later that this is a comorbidity...I deserve this!!!) I check out..."Where's the ladies room?" I ask.

Whoo Hoo Margaret! I'm so happy for you!!! You go girl!!!:thumbup: I still don't get the family history piece (although according to my Highmark BCBS plan you wouldn't need anything with a BMI of 40 but the 6 mo. diet). When I got the call from Magee that I probably wouldn't get approved I asked specifically if insurance ever considers family history and she said no. Both the seminars I went to didn't ask anything about family history on their initial forms (I think they do on the longer packet you fill out once you're accepted into their program). I just got back from my PCP initial visit and I had already typed up a list of the my family history comorbidities of obesity. My PCP was definitely concerned after she looked through it (it's one of the main reasons I started looking into this after my sister had her stroke). I'm going to include it with the rest of the paperwork for insurance, especially after hearing that family history helped you. My blood pressure was still high today (158/110) so when the Dr. came in I did ask her at what numbers does this become hypertension? After looking over my long history of high numbers and that most of my family is on meds for BP, she started me on the meds. I guess this is a good thing...for insurance at least (1 more comorbidity), and actually for my health. I weighed heavy- at a 37.7 BMI so I'm good for the diet now. Wish me luck...I go to the AGH Seminar on Thursday and I'm hoping I look like a good candidate now. I SO need this for my health!

Hello all! I've been lurking:peep: here a few months and decided to join. I feel like I have so much in common with many of you already. BTW-I'm married, 49, 3 kids, 1/2 hour North of Pittsburgh. Today, I'm in need of hope/suggestions! I've just started this process so I'm at the :confused:"Head spinning Off-Insurance maze-Where do I begin to scale this wall" :banghead:stage. I want to start out right on this forum, so I'll post my details and more questions under the insurance sect., but let me tell you in a nutshell why I need some encouragement. I've got a low BMI (between 36/37), huge family history of obesity related health issues, but I don't have a diagnosis of any of, what I'm learning are the "Big 4" comorbidities (although I'm wondering if I don't qualify as hypertensive- been running 140 something over 90-96). I've got many minor comorbidities. We have Highmark PPO Blue - need BMI 35+ with comorbidities, 6 mo. diet (and no, I can't afford to self-pay:piggy:= 2 college tuitions). After talking to my PCP (not real encouraging, but gave me Dr. names), I decided to attend 3 different hospitals intro. seminars to learn all I can (seems like most ppl. only attend 1, why?). I've been to 2 and the first one never even called me after and the second one called and said I probably wouldn't get approved. I see my PCP on Monday (wanted to start my 6 mo. diet then) and I attend the 3rd hospital's seminar next Thurs./13th. Someone throw me a lifeline that this might still happen for me. What else can I do to qualify? I feel like after giving up hope I finally found the answer to better health and now I'm not yet "sick enough yet" to get it. Do I wait to get diabetes, hypertension and have a stroke or heart attack like my parents/siblings? As my husband put it- I feel like I'm "Circling the Drain". I'm such an up-beat person but I'm getting discouraged. Please send hope!:thumbs_up:

Shira- Thanks! The Highmark site has been down for routine maintenance for hours now, but hopefully I'll get in before tomorrows appt. Got in, it's the same info. I've got, but I'll search a way to ask questions. Just curious...has Magee called you back since your seminar to let you know if you're accepted?

Sox- Glad to know someone in the same boat. I’m putting together a family health history to show my PCP….hope that will help show why I need this. I’m also going to ask about being put on medication for the hypertension…diet hasn’t changed anything and I know from talking to my siblings that I’m at the point they were when they were put on it anyway…so it’s not like I don’t need the meds- I figure it can’t hurt to ask. I’d rather be disappointed now than 6 months from now. Pat- I’ve been on some of the BCBS sites others have mentioned from other areas/states. It’s amazing how different they are and how specific some are (IL one was very clear)...my Highmark policy copy I got is so vague “40 or a BMI of 35 with comorbidities (e.g., hypertension, cardiovascular heart disease, dyslipidemia, diabetes mellitus type II, sleep apnea).” Does that mean I need 2 of just those or can I have several other ones? Who knows! And mine won’t accept WW or Jenny Craig…has to be “supervised an monitored by a physician working cooperation with dieticians and/or nutritionists”…so is just my PCP good enough? I tried to get on your HCBO.com site and our account numbers aren’t the same…must not include Highmark. I asked my husband and he said he’ll get me the online link for asking questions to Highmark…good suggestion and way to document the specifics they want. I’m bulking up water for tomorrow (geez) and I’ll let you all know what happens.

