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I'm learning more about this than I wanted to learn. Apparently, the local HMO plans that are associated with FEHB use the medical policies of their local BC/BS affiliates. All of those that I've looked at in fact do cover lap band. However, the national BCBS PPO FEP plan uses national policies. The national policy, however, states that there is not enough US research to support approval of the band. This is in direct contradiction to the policies of the affiliates. So now I'm in the uncomfortable position of BCBS having stated that I meet the medical criteria, but they simply won't cover the band. They will, however, cover the gastric bypass. Advice?

I'm in Illinois, and we have the national standard option BC/BS FEP plan, PPO. The policy has a specific statement that it covers "gastric bypass and gastric stapling procedures", and they tell me that it doesn't cover lap band. However, I learned today that my other insurance, Unicare, has approved me for lap band. HURRAH! Otherwise, I was all set to get my husband to change at the next open season. :confused: :clap2:

@Janet thanks for the advice. everyone is telling me the same thing the slower the better. i joined this group bc i really need to stay focused and motivated. its frustrating because i did go through the surgery and really dont feel different. i know i have to be patient it also doesnt help me at all that i am obsessed with the scale. i know i should stay away from it but can't. i even told my hubby to hide from me lol. really obsessed im on it about 6 times a day. @ymjackson i think i eat enough just really staying away from all the junk and rice. rice is my downfall i used to eat it everyday, now I'm down to once a week. that's a challenge! i don't track my calorie in take i know i should. I just really don't want to feel like having surgery was just a waste of time. hopefully next week when i go in for my second fill i will feel a lot better. thanks for listening girls!

You guys are amazing! I truly thought that by putting myself out there, I would get nothing but negativity and judgement. Boy was I wrong. Thank you for your kind words. no one offended me, and sometimes one needs a "tell it like it is" talking to. I just found out that my work offers a smoking cessation program for free. I'm going to take advantage of it ASAP. Just called and left a message. I am currently going to school for nursing. I think that's what makes me even more pissed about my behavior is that I of all people know what I SHOULD be doing. I sit and think, why the heck are you doing this to yourself? My self esteem, self worth and God forbid my self accountability are way off. I made a simple phone call to my surgeons office and behold Medicaid will cover my visit. I think what's really held me back from that phone call is now dealing with the consequences of explaining why I haven't and continue to be irresponsible and unsuccessful. My surgeon is a no bs kinda woman and I'm sure if she could she'd rip this band from my body. Just FYI, I do have an IUD. No more babies for me! I used to talk crap about people in my situation. Im fertile mrytle and dont expect anyone else to pay for my kids. My husband has just started getting a new regimen of treatment for his mental health and so far I have seen a glimpse of his former self. My son is on track with Autism intervention. You all are right, I have to start focusing on ME. No more pity party. I'm not that kind of person. I don't settle for this kind of life. So since last night: 1. I have decided to take accountability for the things I can control and stop boo hooing about things without making an effort that is required. 2. I have a plan to stop smoking. I will wait to hear back from the smoking cessation guy, or stalk his life until he gets back to me. For myself, my kids, money, and I hang my head as I say for the cancer patients I take care of. Yes, I said it. I work in a cancer treatment center as a CNA. I hate myself some days for putting myself at risk for what my patients are dying from all the time. How much more in your face could the potential consequences be? 3. I made an appt with my surgeon. I'll see her on July 26th. Hopefully she won't make me want to jump from a building. Maybe I need her swift kick in the butt. 4. I'm going to start forcing myself to eat. Summer is produce season, season of lean grilling meats. No excuse. Getting a food tracking app is on tonight's agenda. 5. Exercise. I actually get a lot of that with my job and school. I'm just going to make an effort to track it and be more consistent. They have apps for that too. 6. Lastly, I'm just going to keep rolling with the punches. The things I can't control can't define me. I choose how to handle them. I'm feeling so motivated right now! Thank you all so much. I'll keep in touch. Hugs!!!

