Randi

JOJO, I actually decided I wanted WLS a couple of years ago, but only the gastric bypass was available to me through my insurance carrier. After attending the seminar, that surgery struck me as way too drastic an option for me. So, I decided that maybe I hadn't quite put forth enough sustained diet and exercise effort over the past 20 years -- yeah right. When I turned 40 I said to myself, "Self, if you're not well on your way to losing the weight in a year, you need to go ahead and have the WLS. It's time for this struggle to end." Bingo! I'm 41. Now, I'm keeping the promise I made to myself last year.

I can't pinpoint it to one particular thing . . . I know that every time I tried a new diet I hoped it would be the one that would help me lose and keep the weight off forever. That never happened. As the years have gone by, I've gained more and more weight and now suffer from high blood pressure, cholesterol, arthritis, joint pain, depression. I kept thinking what's next. When I turned 41 this year, I decided I didn't want to struggle with my weight any longer. But mentally, I couldn't get myself to try not one more diet. The thought of regaining the weight plus some extra equated to too much effort for the reverse payoff. I'm pursuing the band as a tool to help me keep the weight off because I too want to be a member of the "Gone for Good" club -- both weight and comorbidities.

Ditto on the Scarsdale.

So, the moral of the lapband story is . . . if you're overweight we won't cover you and if you're not, but you had surgery, we still won't cover you? If that's what we're up against, the road ahead could be very long for someone who has to change insurance policies after they're banded (i.e. change in job). From your post, it seems like it's being looked at as a pre-existing condition.

I will let you know what happens. I'm hoping to know this coming week whether I'm approved or whether I will have to submit an appeal letter. My surgeon did not submit to TRICARE for approval of the procedure. Instead, my PCM is using the information provided by my surgeon to go in for TRICARE preapproval. From what I understand, if the surgeon submits for the non-covered procedure, it would be denied. Now, there's nothing saying I won't be denied anyway, but at least my PCM is willing to fight for me and get passed the gatekeepers of the automatic "No" response.

Good for you, Carol. I know you gave her "food" for thought that day that she wasn't able to just will away. Perfect timing on the call to OR if I must say so myself.

Thanks for the laughs! I know I'll be back to this thread for ideas on bandster living. It appears there's a lot of bandster truths embedded in the humor. Although I'm not a bandster just yet, I have a couple more to add: If you're moving through your closet clothes sizes in reverse, you might be a bandster. If you refuse to donate any of the clothing that's been hanging up in your closet for years to Goodwill or Salvation Army until you're absolutely sure you can't fit it or don't want it, you might be a bandster.

Maybe the choice was just between VG versus non-VG band?

1. Call 1-877-lap-band. The agent may be able to assist you with finding financing. 2. Research ways to raise your FICO score, then reapply for financing at a later date (3 to 6 months). A good start might be the Suze Orman website: www.suzeorman.com. Also, here's an additional link to the FAQs on FICO: https://www.myfico.com/Suze/CreditKit/Faq.aspx#8 3. If you have a 401k, you might be able to use a portion of it to pay for your band. Check out this thread discussion on using the 401K option: http://www.lapbandtalk.com/showthread.php?t=17754&highlight=401k

It seems way too easy to take the moral high ground, especially when you're already banded or you meet the BMI or weight requirements for the band. I think it better not to judge until you walk a mile in the other person's shoes and go through THEIR daily struggles with obesity. Comorbidities or not, it's a personal choice how one chooses to go about getting the band. For those who can afford it, that may mean a trip to Europe where banding is done as a means of prevention. However, I will not judge those who can't and must rely on the grace and, sometimes, arbitrary rules of their insurance carriers, but feel strongly about getting their health and their lives back on track.

amberakamom, I'm covered by Tricare Prime. I learned yesterday that the Tricare contract is scheduled to be updated in January 2007. I expect at that time the Adjustable Gastric Band will be listed as a covered procedure for those who meet the established criteria. Until that time, TRICARE only covers the procedure on a case-by-case basis and your PCM is the key for TRICARE approval.

I currently work as a Database Analyst on a government contract in San Antonio, but my company is based in Herndon, Virginia.

