abraxasbear

Has anyone with the Blue Cross Blue Shield Federal Employee Program been able to get them to pay for penniculectomy or abdominoplasty, after the plan paid for your lap band surgery? If so, what did they look for in order to approve it? The current policy manual doesn't really say anything about such things, other than saying they don't cover (purely?) "cosmetic" surgery.

Feeling very discouraged today. I called to follow up on the preauthorization for my band removal, and after placing me on hold, the rep came back to tell me they'd decided today to DENY, on the basis that it's "not medically necessary." This, after the surgeon has said it needs to come out as soon as possible. Apparently a badly dilated pouch, with nausea and vomiting, isn't what they consider "necessary" to deal with. :( Has anyone had success appealing for band removal, with no revision surgery? Especially with BCBS Federal Employee Program?

Feeling very discouraged today. I called to follow up on the preauthorization for my band removal, and after placing me on hold, the rep came back to tell me they'd decided today to DENY, on the basis that it's "not medically necessary." This, after the surgeon has said it needs to come out as soon as possible. Apparently a badly dilated pouch, with nausea and vomiting, isn't what they consider "necessary" to deal with. :( Has anyone had success appealing for band removal, with no revision surgery? Especially with BCBS Federal Employee Program?

Anyone here who had to get pre-authorization for a band removal, without any subsequent revision? My pouch is seriously dilated, and the surgeon wants to remove it ASAP. I'm not willing to do any further WLS. If you had to do this, did you have any trouble getting insurance to authorize it?

Anyone here had to get pre-authorization for removal of the band, without any further revision? Mine is causing problems (serious pouch dilation) to the point the surgeon wants to remove it ASAP, but it's being submitted for pre-authorization. If you had to go this route (as opposed to ER sudden removal, etc.), did you have any trouble getting it approved?

CONGRATS, Ninejuan1, on getting set up with a new doctor and back on track! I'm afraid my own "return to the office" has turned out a little different, but it's important that I went. The doctor withdrew Fluid to make sure my band wasn't leaking, and I immediately had a sharp, burning pain traveling up my esophagus. That's not supposed to happen, so they set me up for an upper GI. The upper GI led to an endoscopy this past Wednesday. It turns out that my pouch is seriously dilated, and my band needs to be removed. I go in next Tuesday, and presumably will schedule surgery ASAP. It's a serious issue, and needs to be taken care of---it's good that I didn't continue to shy away from the office due to my embarassment, etc. Things will work out okay. The doctor would like to revise me to a gastric bypass, but I think I'm going to try some other approaches before getting another WLS.

I had lap band surgery over two years ago, in November of 2010. I began at 339 pounds, lost twenty in the pre-surgical two week low carb diet, and after surgery got down to 249. Then I bounced, and everything seemed to go wrong. Looking back, I think I was over-eager about increasing my fills, and it got me to the point where there was zero hunger control, etc. Now, I'm back up to 325 pounds. My band is still at around 9cc, but it doesn't really do much at all for portion control anymore---just creates problems with certain foods at times. I feel like my eating is completely out of control again, and I'm discouraged as hell. I haven't been back to my bariatric doc's office in about a year and a half, just out of sheer embarrassment. That said, I can't handle being this big again, and I need to do something, but I'm honestly afraid of going back to the doctor. Has anyone else been in a similar situation? Is it possible after this degree of failure to get back to a place where the band is actually helping again and serving its purpose, or have I likely just screwed this option up permanently?

I just called the office. My doctor is booked up pretty heavily right now, but they fit me in on May 30th during the time of day he doesn't normally schedule anyone. Apparently he really wants to get me in there. I wish it was sooner, so I could just get it over with, but I guess it's committed anyway.

