Candle

I have Anthem BC/BS there's an exclusion on my policy too. I am canceling and taking out an individual plan with GHI (I think they are only a NY company) They cover the band and as long a there's no gap in coverage I'm told I don't have to worry about the weight being a pre-exsisting condition. I'm not completely convinced this is going to be as easy as it sounds but we'll see in a few months when I finish the doctor supervised 6 month diet and we submit to the insurance company ... *fingers crossed* Between co-pays, the shrink and tests not covered by insurance, I'm out about $750 out of pocket. I'm going to freak if GHI doesn't cover it. Plus I'll be stuck with their crappy plan until open-enrollment in Jan for my regular BC/BS policy.

I'm waiting for the sleep center to call me to schedule my sleep study. I'm a little nervous because my doctor scheduled a follow up appointment to go over the results of the sleep study, in 8 weeks. I hope it doesn't take that long to get an appointment. She said if I have apnea at a more than mild level I have to get a CPAP machine and do a second sleep study. Ugh!!

I just went today. They had me do all these breathing exercises and now I need to go to the hospital and get a chest x-ray. I'm waiting on the sleep study appointment(s).

Just got the explanation of Benefits letter on my surgeon consult ... I only had to pay the co-pay of $30.00!! Woo-Hoo!!

I've got a few apointments coming up. *fingers crossed*

I was just at my doctor on Tues and home was 7lbs less than at the doctor's office.

This is the reason for the exclusion on my plan (out of CT). Not my employer's "choice". (I bet it’s an EMPLOYER exclusion in the majority of cases though)

Anyone else?

Thanks I'm trying to work magic with the scheduling. lol

I can't see why an MRI would be a problem. The only thing that really messes up an MRI is steel or metal, right? Because of the magnets involved. I've had spinal surgery and have steel rods in my back so MRI's don't really work for me. I know if the rods had been titanium an MRI would be fine.

I'm so overwhelmed!! <O:p</O:p My job has been understanding so far but that patience is going to wear thin soon!<O:p</O:p <O:p</O:p Time off for:<O:p</O:p <O:p</O:p Surgeon consult<O:p</O:p Upper GI consult - then another appointment for the test<O:p</O:p Nutritionist<O:p</O:p Shrink<O:p</O:p Pulmonary Consult - then another appointment for the sleep study<O:p</O:p Cardiac Consult w/ EKG & ECHO - then another appointment for the stress test<O:p</O:p An appointment each month w/ my PCP for the 6 month diet<O:p</O:p <O:p</O:p Plus I just had some major dental work done to be sure my teeth are in perfect shape – chew-chew-chew. That’s been 4 appointments in the last 8 weeks!<O:p</O:p </O:p How do people who work a regular 9-5 M-F job do it? :help: <O:p</O:p Going to Mexico is looking better and better - lol</O:p <O:p</O:p

Wow! $1600! It's really amazing how everyone's experience is so different! Seems like every doctor does something different.

I haven't been banded yet but my doctor's fee for surgery includes the first 3 months of after-care and fills. I thought most did the same - free for 3-12 months. After that, I will have to self pay for my fills and doctor visits ... $75.00. My doctor doesn't do fills with fluro regularly but if they need to, I think they said the fee was $225.00 I live in Long Island, NY ... I thought THIS was the most expensive place on earth - lol. You are in NJ? In all my research I have never seen anyone say their fills were $1,000.00!!!!

As I posted in your other thread - I have Anthem as well but there's an exclusion in my policy so they cover nothing The first 2x I called Anthem they told me they DID cover the band then when I called to get details on requirements and if I needed the 6 month diet, they finally got it right and told me I'm NOT covered. Make sure you give them the CPT code and get a definite "YES, you are covered." Good luck

I agree completely.<O:p</O:p <O:p</O:p All the problems I have encountered with insurance have been making me think about once this is all over, looking into ways to help fight insurance companies from excluding/not covering WLS surgery.<O:p</O:p <O:p</O:p Fighting for change in insurance procedures is probably a lost cause but there has to be a way to make them realize that in the long run, it's cheaper to provide coverage for WLS than to pay for all the mental and physical ailments, diseases, disorders, medications, etc that are related to obesity.<O:p</O:p

Where do you live? That will play a role in how much the surgery costs. (In most cases) <O:p</O:p <O:p Are you in CT? Someone on this board was telling me about a doctor in Hartford who only charges around $11,000. I checked and he's on the Anthem physician list. (I don't know anything about his experience or reputation though) <O:p</O:p <O:p</O:p Seems like on average the surgery is any where from $18,000 - $25,000.00. Plus or minus about $5,000 <O:p</O:p <O:p</O:p I would call Anthem [ :rolleyes aren't they just soooooo pleasant and helpful? :rolleyes ] and ask them to explain exactly what that mumbo-jumbo means. Sounds like you'll end up having to pay the full $2500 <O:p</O:p <O:p</O:p Self pay can be as cheap as $7500 in <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:pMexico</ST1:p</st1:country-region> or $9950 in <st1:City><ST1:pDenver.</ST1:p</st1:City><O:p</O:p

Let me know if that works out for you - I may be in the same boat if insurance doesn't work out. I will have had all the pre-op tests completed before I know if I am denied.

capitalone.com > tab for: health care finance > cosmetic http://www.capitalonehealthcarefinance.com/cosmetic/ Quite a few people here have used Dr. Kirshenbaum in Denver. There's a huge multi-page thread on him in the doctor forum. Good luck (remember to write off your medical expenses on your taxes next year!)