Most of my black friends are offended by the term "African American". The only people I know who care about whether or not blacks are called blacks are white people. My grandfather was from Greece, but I was born and raised in San Diego. I've certainly never been called "Greecian American", I'm called white. So why does my black friend, who is 3 generations removed from Africa and who was born and raised in Chicago, get called "African American"? (PC BS). And I hate "He's racial" being misused as a negative statement. We all have race. We're all racial. Something I've found interesting, but never shared here - a black lady I work with is considering LB seriously, and we've talked quite a bit about it. Another black lady sits across from her and once day when I was coming up to talk to first lady, second lady says something to her - I didn't hear what - and first lady looks at me and says, "It's a black thing..." So I asked her, "What's a black thing?" - as I hadn't heard what was said. She tells me "Weightloss surgery... black people don't really like that stuff." And lady 2 then says, "It's just a matter of mindset, you don't need all that stuff" (referring to the surgery) and walks away. I have noticed that of the people who post pictures here, that I've seen, the majority are white. So since I heard this conversation, I've been curious about how WLS is perceived among different races. My mom has two bothers, one who is married to a Hispanic lady who had two kids from her previous marriage w/ a Hispanic man. One of those kids is very, very dark-skinner, the other is light medium. Once several years ago the older of those two kids was "discovered" to be dating a black guy. All hell broke loose, and my aunt started ranting and raving that her daughter was ONLY to date her own kind. So I asked, "What - you will only allow her to date Hispanics?" -- and she got irate and started screaming at me about how her daughter is white because her adoptive father (my uncle) is white, and how could I be such a racist, and how could I offend my own family that way. She said no other race would ever be good enough for her daughters (even their own, apparently).

At your BMI you are obese and at a high risk for various problems such as diabetes, etc. So it doesn't really matter if it is 85lbs or 115 lbs. For your questions... My process was a piece of cake. After my research and choosing a doctor I scheduled surgery for six days later. Getting surgery is really quite easy if you aren't battling an insurance company. I went to Dr. Aceves in Mexico. Best thing I ever did. If you go to Mexico please let us know so we can tell you what and how to do your research. It's a very safe process but you still need to know what you are doing every step of the way. Yes, I felt the lap band was my last ditch effort to lose weight, and it works. Yep, I approached my family doc about it and I was pretty sure he would be anti-surgery and anti-Mexico. I could not have been more wrong. My doc specializes in sports medicine and family practice. He's quite the athelete himself. He runs daily, works out, sugar wouldn't pass his lips even if he was restrained and force fed the stuff. You know the type I'm talking about. I thought he would think I was taking the weenie way out and instead he was very supportive. I had to have a back up plan in case of complications since I went to Mexico. He said he would do anything necessary and he has. He's been great. MUCH different from what I expected.

I have gotten Medicare to reconsider accepting the Sleeve Gastrectomy. you need to view the psoting. They are soliciting public comments. http://www.cms.gov/medicare-coverage-database/details/nca-details.aspx?NCAld+=258&ver=2&NcaName=Bariatric+Surgery+for+the+treatment+of+Morbid+Obesity+(2nd+Recon)&bc=ACAAAAAAAAAA Please visit this site and post any information in favor. Thanks. Marcia name='likasulema' timestamp='1318798760' post='219248'] i have medicare as my primary coverage, but empire blue cross as my secondary. MEDICARE does NOT cover the sleeve yet because its relatively new (few years or something. ) Medicare DOES cover the lapband and gastric bypass. (but i want the sleeve) My surgery for the sleeve is 12/7 - medicare will send the "official" denial for the sleeve after hospital sends bill, empire needs to see the "official" denial first, and then empire looks at my qualifications in having the sleeve. I have all the qual.. (BMI, diabetes, high chlolesteral, and high blood pressure, and sleep apnea (aren't I lucky???!!!) The insurance companies know that Medicare doesn't cover the sleeve, but they need the official denial after the surgery. Then the other insurance company can proceed. I know this sounds weird, its the beurocracy (msp) but thats how it was explained to me. Empire does cover the sleeve - so they told me after all the paperwork is sent in I will be 99% positive I will be approved. They can't officially guarantee it for obvious reasons. But they did tell me unofficially of course that everything looks fine. so the bottom line is MEDICARE doesn't cover the sleeve, no if ands or butts, but your secondary might cover it, like my empire blue cross. hope i've helped - without confusing you too much - write back w/any more questions )

I was sleeved by Dr. Almanza on 03/01/12. My start weight was 228 and my current weight is 121. My personal goal is 110 but I am not rushing the last 11 pounds bc my skin has done much better than expected. I want a mommy makeover but I need a financial miracle first.

