New here - considering the Lap Band

[kari_berry 0]

Hello everyone. I am new here to the forum. I was recommended here from someone at the 3 Fat Chicks Website. I am here obviously because I need to lose weight.

I am 22 years old, 5'4 and weight (I'm sure) over 305 lbs. Back in April 2003 I started a weight loss program, and successfully lost about 50 lbs. Then after August 2003, I started eating "normal" again, but I was still exercising daily - and I gained back ALL of the weight, plus a little more.

I am miserble. I have tried every diet known to man, and nothing has worked. The last few weeks, I've just felt like I'm doomed to spend my life fat.

I don't want to live like this. I am young. I should be out having fun. I currently cannot walk long distances without becoming very short of breath. I have chest pains every day. I just found out a few months ago that I have high cholesterol. Imagine that! 22 years old, and high cholesterol! That's crazy! And it's scary!

Last night my sister asked me why I wouldn't consider surgery. After I thought about it - I realized that I don't have to have Gastric Bypass surgery. That truly scares me. But I remember hearing about the band.

So I am here today to find out about the band. Any information that you could provide to me would be greatly appreciated. Here are a few questions that I have.

How long has the band been around?

Where do you begin with trying to get your insurance to approve the surgery?

Is the surgery difficult?

What is the recovery time?

What are the complications?

Have there been any severe complications with the band?

What is the recovery time?

Is there an "average" weight loss?

Any other information that you may be able to provide me would be greatly appreciated!

Thanks so much, and I look forward to getting to know many of you!

~ Kari ~

[whippledaddy 5]

I wish there had been this tool when I was 22 and fat. I had to wait thirty years.

You don't have to live this way. The lapband can help. My wife had the RNY, and I am getting the band this November (I hope).

The band is less invasive, you should be able to lose fifty percent of your excess weight, and it can be for life. It will always be there to help you.

I have heard of no serious complications with the band locally. I'm in alma, Middle of the Mitten. The complications, if any, are small in comparison to what is possible with the RNY. I should know, my wife had many complications with the RNY.

Look around this site, most of the questions you ask have already been answered, and the good folks who run this place will be more than happy to get those threads up for you, or start new ones.

This is a great place. We have all been where you are now. Some of us have been banded a while back, some recently and some are still waiting.

Good luck, and welcome!

[blossom 2]

Hi Kari! I am not banded yet, so I can't give you first hand information. But I can tell you that just reading all the info on this board will answer most of your questions (along with a lot of giggles!). You will be so glad you found this board, I know I am!

[Iluvharleys 15]

Hi Kari!

What Blossom said is great advice. I have read the boards and went to the internet and looked up several sites. You will get tons of imformation just reading all the threads here. Some of the threads will point you to some more interesting links. Please study everything you can before making any decision.

Betty

[La_madam 20]

Hi Kari

He is a link with alot of info

http://www.lap-band.com/

The band has changed my life .I 'm so happy with my band!

I would of never imagined in 5 months I would be down over 50 lbs with minimal effort..I have tried all the diets known to man to never have such success as I do with my band.

Best of luck to you on your decision. This site will be sure to help you find the answers you are looking for

[hagerteresa 3]

Hi Kari,

I have been banded just under 5 months and am down 64.6 lbs with very little effort. I have not had any fills yet which is unusual but I am still losing little by little. I am an active house keeper for a living and took 1 week off of work and was fine when returning after that time. It is a fairly short surgery and pain is pretty minimal. There is discomfortness but the worst of it is only for a few days. I had my surgery in Mexico because I knew my insurance wouldn't cover it and didn't want to hassle with them. I started my band journey at 362 lbs. I can totally relate with your current feelings. I am only thirty years old. Good luck on your research and we are all here if you have more questions. Teresa:)

[New Hope 37]

Kari, first, do you know that your health insurance covers weight loss surgery (if so, what particular type), or do they have a definite clause in their policy saying that "All WLS are excluded". Your Benefits Coordinator (at your job) can probably answer this for you and/or you may have to call your health insurance co. direct.

