Unethical bandsters?

[ofps 1]

This has definitely been controversary. I'm not new with a weight problem. Cortisone has also played a role, but only to create a verasous apetite. I am the one who ate my way here. I started the procedures the gastric bypass the first of February 06. During my psyc eval, I met a young woman, who was planning on gaining 40 more lbs to qualify for the procedure. WITHOUT trying, I gained another 60 lbs from Feb to surgery (July). Clearly she had a weight problem even though she didn't have near what I had to loose. Yes, her insurance was going to pay for the surgery, and mine didn't, but I don't begrudge her for trying to get help. Every surgery comes with 'baggage' and risk. This is a life changing procedure, not a walk in the park. Every doctor probably has certain criteria that has to be met before the operation can be performed, and if those with less than 100 lbs to loose meet this criteria, then that's their choice. I never 'believed' in cosmetic surgery, but when I loose enough, I'm planning on getting a tummy tuck! bet you sweet a! I don't begrudge anyone who feels the need to inprove the quality of their life, if they need to gain alittle to do it........eat an extra cinnamon roll for me too. I can't have them anymore! ofps

[Loving-It 0]

Opening this up for discussion - in general - is it ok to "nudge" the system this way? Is there anything wrong with doing it? What's the line between what's "ok" to nudge, and what isn't?

I've never heard of this before, so I don't have much of an opinion.

I will say though that if it's the only way for someone to get their life back, then so be it. Desperate times call for desperate measures. God bless those who do have to go to such extremes. :cry

[nolagirl2 0]

<table id="HB_Mail_Container" unselectable="on" border="0" cellpadding="0" cellspacing="0" height="100%" width="100%"><tbody><tr unselectable="on" width="100%" height="100%"><td id="HB_Focus_Element" unselectable="off" background="" height="250" valign="top" width="100%">Me thinks you are splitting hairs, when the debate focuses on the words and not the intent of the words the debate becomes silly. Want, need, desire, whatever term you use, as long as you use them it allows the blame to be placed on the victim. Every time someone rationalizes anothers problem by stating "they do it because they are getting something from it" you allow others to assign blame on the fat person...

I refuse to be minimalized by the legions of Doctor Phil fans who have decided that I am fat because I choose to be because I get something from it. I refuse to blame fat people for being fat and every time someone expounds the huey that fat people are fat because they need, choose, want, desire,get etc to be fat they give everyone a free pass to treat me with disrespect because it's my choice.

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I think its reactionary and defensive to say that anyone is blaming the victim. I was just saying that, especially in my experience, it's emotionally complicated being fat. It is a big part of my identity, and change is scary. It is, in some ways and for some people, easier to be fat than to change. None of this is in any way blaming the victim. In many ways I chose and tried not to be fat; in some ways I chose to be fat. This is my experience.

As far as opening doors for other people to blame the victim... Who exactly?

I just think recognizing the complexity of a situation is okay. I don't blame fat people for turning to food for comfort. I don't blame them for being fat. I don't blame them for their choices and their condition. A corollary is how people always want homosexuality to be explained as either biological or sociological - nature v. nurture. I personally believe that it is a bit of both, but that doesn't mean that I blame gay people or think that they choose it. I still think it's an intrinsic part of their being, but I don't need to say that its due purely to biology just to try to make that point clearer. There's going to be subtleties and shades of gray in any situation; it isn't malicious or hurtful to acknowledge them.

[Wheetsin 714]

It's not a matter of semantics when the words used completely change the intent of what is being said. Nor is it semantics when you say that someone said something they didn't.

I do not want to be fat. I get something out of being fat. Since both statements can be true, their intent is absolutely not the same.

And IMO - "getting something from it" does not equal "it is your fault".

[Alexandra 55]

So why does a person with lower start weight (who is still obese mind you, which technically I was until just a few short months ago) seem less deserving to some of you had higher start weight? It's unbelievable.

Of course everyone "deserves" the care, no question about it, and I nowhere implied that one person is less worthy of surgery itself than another. I was addressing whether insurance carriers are wrong in making such determinations, and I don't believe they are. They have to, absolutely have to draw the lines somewhere. The simple fact is that unless insurance carriers did this sort of triage and line-setting, they would all collapse immediately under the cost of medical care for people who want it.

Believe me, I despise our insurance system more than most people, I'm not defending it. I'm just explaining it. Our absurd system just is not set up to provide healthy people with expensive preventive care. There has to be a diagnostic guideline, and the existence of that guideline invites fraud. It's a horrible system in just about every way, but it's what we've got.