Hi, I live in St. Louis and am scheduled to have my surgery on Sept.1. I am using Dr. Darin Minkin at DePeres hospital. If anyone has used this doc I would appreciate hearing from you. He seems to be alright but I would feel a lot better if I heard from someone who has already used him. I am very lucky that my insurance will cover my surgery. I have bluechoice and I am a federal employee. The doctors secretary said that bcbs is only paying for fed. employees at this time. I need to lose at least 100 lbs. and am very anxious to get started but I am also very scared.

Okay...I'll try again. THiS was an inquiry into regrets. Some of us have a few. If you are about to have this surgery--or recently banded--and hear that someone else did NOT experience a safe, simple, successful journey to a healthy weight...it might feel threatening. That's because MOST of us read that all it takes is following the rules and people who follow the rules will succeed. Truth is, some do and some don't. And most people don't want to face that risk, so they'd rather shoot the messenger...as though that will protect them from some possible failure. There is (obviously) a lot of emotional garbage that enters into a wls desicion. Once you get there, and convince yourself that it is time to take this step, it is difficult to accept that it still might not work. WLS MAY work; it MAY not. I will repeat for those who would rather go for creative interpretations of what I'm TRYING to communicate: 1--No wls is without risks...INCLUDING the band. 2--The most successful procedures carry the highest risks. 3--The RnY and DS are not the killer surgeries that band-or-nothing people claim they are. (If they were, our insurance companies would use that excuse to not pay for those surgeries.) 4--There is no BEST wls. 5--What's right for someone who is 30, may be the wrong choice for someone who is 60. What is right for someone who was a normal weight and became wheelchair-bound and recently gained 150 pounds may be wrong for someone who has been obese since childhood. 6--LapBand is the safest SURGERY...but SURGERY IS OVER IN A DAY. 7--LapBand and RnY have similar long-term results. 8--The DS has better long term results than the band or RnY, but has life-long malabsorption issues. (More so than RnY.) 9--Many people are not prepared financially, emotionally, intellectually to provide themselves with proper post-op care, regardless of surgery. 10--When my band worked well, it worked well, AND I still regret waiting so long to have my band removed once it became problematic. If I recall, I was one of the first people on this board to announce that I was having my band removed. Since then, many people have had their bands removed for many reasons. I don't have a problem with the band needing to be removed...I have a problem with people who are so emotionally invested in the concept that if they follow the rules everything will be just fine that they have no other technique than to try to chase away the person bringing the news they don't want to hear. The why-don't-you-go-away chants aimed at me--and I have been here since Alex decided one day on the old Spotlight board to start this place because there were no band-only boards around--are ridiculous...especially coming from people who have little or no experience with the band. I almost NEVER discuss the whether someone should or should not get the band. I answer inquiries into regrets, and complications and other areas where I have experience. Frankly, I don't care who gets a band and who doesn't. But I DO care when people are being fed bullshit. If someone--or an Army, for that matter--does not like me or the way I respond to posts, they might want to hit the ignore button and remove me from their view. THAT would be the intelligent thing to do...which is why I don't expect those who claim I'm terrible to read to do anything like that. They would rather mis-read, misunderstand and mis-paraphrase me...so that they have a place to hang their fear of failure. Again...my problem is not with people getting or not getting the band...my problem is with ignorance and lies.