Shassy- I go to the AGH seminar this Thursday...I almost cancelled, both because I was discouraged that I'd not get approved but also because I was frustrated with the staff at Colella's office...I'd left 3 messages and sent an email (to Patty) all with NO response...hmmm. I'll give them another chance when I go this week, but I've read lots of negatives about his staff...I'll keep you posted. Christine- I'll try to my PCP to write hypertension in my file...she'd already talked to me about how to cut back on salt, diet, for the high BP last time. Maybe we could discuss my comorbidities each visit as well and note changes if this will help with insurance? THANKS!!!

Thanks MacM....Insurance . I don't get why in a business of numbers where everything is usually black and white that the insur. co. make this so "grey". I feel like it's a "game" and even if you think you're playing by their rules, you still might get denied (after playing 6 mo.) because you didn't know ALL the rules. Why can't they just spell things out ARRGH!... Vent over, sorry. Shira- I went to a Magee seminar (held in Cranberry) also (BTW Dr. Eid was great if you haven't picked a Dr. yet). They're the ones who told me I would probably not get approved.:party: Do you have Highmark also? Are you on medicine for any of your comorbidities? When you called insur. did they ask about your comorbidities or just the 35 BMI...you're making me hopeful again...thanks!

Thanks Ebonie! I'm starting to type up my form now. Did you handwrite the notes at your visit or did your PCP? Did you use a form or did the PCP just write things on their regular files/Dr. notes? Thanks!

First things first. I had no idea what a Blog was and now I'm writing mine...a "journal", I get it. My kids would be proud of this technological feat (maybe someday I'll figure out how to do those photos online-Avatar...isn't that a Cartoon?)...except at this point I've decided not to tell anyone about this "journey" except my skinny DH, whom I dearly love. Let's face it, if you've never fought obesity for more than a decade (OK, I'll give him the "college fatties" that he soon lost) you just don't get it. He's supportive in his own way (he just sat through two different information seminars with me), but I know him well... He married a 5'9" (I've lost an inch), 132# art teacher who also taught 8 aerobic exercise classes a week. He's watched me go up and down the scale drastically. It's hard, but I can lose major weight (up to 50)...My real problem is keeping it off. Heck, I was 80# lighter just 8 years ago when we moved here and I've been up and down 30 and then 45 pounds of that twice in the 8 years since. His reaction to Lap Band "It's so drastic. Can't you just do Atkins again and then we can get you a gym membership so you can keep it off?" (I wish). Now, I can hardly move around without hurting at almost 250#...I'm sure I LOOK lazy sitting in the recliner with the heating pad on my osteoarthritic back. Ahh...if only they knew how much more WORK it is to be fat...seriously, just think about it...how much time have I spent researching, doing, logging diets and exercise plans...how many minutes a day are spent just thinking about food/diets/self image/my obesity...I wish I could get all that time back to just Live Life! Will everyone I know be surprised if I lose a lot of weight...no, they've all seen me do it before...but they, and I, will be shocked if I can keep it off. That is my secret hope...I just want to feel healthy again...and getting back into those skinny jeans will just be a bonus!!!! I'll track my progress another time, but I'll tell you in my few months of researching this I've done a 180 on sharing this process, at least for now. I'm known as a "sharer", nothing is sacred...I had my hysterectomy and incontinence sling surgery...everyone knew (yeah, even the husbands in the neighborhood...I can't help that they were at the bus stop waiting for their kids while the Mom's were asking me about it...they couldn't have talked a little louder about "the game last night"?) and I shared whatever anyone wanted to know...if you've never been through incontinence "testing" you haven't lived (and the surgery failed, so I'm starting testing again...wee!...literally). I don't get embarressed by this stuff and I find a sense of support by sharing to whomever wants to know, but I've changed my mind for this process. After reading many others experiences both positive and negative with telling others about their Lap-Band, I've decided for once in my life to keep this under wraps. I think what's left of my self-esteem just can't handle any negativity about this. It's against my nature to not share this, and it's going to be harder on me, so I was glad to find an outlet here for sharing...even if no one ever reads anything. So HELLO "My Blog"! I'm not really keeping a secret if it's here for the world to read. This will be my place to vent, to plan, to track, and hopefully to celebrate, and maybe find some friendly support along the way! Thanks for listening Blog.