[TommyO 5]

<TABLE id=HB_Mail_Container height="100%" cellSpacing=0 cellPadding=0 width="100%" border=0 UNSELECTABLE="on"><TBODY><TR height="100%" width="100%" UNSELECTABLE="on"><TD id=HB_Focus_Element vAlign=top width="100%" background="" height=250 UNSELECTABLE="off">Wheetsin, is it not possible to interpret your words in the manner I suggest. Seems to me I am not alone in my interpretation suggesting it quite possibly a matter of sematics.

pfunkem, reactionary yes (It would seem to me any response is a reaction) defensive not a chance. I am not even slightly defensive about this the topic or any other for that matter I am very comfortable with who I am. I could probably use a little humbling and seldom if ever do I take anything personaly hence I am seldom defensive.

In answer to your question ...Who exactly? Suggest you read some of the threads that discuss the discrimination that some members of this board have felt as obese people.

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[katt 0]

Wow. Isn't it amazing how threads change their course. Most recent research seems to be trending in the direction that obesity is at least in part genetic. There we go with nature vs. nurture again. Only with obesity it seems to be a combination of the two. Plus our sedentary lifestyles. I can tell you for sure that I am allergic to exercise. I break out in sweat. Hate that. I am learning that I don't have to like it, I just have to do it. But back to the topic. I receive no secondary gain from obesity and never have. I acknowledge and accept the part I play in my fat but I do not want it, desire it, gain from it. Katt

[Wheetsin 714]

:confused: :lol: :lol:

[matziq 0]

I thought about going on an eating binge for a few months until I reached that magic number...but instead I just did self-pay and got it done.

I agree it is wrong to defraud the insurance company...but at the same time, a man who has been 100 pounds overweight for years and years should still qualify even though the bmi is lower than what the insurance companies set.

[Carlene 12]

I thought about going on an eating binge for a few months until I reached that magic number...but instead I just did self-pay and got it done.

I'm not sure I would consider that unethical. I think it's more of a trade-off.

People job shop to find one that has insurance that will cover WLS, so what's the difference?

Now...sewing lead weights into your undies is a different matter. I think that's cheating, and a little strange. I would be afraid of being caught and feeling absolutely mortified!

[JMO 0]

So... quite contrary to the words that are being put in my mouth, I don't think people want to be fat. I know of very few people ever who have sat down and made a conscious decision to gain weight, or made it their New Year's resolution to gain fat (I personally only know 1 person who has ever done this).

Cheers!

So sorry, I must have misunderstood I was NOT trying to put any words in your mouth.(I swear) lol I Just read that different... Wheetsin I just love your debate threads, but dang they are so addicting... lol

Thanks

[Time to love me 0]

. I haven't seen the topic come up in a while, but when I first joined it was fairly common for someone to want advice on how to qualify for the lap-band, even though they don't qualify. And there was a lot of advice given about putting sand in clothes, weights in shoes, forcing down a gallon of Water before being weighed, etc.quote]

Funny that you had said this. When I went to my very first appt. with the WLS Dr. the Nutritionist made me put a gown on to be weighed in and I was asking what the big deal is and she said they have had a few people who wore weights on their legs, arms and put heavy things in their pockets. I was so oblivious at the time and said "Why would someone do that and why do you care"? :doh: I felt so stupid when she told me why! People were just under by ten pounds or so. I guess one guy was shaking the Dr's hand and all of the sudden.. the weights he had on his arm slid down to his wrist! I'd be so afraid of being caught... GO figure, I was a police officer for several years. :mod:

[Marimaru 7]

1. Should people on publicly funded insurance, e.g. "my tax dollars pay for their medical care", have WLS covered? I think the self-pays' responses to this will be particularly interesting.

I was self pay because I didn't have any insurance at the time. If I'd had Medicare, I probably would have tried to go through them. If they qualify through Medicare they have probably jumped through so many hoops that they 'deserve' it anyway, lol.