Kari, talk w/ your primary care physician (family dr.) about weight loss surgery. He/she may not be familiar w/ the Lapband, so print out and take them some info. He/she should have your health history. Do you have co-morbidities (high blood pressure, diabetes, heart trouble, asthma, etc.)? Do you have a family history of any health problems? What types of weight loss have you tried (Weight Watchers, Adkins, diet pills, fasting, various diet plans, dr. supervised diets) -- anything you can remember doing to lose weight? Are you on any current prescription meds. for any health problems (what type, how often taking)? Problems you are aware of that are currently causing you problems in doing every day things (ex. joint pain, difficulty breathing, fatigue, depression, etc.) Have all of this stuff written down (and keep a copy) and give to your dr. I'm sure that you'll think of other things. You're going to need to "defend yourself" as to why you need weight loss surgery. The more prepared you are, the better your chances are.

My insurance company first denied me, I appealed, 8 months later I got my Band. A lot of Bandsters have gotten theirs a lot sooner.

Best of luck to you!

[kari_berry 0]

Thank you all so much for the replies!

First off - I'm not really sure if my insurance covers this surgery - or resitricts any type of surgery like this. I need to find this out soon. I'd hate to do ALL the research, and then find out that this is not possible.

My aunt and I work for the same company, and she works in HR dealing with all of this information, so she should be able to let me know. I just hate to ask her, because I have a feeling she might judge me, or try to talk me out of it.

As far as my health goes - I did have high blood pressure at one time, but lately it has been normal. I do have chest pains daily - the kind that are sharp, and take my breath away. I found out back in July that I have high cholesterol. I also have shortness of breath ALL the time, except when sitting. Just walking down the hall makes me out of breath. In the past I have also suffered from depression, and have gone to therapists. Mostly dealing with my weight issues. (I'm not sure if these records are attainable, as these offices are no longer around.)

There is a history of health problems with my family. My father has type II diabetes, and his father also had this too. My father has had two heart attacks, and high cholesterol / blood pressure. He also has another heart condition, but I cannot think of what it is called. (Starts with an A). My mother is Hypoglycemic (sp?), and there is a large history of cancer amongst her side, and my father's side.

Unfortunatly - I have not really seen a doctor since I was about 19 years old - due to no health insurance. But there are records from before then.

I have tried many diets. No carbs, cabbage Soup diet, sugar busters, L.A. Weight Loss Clinic, and the Meical Weight Loss Clinic TWO times. Once when I was about 14 years old, and once again when I was 20 years old. I have also been on Xenical with no success. (Those who have used it probably know how yucky it can be!) Nothing has been able to help me. Lately I just feel as if I've been doomed to be fat.

But on a lighter note - I am SO HAPPY that everyone here has had such a great success with their bands! I am praying constantly that my insurance accepts this. This could mean a new, healthy life for me!

Once again - I thank you all for your replies. You are all VERY helpful, and supportive! I look forward to getting to know each and every one of you! I promise to keep everyone updated when I find out about my insurance! Keep your fingers crossed for me!

Thanks again!

~ Kari ~

[Alexandra 55]

Kari, it sounds to me like you shouldn't have any trouble making the medical case for surgery. And you don't have to ask your aunt about whether the surgery is covered if you don't want to. Somewhere you must have a copy of your insurance contract--ask your aunt for a benefit booklet if you can't locate it.

Then look for Exclusions. If you find the section labeled Exclusions you should be able to quickly determine whether bariatric surgery is covered or not. What you might very likely see is a phrase that says something like: "Treatment for weight loss is excluded, except for treatment of morbid obesity."

If that's what it says, or something like it, then the next step is to get to a doctor for a physical. Be sure they put the diagnosis of morbid obesity in your file and on your record. The code for this diagnosis is 278.01, and that number should be on everything for which you seek treatment starting as soon as possible. You want to make the case that you suffer from this medical condition and that treatment is necessary.