So glad to have found this discussion this morning! Just last night, I posted the following in the "general discussion" thread (evidently the wrong place for it): "I had lap band surgery over two years ago, in November of 2010. I began at 339 pounds, lost twenty in the pre-surgical two week low carb diet, and after surgery got down to 249. Then I bounced, and everything seemed to go wrong. Looking back, I think I was over-eager about increasing my fills, and it got me to the point where there was zero hunger control, etc. Now, I'm back up to 325 pounds. My band is still at around 9cc, but it doesn't really do much at all for portion control anymore---just creates problems with certain foods at times. I feel like my eating is completely out of control again, and I'm discouraged as hell. I haven't been back to my bariatric doc's office in about a year and a half, just out of sheer embarrassment. That said, I can't handle being this big again, and I need to do something, but I'm honestly afraid of going back to the doctor. Has anyone else been in a similar situation? Is it possible after this degree of failure to get back to a place where the band is actually helping again and serving its purpose, or have I likely just screwed this option up permanently?" Just like you, Juan, I haven't been to my doctor since November of 2011. I just got off the phone, after scheduling a new appointment for May 30th. He was heavily booked up, and it wasn't a time of day when he usually schedules people, but he wanted to be sure and get me in. I have to say I'm nervous about seeing him, but it's time to swallow my pride and just do it!

Mis73, I think you bring up a good point. I think I really approached the band as a "portion control" tool, rather than a "hunger control" tool. Ugh!

I'm four months out from getting banded. I'm currently at 8 cc in my 14 cc band, and very nearly at the "sweet spot." Along with the great weight loss results though, I'm noticing a "not so great" result. I've had increasing flatulence, which only seems to get WORSE as my band gets filled more. I've searched the archived messages here, and the posts on this topic all seem to address a short-term issue that goes away shortly after banding. Am I unusual in having this issue persist/worsen? Any tips on solving it? I'm not eating any particularly large amount of foods you'd expect to cause the problem---in fact, diet doesn't seem to affect it one way or another. The only difference I notice is that it can be worse after drinking a lot of liquid. Help??

I'm at 10cc in a 14cc band, and I'm travelling to Peru for two weeks in October. I'll be taking part in some ceremonies with traditional healing plants, which are known to sometimes induce vomiting. Knowing that vomiting could be an issue with the band, I asked my doctor about this. Much to my surprise, he recommended that I get a partial (as in "most") unfill before my trip, and refill afterward. As he put it, you don't want to be out in the jungles of Peru, having a problem with the band. I have some real misgivngs about this idea. In talking with the guides leading my planned trip, the vomiting reaction is not really common (they've had only one person vomit, and he'd worked himself up ahead of time to the point that he was overanxious and probably brought it on himself). Naturally, I also worry about regaining weight during the trip. Finally, if I do get a "big" unfill before the trip, can it all be replaced afterward, or would I have to work up a little at a time, just as I did to get to my 10cc? Has anyone else here been temporarily unfilled for travel purposes? Has anyone not had an unfill prior to travel, and wish they had? Thoughts? Experiences?

I've had a terrible time with Federal Employees Blue Cross Blue Shield. At first, my pre-authorization paperwork had to be resubmitted after it was "lost." Then they pre-authorized the surgery within a day. Unfortunately, they didn't bother to tell me or my surgeon's office that you have to get TWO pre-approvals, one from the office that handles the surgeon's professional fees, and another from the office that handles the facility (hospital) fees. To make matters worse, these two offices don't share information, so the office handling the hospital charges ended up sending me their refusal to process $37,000 worth of hospital charges, because they had no records to support the procedure and it wasn't pre-authorized by them. After multiple calls, I was able to get the second office to retroactively authorize my surgery. I expected to be charged a copay of $150 for my surgery and overnight hospital stay, since my surgeon requires all his lap band patients to stay in the hospital overnight. Imagine my surprise when this weekend I received a new explanation of benefits, indicating that my share of the bill was $1,496.72. More phone calls ensued, of course. I found out from the insurance claims office that the additional charges were due to my surgeon's office reporting the surgery as OUTPATIENT, rather than inpatient. They said all I needed to do was have the surgeon's office correct the medical record, and the billing department could resubmit a corrected claim. I called the surgeon's office today, only to learn that they ALWAYS report lap band surgery as outpatient, and they justify this by getting you out of the hospital in less than 24 hours, even though it's overnight. (Mind you, I went into the operating room at 7:30 a.m., and was discharged the next day at about 9:30 a.m., so that's not under 24 hours!). The surgeon's office refuses to make the necessary correction, and so I'm stuck with the larger out-of-pocket bill. I wish I'd known this BEFORE surgery, so I could have REFUSED the overnight stay. In any case, BE WARNED that what you THINK you'll be paying out of pocket could be very different from what you actually are charged---in my case, literally TEN TIMES the expected out-of-pocket!