2. Should insurance companies be able to impose a time limit before something with debatable medical necessity is approved? I see the "it saves them money in the long run" argument -- but the numbers don't back that up, at all, and that's why there are more and more denials coming down every day. The average person doesn't stay with their insurance company long enough for the business to see the fiscal benefits. For example - I started with my new company in June of last year. I had surgery March of this year. I had 3 office visits not related to surgery, but surgery related billings in excess of $35,000. (Meaning, if I hadn't had surgery, I would have cost my insurance company a couple hundred dollars). I can change policies in November when we have open enrollment. If I change carriers, I just cost my insurance company a LOT of money, because they'll never get enough premium from me or my employer to come remotely close to what they paid out for my surgery. So back to the original question -- should insurance companies be able to impose a waiting period before they'll approve surgeries of questionable necessity, to ensure they're not out a ton of money on an elective procedure? (I think the necessity of all WLS is debatable, when compared to things like trauma surgery)

My insurance has a "pre-existing condition" clause. They will not treat anything pre-existing until after 6 months that you've been with them. I think that's a bit different than what you are asking though. I'm not sure how they would be able to impose this time limit, other than something like the 6 month supervised diet or whatever.

3. On the flip side of that, if someone has WLS, and does not lose enough to get off their medications, or stop their pain, or whatever - AND it can be attributed to much of their own doing - poor eating habits, refusal to exercise, etc. - should they have to pay back any money to their insurance? E.g. the situation is such that - the insurance company did their part, you did not do yours and are costing them as much if not more as before... should they be entitled to any kind of "refund" from you? (Note this is not band-specific...)

This is tough. Like someone else pointed out, what about a smoker on oxygen with emphazema, who continues to smoke (and drink, thinking about my grandfather here)? Granted, oxygen is arguably more necessary than WLS, but that also depends on the case. There are a number of people who get WLS because it's highly likely that they'll die of heart failure in just a few years if they don't get some of the weight off. But then, the whole problem is a question of who "needs" it. My BMI was 45.something, and if I'd had insurance at the time I had surgery, it's likely they would have covered it based on that (based on my current policies guidelines), but I had no comorbidities. My blood pressure was well within normal (though had JUST started to go up a little), my cholesterol is great, no pre-diabetes or anything. So did I NEED it??

As for the idea that many fat people (not ALL by any means) are fat for a reason, I agree with this completely. I agree, because I know it was true for myself. Now, this wasn't anything I sat down and decided one day, it just kind of happened. I've been on diets enforced by my parents (espeically my father) since I was 8. When I was that young, my mom had me eating healthy, no second helpings, and only healthy Snacks. At that time, I ate the sugar free candy she bought me at night in my room. After they divorced my dad put me on slimfast and had me on the scale every single morning. So I took my stupid shake to school and spend all of my allowance on the Snacks that the school sells. food was my control. There were so many other things I couldn't control, but I could control how much I ate, no matter who was trying to stop me. I didn't do drugs or sneak out of the house, but I still had my own 'rebellion'. I've lost 65 lbs in 2 years, and I'm finally in counceling to try and get some 'control' back in my life OTHER than food. I HATE being fat, I've never liked it, and I've never felt like I was skinny, or even a normal size. But I still did it to myself, and there was a reason behind it.

I think another problem with the insurance companies is the general cost of healthcare today. Countries outside the US are starting to advertise their services at a fraction of the cost. There was an article posted on the forum not too long ago about this, and a guy went to India for heart surgery because he couldn't afford it here. I don't remember what they were going to charge him here, I THINK it was about $60,000, and the hospital in India charged him $6,000. Insurance doesn't want to pay, and people can't afford it on their own (for the most part).

[wantlapband 0]

This is to anyone:

Suppose your BMI was 40, you weigh 250 lbs., you get approved, have the surgery. Now your down to 205 lbs and your BMI is 35.5. What if you had to get rid of your lap band at 205 lbs. Would you be happy at 205 lbs? Would it be a struggle for you to lose weight without the help from the band? What if you had to start all over again for approval being at 205. What would you do?

Just wondering..

[Bye 0]

Another excellent LapBandTalk thread!

Anytime you try to cheat when dealing with your health is dangerous. I'm more concerned with the doctor's requirements than the insurance company's (who just want to keep your money).

Blue Cross Blue Shield of GA denied my lapband surgery, because I did not have the bariatric rider -- the fact that I weighed 450 at the time and was beginning to have other health issues where they were paying claims didn't seem to matter. I will self-pay.

But here is the issue, that I want those trying to cheat the system to read closely. I have a heart condition which four doctors have told me that I would not survive gastric bypass on the table. All four eagerly advised lapband surgery for me, which my heart could handle. The one set back is that the bariatric doctor wants me to be a BMI of 40 for surgery.

Right now, I am a BMI 71.5 at 391 lbs. I will have lost 123 lbs by the time I reach a BMI of 40. The lapband should take me down to 165, which I am extremely excited about.

So, I advise everyone to do what your doctor says and not try to cheat the system. If they are operating with false data, you could be the one to suffer in the end.