In my case, my employer put a WLS exclusion on the plan (I have Aetna) and my husband's employer put a WLS exclusion on their plan (he has BC/BS). So it's not necessary the insurance carrier but the employer who determines what they will/will not cover. I'm sure by having a WLS exclusion, they saved a wopping $1K annually or something stupid like that. Anyway, I had to self pay because if you have a WLS exclusion, appeals are fruitless even if you will die without the surgery. I paid $12,900 which covers all post op care, including unlimited fills for the 1st year post-surgery.

swallowing the stuff - especially after taking the fizzy powder first was a struggle! but i did think it was cool that I got to watch everything on screen and see it flow down into and out of my stomach. thank goodness I have didn't have to do it post-op - there is no way i could have gotten it all down. for my leak test, the surgeon did a dye test before closing me up while the tube was still down my throat - fed dye into and "stressed" my sleeve with some pressure and made sure they didn't see any dye escape from the staple line. so hopefully they'll do that leak test and you won't have to do the barium swallow again. definitely drink LOTS AND LOTS of Water - i felt gross pretty much the rest of the day afterward. I think this was the one that turned my poop a chalky white as well but that could have been the nuclear contrast from the cardiac stress test. good news is - another hurdle down!

That totally sucks.. I will never say you are to young. I bet you most people on here would say they would of loved to have had it at that age bc it would give them so many years back that they lost due to being overweight... listen its hard for me to tell people bc some may not agree. And the problem with telling people is that all it takes is one little negative comment to plant a seed for questioning urself. You don't need to tell anyone why you are losing weight. Im just telling people I'm on atkins. Call me a liar I don't care. You were just looking for support when u told them and you got shot down.. it hurts and it sucks. Stay positive you are doing this for you and no one else.. good luck with everything

So i mentioned before that I had ppwk submited on 4/30 and I was approved on 5/7..yay me! buuuuuuut...yes, here comes the BUT.... i was reading online on an obesity website bout the insurance approval letters and to make sure they dont expire...well i havent gotten mine in the mail so I called Cigna to see if there was some type of 'expiration' and I was told YES...it expires on 5/23 which means and i quote "you have to have surgery on 5/22" UMMMMM. I had told my doctor i couldn't have it until 6/22 and then cigna said i need to have my doctor call them right away to change the date but it may not be able to be changed because i have to have surgery within 6 months of my start date which was in November.. how can i have surgery within 6 months of my start date if CIGNA requires a 6 months supervised diet and a bunch of other crap before they will approve? so that doesn't make sense and to top it off, i haven't started any type of liquid diet not to mention havent even had my PREOP appt, scope or paid for the damn thing....i HATE HATE HATE receiving mis-information or BS information... has anyone experienced this? or is someone (at CIGNA) blowing smoke up my a--.....ok sorry for the vent post but im pretty pissed...

Mr. doctor had me tested for Vitamin D, and advised that I needed supplements. I took them, as prescribed. This was based on my bi annual blood work. Personally, non peer reviewed information as presented above is pure BS! I listen to my doctor, not a wanna be internet specialist with no credentials. Sorry, but that is the bare truth. What the hell is a Nrd??? Goodgle searches bring up nothing! Is that a recognized medical degree??

I was banded in September 2009 and became pregnant in April of 2010 with twins. I was down 63lbs (weighing 158lbs) at the start of my pregnancy. I had no band complications but was concerned with my babies getting enough nutrients since I didn't get an unfill. I did see my band surgeon upon finding out I was pregnant and his recommendation was to stay where I was and play it by ear. His point behind doing that was the fact of unhealthy eating and blood sugar levels while pregnant. With my pregnancy being twins and my history of miscarriage, I was watched very closely by my OB and Perio. Both doctor offices agreed with my band surgeon. I delivered 8 weeks early but at weeks before delivery I was having a hard time with heartburn (which ended after being banded) and everything being "squished". It would take me a long time to eat but I would do what I could to get it down. I breast fed which made a huge difference in my post baby weight loss. My boys were in NICU for 34 days and when I got home from the hospital and NICU stay I had lost all my pregnancy weight plus an additional 2 lbs. All in all, I delivered 2 healthy baby boys and I am still healthy too!

had to post here, as I am having my last supper tomorrow!! I am going to a buffet for all you can eat grab legs...(which aren't actually bad for you...except the butter) but I dont plain on over doing it at all. I don't want it to be a Complete shocker to my body on Friday when I start my liquid diet bc I had just ate so much food the night before. I plan on enjoying my meal moderately tomorrow!!