Hang in there...I'm just starting mine. Also, glad you've confirmed you don't have to lose anything...but you may want to be certain about gaining (not just a month but for the 6 mo. total). I just attended a seminar and they told us they had a person denied for gaining 1 pound (from beg. to end of the 6 mo. diet) and they said the person had lots of big comorbidities and was otherwise a perfect candidate for it.

Thanks all. Love2Scuba - Which hospital are you using? Does your BCBS plan actually say "2" comorbidities if you're 35-40 BMI? Mine doesn't say "2" but does use the word "comorbidities" plural, so I guess that's the same thing. I'll work on the PCP this week, but they're not real supportive since I'm at the edge. I hope my weight last visit being one pound below the 35 BMI doesn't bite me in the butt (yep, that was with water...had to ask to go to the bathroom while she went to look for Dr. names...incontinence...it's a terrible thing). I hope she'll let me start fresh...hoping my BMI will be almost 37...wish I could reschedule for the afternoon (good tip), but it's first thing Monday and they're closed all weekend. BCBS says you can use the PCP for the diet but they need to be working in conjunction with a dietician...does your say that, and how did you do that? My PCP just gave me the "American Fare" plan with sample meals. Do you need to see a dietician at the beginning (I know if the surgeons office accepts me I'll be seeing their dietician...but they all said that is just before you start the pre-op diet)? Thanks for the support!

First things first. I had no idea what a Blog was and now I'm writing mine...a "journal", I get it. My kids would be proud of this technological feat (maybe someday I'll figure out how to do those photos online-Avatar...isn't that a Cartoon?)...except at this point I've decided not to tell anyone about this "journey" except my skinny DH, whom I dearly love. Let's face it, if you've never fought obesity for more than a decade (OK, I'll give him the "college fatties" that he soon lost) you just don't get it. He's supportive in his own way (he just sat through two different information seminars with me), but I know him well... He married a 5'9" (I've lost an inch), 132# art teacher who also taught 8 aerobic exercise classes a week. He's watched me go up and down the scale drastically. It's hard, but I can lose major weight (up to 50)...My real problem is keeping it off. Heck, I was 80# lighter just 8 years ago when we moved here and I've been up and down 30 and then 45 pounds of that twice in the 8 years since. His reaction to Lap Band "It's so drastic. Can't you just do Atkins again and then we can get you a gym membership so you can keep it off?" (I wish). Now, I can hardly move around without hurting at almost 250#...I'm sure I LOOK lazy sitting in the recliner with the heating pad on my osteoarthritic back. Ahh...if only they knew how much more WORK it is to be fat...seriously, just think about it...how much time have I spent researching, doing, logging diets and exercise plans...how many minutes a day are spent just thinking about food/diets/self image/my obesity...I wish I could get all that time back to just Live Life! Will everyone I know be surprised if I lose a lot of weight...no, they've all seen me do it before...but they, and I, will be shocked if I can keep it off. That is my secret hope...I just want to feel healthy again...and getting back into those skinny jeans will just be a bonus!!!! I'll track my progress another time, but I'll tell you in my few months of researching this I've done a 180 on sharing this process, at least for now. I'm known as a "sharer", nothing is sacred...I had my hysterectomy and incontinence sling surgery...everyone knew (yeah, even the husbands in the neighborhood...I can't help that they were at the bus stop waiting for their kids while the Mom's were asking me about it...they couldn't have talked a little louder about "the game last night"?) and I shared whatever anyone wanted to know...if you've never been through incontinence "testing" you haven't lived (and the surgery failed, so I'm starting testing again...wee!...literally). I don't get embarressed by this stuff and I find a sense of support by sharing to whomever wants to know, but I've changed my mind for this process. After reading many others experiences both positive and negative with telling others about their Lap-Band, I've decided for once in my life to keep this under wraps. I think what's left of my self-esteem just can't handle any negativity about this. It's against my nature to not share this, and it's going to be harder on me, so I was glad to find an outlet here for sharing...even if no one ever reads anything. So HELLO "My Blog"! I'm not really keeping a secret if it's here for the world to read. This will be my place to vent, to plan, to track, and hopefully to celebrate, and maybe find some friendly support along the way! Thanks for listening Blog.