DadrillSsgtsWife, I'm in the process of trying to get TRICARE Prime to pay for the band. Keep in touch. I'll let you know how it goes. So far, I know of one person who has the band through Tricare, but she also has Medicare (not sure whether it's A or :cool:. Her name is DivaMom and she was scheduled for banding yesterday.

amberakamom, That's some great information!

Tired Old Man, Finally, a happy ending to an age old story.

Hunnybun, Who is your insurance carrier and in which city and state are you located? Go out to www.yahoo.com and in the search box input the words bariatric your city your state (e.g., bariatric san antonio texas). This should get you started on finding any other bariatric surgeons in your area. Also, have you checked with your insurance company to find out how you can view a list of their in-network providers online? You'll probably find there is someone with more experience available, although you may have to drive a little bit further out of your way. The surgeons may not be listed under the "Bariatric Surgery" umbrella with your insurance company, but rather "General Surgery."

Lisa25, The way I look at it is that you're a GAW (Grown Ass Woman) :confused:). If you've been dieting an exercising all this time and haven't lost and kept the weight off by now, you're probably not going to unless you suffer some long-term illness (God forbid). Although having your mother's support would be great, if she can't give it, and you're tired of hearing the same record repeated, tell her it's an OFF-LIMITS subject. I've had to do that with my Mom a time or two in areas related to my life. For the record, my Mom actually recommended Gastric Bypass to me many years ago. Then, pulled back her support once her own Mother got stomach cancer and had to have the majority of her stomach removed, but not rerouted. She saw her struggle and didn't want that for me. Now, that I've decided on the band, she's not fully supportive, but she also knows that I'm a GAW who, in the end, will make the best decision for my life with or without her support. I have no doubt both your mother and mine will eventually lend their whole-hearted support. One more thing . . . if you don't want to issue the "hush stop talking to me about that" order to your Mom, you could always allow her to become more involved and knowledgeable about the banding process to ease any concerns she may not be sharing with you. Have a great day you GAW you!

Sherri, I have Anthem BC/BS and there is a WLS exclusion rider on the policy. Did you have the same issue?

RLittman, When I attended the WLS Seminar, my surgeon said she requires her patients to do at least a two week pre-op diet, but sometimes she has them diet longer -- a month or more -- depending on the concentration of belly fat. The purpose is to shrink the liver prior to surgery and to avoid having to do an open procedure.

Violet, Maybe you could schedule the surgery on a Thursday and take Friday off in conjunction with the weekend? That would give you at least four days to adjust mentally before you return to work. Another option may be to check with HR to see what policies they have in place to assist your particular situation? For instance, my company offers a vacation purchase program that can be used in advance of accrued leave. The employee is charged a little each pay period for the days purchased. HR may also have a policy which allows you to charge the time as LWOP (Leave Without Pay). It's similar to FMLA in that you're not paid for the time period you're absent from work, but I believe that's where the similarity ends.

Francesca, Maybe the BioEnterics Intragastric Balloon would be an option for you? It's by the makers of the lapband, but I don't know if it's FDA approved yet. The way it works is a ballon is placed/replaced in the stomach non-surgically at 6-month intervals. It sounds promising and here's a link for anyone interested in doing more reading on the subject: http://www.allerganandinamed.com/pdf/health/94211C_BIB_Tarpon_Springs_Brochure_Intl.pdf#search='gastric%20balloon'

Barb, Request to see what was submitted. You're definitley entitled. There may also be something in there that you can use in your appeal letter.

There's a couple of appeal letters posted at this thread: http://lapbandtalk.com/showthread.php?t=2527&page=2.

SleepJean, LOL on the analogy of writing the diet book. I notice that Oprah does something with Green every few years. So, maybe they enjoy some kind of mutual support agreement. Hey, where did you get your weight loss ticker tape?

Diane is right. Anything Oprah touches turns golden. Just look at how her book club has increased sells for those authors. I remember years ago on the show Oprah rolled out the equivalent of fat that she had lost, I think on Optifast. I wonder how many of her viewers tried Optifast after that. I venture to guess Optifast sales soared. If it were me, and I had the type of influence that Oprah has, I wouldn't say a word about having the band until I was years post-op. Because if it doesn't work for her, millions of people will get the idea that it won't work for them either.