. I have Aetna Health Maintenance Organization..Im currently 270 with a BMI of 41....I know i qualify with a BMI >40..I'm hearing that Aetna requires a 2 year weight history. Will they deny bc I havent been 270 for the last 2 years. My weight fluctated from 225 to 270...

so true bandster buddies i have a friend like that i made a mistake to tell her about my band boom tells her sister when i told her to pls keep it prvt i call those kind of ppl stabbers !!! bc they dont care and they will do anything to put u down so you wont continue weight loss

On my list from the Dr. on medications to aviod is mainly aspirin and ibuprofen. Ex: Advil, BC powder, Pepto Bismol, Excedrin, Mortrin, Alieve Safe for joint pain: Vioxx, Celebrex, and Mobic Erythromycin should only be taken with caution and your physician's approval, becuase of stomach irritation.

When you get your insurance ask for a copy of your policy. Maintaining a high weight is not necesary. They go by the weight that you were at befor you started your 6 months diet plan. Atleast that is what it says in BC/BS of Illinois manual.

When I first looked into Lapband surgery, I called a practice in NY that was listed as a Center of Excellence. They required a $1000 nonrefundable fee, $50 of which had to be paid before they would even book an appointment. I called my insurance and asked about that. Anthem Bc/Bs said practices are not supposed to do that and that it was somewhat shady. I called the doctors office back and asked more about it, and they told me it was for the hassle of dealing with insurance companies. This just didn't sit right with me, so I called another practice and talked to them.. made my appointment with them, and they've been wonderful. I would definitely shop around. The doctors are paid well by insurance companies, there is no reason they need to add extra fees.

When my reflux was VERY BAD my coughing was also as my throat was irritated by the acid. Nexium doesn't sound like it's working. As far as the ER they are usually staffed by NEWer doctors - just out of school so they actually tend to have more current info than most other doctors. I was sent in for an upper GI to a hospital that does NO bariactic surgery and they were looking at my band and found what my problem.was...Granted I'd have been more happy at the hospital that did the surgery but I was equally happy now knowing I can trust this place if need be. Please don't let the fear of weight gain stop you from seeking help. Hopefully this is only a small speed bump on your journey. Better to live well than die skinny! Don't let it get that serious! Yes, I do mean to scare you - but only because I care! Good luck.... Linda (PS - I would go back to a liquid diet for now because all the throwing up causes swelling which then makes the band tighter - worrying about band erosion and band slippage to a lesser degree...actually more concerned about band twisting as that can cause the problems you're having. I just had fluid taken out as this week after a band-fill a month ago progressively was causing more pain. throwing up and swelling...now I feel human again and it took 1.5 cc's out..and I lost 3 bs. after it was taken out!)

There will be loose skin bc of how rapid the weight loss is. Start exercising and weight training as soon as you get cleared to. Also, lotion lotion lotion. Keep your skin moisturized. Other than that the rest is genetics...some people have great elasticity and others not. My skin is loose but I didn’t weight train right away...wish I did. I am now. I’m 44 as well. But ill take the loose skin over how big I got any day!!

Complain away! It's important to get those feelings OUT in the open and not let them eat away at your motivation! You mentioned BC pills and TOM. Another 2 factors that will affect you weight dramatically from day to day and week to week is your hormonal levels! So you've got lots going on "in the mix" right now! And of course the healing and recovery overlays everything else. Feel free to feel down for a moment when you're comparing yourself to others (hard not to, I know). Then let that pass and turn to the positives (and grab that drink container and drink to it!) Try Protein shakes.....they will help you deal with 2 challenges simultaneously....protein and fluids! The more protein you do now, the better for weight loss, muscle preservation, long-term preservation of your hair (hair loss sometimes doesn't make itself known for 3-4 months, and early protein helps prevent or at least reduce it!). And of course, I forgot to mention that you should be taking body measurements! If you didn't do this just before your surgery, start now! Often times the body is changing dramatically and the scale doesn't reflect these changes. And many of us can't see the changes when we look in the mirror! Measurements done on a regular basis (I plan on doing mine monthly....so another 2 weeks for me to compare to my starting numbers) will help you see your progress even when the scale is being stubborn. Good luck, and don't worry about venting. That's why we're here! Who better to understand how you feel, and to help you feel better?