I'm a Newbie and just starting into this (I apologize now, if there is a list on this site, but I couldn't find it). My insurance is Highmark PPO Blue (BC/BS) of PA. I have a low BMI (36/37) so I'm learning that I need to document as many comorbidities as I have with my PCP -eg. my insurance needs 35-40 BMI "with comorbidities (eg., hypertension, cardiovascular heart disease, dyslipidemis, diabetes mellitus type II, sleep apnea" (note- comorbiditieS, plural). While at an initial information seminar at the hospital I was surprised to see Asthma (I developed adult onset Asthma a few years ago) on their list of minor comorbidities during the slide show as obesity related (still don't know why as I didn't get a chance to ask, but now I know to add this in my documentation). I thought I'd start a list of what everyone's Dr's. have considered worth documenting to insurance as a comorbidity, then I can discuss the ones I have with my Dr. These are the ones I've found so far (no I don't have all these). Please add others you know of...Thanks! COMORBIDITIES - I've read these are the Major 4 insurance is looking for: 1. Hypertension- High Blood Pressure (Anyone know the threshold numbers for this? Do you have to be on meds?) 2. Diabetes Mellitus Type II-metabolic disorder resulting from the body's inability to produce enough, or to properly use, insulin (Do you need to be on meds.?) 3. Sleep Apnea- Obstructive, Pickwickian syndrome (I've heard some ins. need certain numbers on this as well). 4. Cholesterol: Hypercholesterolemia-High Cholesterol (What are the threshold numbers?), Dyslipidemia- abnormal concentrations of lipids or lipoproteins (eg. high total chol. or high levels of triglycerides) - Others/sometimes called "Minor"?: 5. Metabolic Syndrome: Abdominal Obesity (high waist circumference), High Serum Triglycerides and High HDL Cholesterol, High blood glucose levels, High blood Pressure (combination of 3 of the 4 above) 6. Respiratory: Asthma and Respiratory Disease, or Exertional Dyspnea- Shortness of Breath with minor exertion 7. Cardiovascular: Heart Disease, Cardiomyopathy, Atherosclerotic cardiovascular disease, or Venous stasis disease - faulty veins that allow blood to collect in the lower legs (swelling), Venous Thromboembolic Disease 8. Pseudotumor cerebri - increased pressure in the brain which causes chronic headaches and eye problems (specific disorder mainly in obese women) 9. Liver Disease, Non-alcoholic steatohepatitis - fatty inflammation of the liver that is not caused by alcohol damage, 10. Gall Bladder disease 11. Gastroesophageal reflux disease- GERD- a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus, or acid reflux 12. Incontinence: Stress urinary incontinence- involuntary leakage of urine caused by increased abdominal pressure from excessive body fat 13. Spine: Degenerative disc (spine) disease- wearing down of discs in the spine 14. Joints: Osteoarthritis or Weight-related arthropathies (joint diseases) which impair physical activity, degeneration of cartilage and its underlying bone within a joint 15. Depression or Obesity-related psychosocial stress 16. Skin: Intertriginous soft tissue infections - infections in excess folds of skin that are caused by obesity, rashes, sores 17. Impaired Activities: Significant impairment in activities of daily living and work (list normal activities you can't do) 18. Gynecological problems (abnormal menses, infertility), Polycystic Ovary Syndrome 19. Cancer: Some are related to obesity eg. endometrial, breast and colon