Hampton Roads/Peninsula thread

[Trixie78 0]

Does anyone here locally have experience with getting coverage for WLS from Anthem Healthkeepers HMO? From what I've read, they'll cover it if my BMI is over 40 (or 35 with co-morbidities). My concern is that I will have to document previous weight loss attempts, and I've never been on a "medically supervised" regime. Any thoughts/suggestions?

edit: I did search the insurance threads, but was not able to find much specific to my insurance.

[Trixie78 0]

Well, DH just called Anthem for me, and it turns out we do not have ANY coverage for WLS. I am really sad now...I know there is no way we can afford to self-pay for this.

[WDW Luver 0]

Well, DH just called Anthem for me, and it turns out we do not have ANY coverage for WLS. I am really sad now...I know there is no way we can afford to self-pay for this.

Trixie, I am so sorry to hear this. You might try talking to HR . See if there is another insurance option you can switch to in the next enrollment period. Or if they would consider adding the WLS Ryder to the policy for next year. You may have to wait longer but at least you can get all your ducks in a row and be prepared if they do approve it.

[erinshel 0]

hey everyone! I just got banded on April 8th. I am up and moving around really well being 2 days post op. I am actually heading to Busch Gardens in a little bit with friends that are in town visiting. Granted I wont be riding much if anything and Im planning on renting a wheel chair to get me around for the day.

I am hungry but not so bad I can't stand it. I still have a lot of the gas pains in my chest, shoulders, and neck and minimal pain around my incisions. I think the gas pains are worse than anything else.

I hope I can find a great network for support here and the in person meetings from Dr. Clark and his office. Thanks!

[luvmy2dogs 2]

Hi! WELCOME Trixie and Erin and WDW. WOW! So many new ones since my last visit. hee hee Glad you all decided to make the lapband journey.

WDW: I never really considered gastric bypass, so I can't really say if one is better than the other. I know on my last visit with Dr. T, he made this comment. We (the bandsters) have an edge over the bypass patients in the fact that after the first year, the bypass patients have really lost what they are going to lose. Most lose all their weight in the first year. They can lose their restriction over time. With lapband, he said you will almost always have restriction. He said he doesn't have anyone to the max fill without restriction. He said he has a few teetering on the max, but none to the max. He said the band patients will always have restriction with the adjustments. Once the bypass patients lose restriction, it is lost. I know with band the weight loss is slower, but overall, I think it may be a more permanent choice as long as you follow the rules. You can certainly ruin either one of the surgeries if you dont follow the rules. Also, almost everyone I know that has had bypass has gained their weight back. But... I also know some that have gained it back with the band. It's all about the discipline. I've said so many times, this is just a tool, and you have to be able to make the lifestyle change for sure. You can eat ice cream or milk shakes all day and it will slide through your pouch nice and easily and you will NEVER lose weight. If you go back to your old eating habits, you will go back to your old weight. I don't know about anyone else, but I'm petrafied of that happening after I've come so far. There are also alot of other cons to the bypass, such as malnutrition, loss of hair, bone loss, etc... You don't have a lot of those problems with the band, as long as you get in your Protein and follow the rules. :-) I have a few close friends that had bypass, and the issues they had kept me from ever even considering it. I'm certainly not saying it's wrong, it just wasn't right for me. I'm sure millions have had healthy successful weight loss with it.

I love my band. It took me a long time to get to restriction, and it definitely has not been an easy journey for me, but I'm so thankful I was able to do it, and am so sorry for those that are facing insurance nightmares. I had one as well, and kept fighting it until they did approve the surgery. It was the best decision I ever made.

Trixe, definitely do NOT give up the fight for coverage. There are ways to get around it. Does your company have multiple carriers. Switch out if they do. Keep trying! Don't give up. Do what you have to do to get healthy! If they absolutely will not cover it, consider going out of the country. Many have done it and have been very successful! You can always go back to Dr. T for your fills. The surgery is 1/2 the price in Mexico, and hundreds of people on the forums have gone there. I hate to tell you to do that, as WLSC is so great, and I love Dr. T, but you do what you have to do.

Or... start your documentation process now. It's only six months of it. You can last 6 months, and you'll be ready for your surgery sooner than you think.

WDW, it's sad you have to gain 5 lbs to be eligible. Good Grief! Insurance Co's crack me up. What is a 5lb difference going to make in your health. They are so black and white with their requirements. over 40 bmi or nothing. Geez! So.. go to Dairy Queen and have a couple sundaes, and wear those weights under your jeans when you weigh in. lol

Erin, I'm glad your surgery went well. Busch Gardens two days after??? EEEEEEEK! I could barely walk my gas pains were so bad. How are things going so far?