If your policy excludes all sorts of bariatric surgery you will have a different problem. Do you work for a company large enough to be self-insured? Or do you have an "off the shelf" policy from a major carrier? The answers to these questions will determine what your next move is.

[kari_berry 0]

Hello - thanks for the reply again

I did manage to talk to my aunt about it on our lunch. I told her a little bit about the procedure, ect...and asked her if she could find out if our insurance covers it.

She infomed me that on our company website - there is a complete copy of our benefit plan. She told me to look through it and see what I can find.

I've read through some things that I felt were important, via the table of contents. There was a section called "What Is Not Covered Under the Medical Benefit Plan?"

In that section - the only two things that stuck out to me were the following...

Services or supplies which are not medically necessary.

and

Charges for services or supplies which do not conform with generally accepted medical practices.

There was also a section titled "Pre-existing Condition Limitation (For Medical Benefits Only)"

And the one thing that stood out there was the following:

A pre-existing condition is any physical or psychoneurological condition regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six month period ending on the enrollment date.

There were no sections in the table on contents titled "Exclusions".

I guess the thing that worries me is the "Not Medically Necessary" part. All the insurance co. has to say is - is that this is not medically necessary.

All of this insurance stuff is foreign to me...lol. I haven't had insurance since I was 19 years old, and now that I have it...I have no idea what most of it means...lol.

I guess now is the time to learn.

As far as I know - we do not have an off the wall insurance provider. I work for a very large advertising firm. I know my insurance card says - "NGS American". I went to their website - and this below is what I found: (I'm not sure if this will help you identify what type of insurance I have or not).

"Since our founding, NGS has specialized in the administration of self-funded group health plans for companies whose business needs require significant flexibility. This diverse group has included employers in manufacturing, retail, private and public corporations, partnerships, governmental entities and foundations. Each group has presented individual challenges in both implementation and administration."

I hope that helps out a little bit. I still have some reading to do though.

Well - Thanks again so much for helping me out. This is a start I suppose!

~ Kari ~

[New Hope 37]

Kari, can you call your health insurance company direct and speak with someone? The contact number should be on your health insurance card. Best of luck! I know that you are ready to feel better and be healthier!

[kari_berry 0]

Hello New Hope -

I think I might call my insurance provider and find out. I am a little nervous about calling though. I just feel like they might tell me "no" when really it might possibly be covered.

Thanks again for the advice. I may call them tomorrow

~ Kari ~

[New Hope 37]

Hey, you don't have anything to "Lose" except weight and poor health! You probably can only reach them on Monday through Friday, normal business hours. And be prepared to stay on hold for a while. They may have to "get back with you" with the information. At this point, you don't have to give them specifics, you just want to know if the Lapband bariatric (or obesity) surgery is covered. I'm crossing my fingers for you!

[slenderella 7]

HI, I just wanted to encourage you to call your ins. co now!!!They were soooo helpful to me in my decision to do this....I have BC/Bs ppo, they told me that I did not have to be preapproved, gave me a list of the conditions that I would need to meet, she was very helpful...You do have to follow all of your Dr.s reccommendations, testing etc...my surgery was paid for after about 1 wk after surgery!!!!AWESOME. If one person tells you no, call back and speak with another to be sure. If they all say no ask to appeal, this is a life threatening situation and you need this surgery to stay alive and get healthy!

Good Luck, oh I'm in MI also, Armada near Romeo where the apple orchards are...if you need a GREAT Dr. let me know.

Nancy

[kari_berry 0]

Thanks so much New Hope & Slenderella -

I want so bad to pick up the phone right now and call my insurance company - but unfortunatly I am at work during the day, and I share a large cubical with my co-worker. Though there is a small divider to divide our space - there really is no privacy on the phone. She is the last person that I would want to know about this. I will have to do it on Monday while she is at lunch. No biggie. I am just going to keep praying that this is covered.

Slenderella - I am in S.E. Michigan - just about 2 or so miles south of Detroit. I *think* I've heard of those apple orchards before. My fiance' wants to go out there this fall.