I have Anthem as well but there's an exclusion on my policy, so they don't cover anything Did you ask if they cover fills? (I forgot to ask that)

I've watched a few proceedures on or-live.com and in each one, the doctor stood on the side - not between the legs.

Sorry to hear things didn't work out with the insurance - at least you know you did EVERYTHING you could! You really have provided some great resources & information in the insurance forum for people in need. That said ...<O:p</O:p <O:p</O:p I have researched self pay options because I am nervous about what will happen with my own insurance. If I have to go self-pay I would go to Dr K in Denver. <O:p</O:p<O:p</O:p I've emailed with one of the girls in his office a few times and she was really helpful! They charge $9950 total. I think 3 months of after care and fills are included. I forgot to ask but I think it's been posted here that fills are only $15 after that!!! (I could be wrong - sounds too good to be true, right?) If you need to finance, they do not accept Capital One but they do have their own financing option. Care Credit? I haven't looked into the rates or terms of this "loan" .... I would think nothing is going to be as appealing as the medical Cap One program at 1.9% interest for up to 5 years.<O:p</O:p <O:p</O:p For Mexico</ST1:p options, Dr Ortiz seems to be the stand out choice!!! <O:p</O:p <O:p</O:p

My mom told me that about 1/2 way through 1st grade, my teacher told her that she thought I was getting chubby. My mother said it took her a few months to agree. By 4th grade I was FAT. I remember being soooo embarrassed when my mom made me get a training bra near the end of 4th grade :cry I had 2 spinal surgeries for scoliosis when I was in the 7th grade. I know that I weighed 160lbs when the process started. After being in the hospital for a long time and having to be home schooled, with limited mobility while healing ... I was just over 200lbs when I started 9th grade. Plus the fusions on my back meant I wasn't going to grown in height any more. I'm 5'4" which is only an inch taller than I was before the surgery. My sister is 5'9" and my brother 6'1" - lol (I only know these exact #'s because I have my surgical records.)<O:p</O:p <O:p</O:p I blame part of it on genetics, my brother and sister and a few of my cousins, aunts and uncles were/are larger. Polish family - lol. Plus my mother’s weight always went UP and DOWN ... usually one extreme or the other. She didn't set a good example for diet & nutrition. She was a bad cook (lots of hot dogs, mac-n-cheese, pizza, ice cream etc) and never really pushed any of us to play sports or even play outside.<O:p</O:p <O:p</O:p The other part of my weight is depression and just being a lazy adult. Since I'm placing blame - lol - I'll also blame drinking too much and smoking too much pot in the past - lol - stupid munchies!<O:p</O:p <O:p</O:p I really have no idea what I will look like "thin" ...I'm more worried about my mental state *if* I am actually ever able to get to a "normal" weight. I wish my insurance covered mental health - I think the band is going to force me to deal with some of my "issues"<O:p</O:p <O:p</O:p *sigh*<O:p</O:p <O:p

Be sure there are NO gaps at all. I've read stories from more than one person that 5 or 6 weeks went by between vistis instead of 4 and they had to start the 6 months all over again!! I'm on month 2 of the diet and my doctor is just recording my vitals and making notes about what I am doing to lose weight. Low calorie and low carb work best for me (I have PCOS and low carb is the only way to lose weight) and recording my exercise. My surgeon has a form that she simply fills out each month and faxes to them.

I've chosen the band just as much to help me lose the weight, as to help me KEEP IT OFF! It's normal to have doubts ... you'll do fine I'm in the same place. I weigh about the same as you and anticipate being banded in Aug. (stupid 6 month dr supervised diet for insurance) In the last year, since I started working at home, I've gained about 25-30lbs. That put me over the 300lb mark and is what has put me over the edge. I am soooo uncomfortable in my own body right now. Me and my SO talked about vacations for this year and decided to save our money and take a REALLY nice vacation next year instead. We went to New Orleans in October and I was miserable. Too tired to walk very much - uncomfortable on the plane - ate and drank too much while there. Our last vacation before that was Vegas in April. I wasn't quite as heavy but still had all the same problems. The walking killed me - I was too uncomfortable to get massages or be touched at the spa - didn't want to wear a bathing suit, so no going to the pool - hot and sweaty being in the desert heat. I have the same thinking as you about not putting my life on hold but I haven't enjoyed our last few vacations anyway so, I'd rather wait. My SO is taking a trip with "the guys" in May anyway so he's ok with waiting. (and he understands) I really want to get the ball rolling on diet and exercise (but don't want to lose too much on this supervised diet either) We're looking to adopt a dog right now - I hope that will get me walking more at least!

I've read on here, that there a few docs in Mexico that do it for anywhere from $7000-9000.00 There's also one in CO that does it for $9500.00 Depending on the reason WHY his plan doesn't cover it ... you may also try getting an attorney. Good luck.