Good Luck to all of you!

[erinshel 0]

Im doing really good! Ive been back to work all week and not having any major issues... A little bit of pain from sitting for long periods then standing for long periods then sitting again... not fun LOL

I actually started a blog if anyone wants to follow me on it to see my progress

www.erinschwamb.blogspot.com

I cant wait to get out to some of the support meetings and talk to some others that are working toward their goals!

[keamreeves 0]

Hello all just wanted to update you all to let you know where I stand at this point. I am done with all my insurance requirements you know psych eval, physical, letters from PCP, and nutrition consult. The pysch report whould be sent early next week to Dr. T's office and hopefully by the end of next week the paper work will be sent to Tricare Prime and prayerfully I will hear something by the first week of May so keep your fingers crossed and by the summer I will be a bandster. I will keep you updated when I hear something else about my status.

[jeremiahsmommy 0]

hello all from the Hampton roads area. My name is Crystal and I was banded june of 2008. I am really looking for a workout/support buddy in my area. I am the type of person that needs support when it comes to my weight loss. If anyone needs a friend like i do, please email me at jeremiahsmommy07@yahoo.com My best friend i was working out with bailed on me, and i really hate working out alone. Thanks guys!!

[WDW Luver 0]

Got my paperwork together mostly now. I got all my last 5 years of weights ready to go, it only took me 3 drs to get it all! I have the paperwork from Dr. T's office filled out so I will try to take all that over there maybe tomorrow. I have to reweigh since I needed to gain 5 pounds. I was doing fine and was at that mark but have had a stomach bug he last few days and am going to have give it a few more days to get some more liquids and food back in me.

I also need to get my letter of medical necessity from my PCP and will let him know tomorrow when DH sees him.

[keamreeves 0]

Still waiting on the psych eval to be sent to Dr. T's office they told me it would be sent eary this week (Monday or Tuesday) now they are saying the end of the week (Thursday or Friday) !!!! It is going to make me nuts I work for a doctor and I know the games this could have been done so please pray that I can keep me patience and not end up in the psych hospital. LOL !!!

[WDW Luver 0]

Still waiting on the psych eval to be sent to Dr. T's office they told me it would be sent eary this week (Monday or Tuesday) now they are saying the end of the week (Thursday or Friday) !!!! It is going to make me nuts I work for a doctor and I know the games this could have been done so please pray that I can keep me patience and not end up in the psych hospital. LOL !!!

LOL! That probably doesn't look good in the psych eval follow up that you went off the deep end waiting for the paperwork!

Who did you go to for the eval? What kind of questions did they ask? And have you done the computer assessment thing at Dr. T's office yet?

[keamreeves 0]

Yeah I know right that would not look good. I went to Dr. Harry Cole he was very nice and have to go first for the initial eval family history, medical history, etc. Then I had to go back for a 567 question test OMG I hate long tests like with the same question asked 3-4 different ways(head games). Then the last visit was to sit down and talk about the test and any areas of concern that showed up on the test and I passed now I am waiting on him to get the report together and sent to Dr. T's office and yes I did the computer test WLS too and that came out fine, it was not nearly as long. The questions on the big test were simple questions to determine if you anger issues, if you are a hyperchondriac, etc. just be honest the test can tell if you are trying to beat it.

[WDW Luver 0]

Ai, yi, yi, yi! That is a lot of tests! I just called and made my appt for a visit with the dietician and to do the computer test. I called one of the psychs and they said she is backed up over a month. Then another wasn't in, and the 3rd won't schedule me until after I do the computer test at WLSC.

So hopefully I should have all my paperwork together by Monday (except my letter from my doc) and ready to be turned in. And this stomach bug will be gone so I can get a nice BIG Breakfast and a large starbucks coffee and weigh in and hit the 40BMI mark!

Do you have to do a 3 mo or 6 mo supervised diet?

[keamreeves 0]

No I did not have to do a supervised diet. But I had the same run around the list WLS gave me for the psychs so I found one through my insurance company and so I have had eveything done just waiting for the darn report so they submit my paperwork to Tricare. I am trying to have my surgery done during a certain time frame because I am out of school for only 2 months and want to be completely ready when classes re-start in August.

[WDW Luver 0]

I initially really wanted to have mine done the week after July 4th because my kids will both be away at camp and it would be "easy" to do it then. But I don't think that is realistic at this point so I am just trying to be patient and hope for the best as far as when and how I will make arrangements for my kids.