Yes, we're out there! I know of at least two other gay men on this forum, one of whom I keep in touch with fairly regularly (we share the same surgeon, besides).

To me, the bigger question is what to do when you're ready to maintain your existing weight. My goal isn't to be skinny. Even though the charts say I should weigh about 165, I know that I start to look unhealthy and gaunt as I drop below 180. I'm shooting for 200 pounds (okay, maybe 195, just so I'm not in 200s territory), and then I'd like the weight loss to basically stop. Do they unfill a little at some point, if your goal is to maintain without further loss?

I don't get them when I'm done eating. I tend to get them after just a few bites, when I don't take my time as I should (which is still way too often, I'm afraid). When it happens, I hold my breath for 40 second or so, and they always go away.

I started out at 338 pounds, and still weighed 317 when I was banded on November 1st, 2010. My goal is to get down to 200 pounds. As of today, I'm down to 267 pounds, so I've officially passed the halfway point toward reaching my goal! 70 pounds lost, and 68 pounds to go. It's SO NICE to finally have my "left to lose" number SMALLER than my "already lost" number! HAPPY HUMP DAY TO ME!

Now if I could only type "Hooray" correctly in the topic header! LOL!

I had 3 cc in my 14 cc band at the time of surgery, with an additional 1 cc added on 12/16/2010. I went in for a fill yesterday and received 2 cc more, so I'm also at a total of 6 cc right now. My surgeon directs two days of liquids after every fill due to the resulting inflammation, so it's hard to guage what my restriction will be like. What I do know, however, is that I can feel the liquids accumulating in my upper stomach, and not just running through, so maybe that's a good sign!

I know that soda is something to stay far away from anyway, but how would soda inside your stomach rot your band, which is outside your stomach? That doesn't seem to make much sense to me.

I'm 5'8" tall, 335 pounds, and turning 44 years old as I prepare to be banded. As part of this, I'm looking forward to getting into serious weight training--the one "athletic" activity I've ever really enjoyed. I'm wondering, though, whether the restricted food intake will support it. Can you get enough Protein to keep up with the ongoing muscle repair, and ideally start adding muscle? I understand that my focus should probably be on the wide range of health benefits I'll get from losing the weight. To be honest though, the last thing I want is to lose 100+ pounds, just to become a scrawny, pencil-necked weakling with chicken legs. :thumbup: Has anyone else here been able to start packing on some "lean beef" after banding?

Stacy, I think the "two offices" thing differs between the states where the claim is processed. Mine was in Washington State, and apparently the split only is done for claims arising out of the Seattle metro area.

I also had my first fill yesterday. The surgeon had placed 3 cc in my 14 cc band at the time of surgery, and surprisingy, I was experiencing restriction and losing weight (31 pounds in the six weeks since surgery) at a good pace. The nurse practitioner who handles my fills said they usually like to go with five right away (not clear if that meant 5 total, or add 5 to the existing for a total of 8?). Since I'm doing so well though, he only added 1 cc. Like honk, I felt extremely "weird" when I got up from the examining table, but I was able to drink Water without any problem and the feeling subsided in a short time. The nurse practitioner said it was more likely from him manipulating the band, than from the fill itself. He had to do some real poking and prodding to find my port. I'm back on liquids for two days (he even suggested taking three days), but so far I'm having no problem with my Protein shakes or other liquids. Personally, I'm hoping I didn't make a mistake by agreeing that an addition of only 1 cc was a good idea. In the last week I've been able to eat more than before--still a much smaller portion than pre-band, but more than when I first advanced to soft foods. My next fill won't be until January 26th, and I don't want to end up slowing down my weight loss due to such a small fill.

I lost 22 pounds on my two week "very low carb" pre-surgical diet. I was banded on 11/1/2010, and I've lost another 25 pounds since then. Total 47 pounds down---already just over one third of what I need to lose for my goal!

Congratulations!!!!! 303 here, and looking forward to joining the same club! :thumbup: