Alexandra

Tropicana, it all depends on how well your doctor makes the case for surgery. It's not an arbitrary requirement--it's the national standard for what makes bariatric surgery medically necessary. If you don't have two co-morbidities, perhaps your doctor can establish that surgery is medically necessary in some other way. I'll bet you do, though, and don't even know it. I once heard a bariatric surgeon express the thought that anyone who is 100 lbs overweight DOES have co-morbidities, it's just a matter of finding them. You might be surprised what counts.

Liquids are liquids--as long as they have no bubbles, caffeine, or sugar they "count" toward your daily intake. But I've found water is just easiest--I carry around a water bottle and fill it up a couple of times a day. Get in that habit and you'll be fine!

Oh, Tammy, how awful! Strong vibes coming to you for peace and calm. What an ordeal for everyone. Thank goodness no one was seriously hurt...all else is just hassle. Please do see a doctor, though; you could indeed be injured and not know it.

To be an effective, participatory mom to my two children, and a happier, healthier me for myself.

Cathy, we can't advise you on whether your attorney is doing a good job. How much do you know about your insurance policy? How much do you know about the appeal process and how yours were mounted? Did you have any input into the paperwork? Have you spoken with the insurance carrier directly? It's always worth appealing but you shouldn't let anyone do it "for" you without reading over every word yourself. Your doctors have to be a part of it too. If your state has regulations protecting insurance consumers then you should know what they are. In general, if you self-paid for something you can put in a claim for reimbursement. Most carriers require surgical pre-approval, though, unless you have an indemnity-type plan (PPO or other non-HMO coverage). So if you have a managed-care plan and did not get pre-approval for the surgery, there are likely to be stiff penalties for that even if they do ultimately decide it should have been covered. So it may or may not be worth continuing to pay an attorney, or even putting in more time and effort now to get reimbursement. Good luck with whatever you decide.

Flower, you know you've seen it said before, but I'll say it again. Average means average over time. You can't expect to see the same amount drop off, week after week, week after week. It just doesn't work like that. Normal people lose weights in fits and starts. So wait three months, then look back and divide your total weight lost in that time by 12 weeks. THAT'S how you calculate what your average weight loss was for that time. Stick with it, and you'll do great!

Hi Chris! That is wonderful news. Doesn't it feel like a big weight has been lifted? I'm so glad all is in order for you. Now just get back on that horse and keep riding!

This is EXTREMELY good news for anyone dealing with insurance issues, and thank you very very much for posting it, Dr. Hekier! CPT codes are often guarded like national secrets, for some reason, so I know this will help a great deal. Do you know if there is a code for adjustments? That's presented problems for me in the past, with the same procedure being billed different ways on different occasions. it'd be great if there were a standard for it. I'm going to stick this thread in this section because it's really important information. Thanks again!!

That's what I thought, but I didn't want to say anything. Are we right?

Hi Tracey, If all you're experiencing is a taste in your mouth, that could be due to any number of things that have nothing to do with being banded. Reflux usually means a sensation of material--usually liquid, sometimes acidic but sometimes not--backing up into the back of the throat. Often it occurs when lying down, or maybe is only evident upon waking. There are lots of different degrees, but what they all have in common is that the esophagus is not pushing or keeping material down the way it should be, and the material "refluxes" back up. So if all you're feeling is a weird taste it may be something entirely different.

Just realize that a few months of waiting is a SMALL price to pay for a lifetime of better-controlled weight. Honestly, when you look back this will seem like an eyeblink. My wait was almost a year and now it seems like a distant memory--though I definitely can remember some difficult times. I just got through it by determining to think about something ELSE for a while. Stay calm, and it will happen if it's meant to.

Sue is right, you're not asking the right questions. It's not your insurance carrier's job to "offer" medical care. You and your doctor make your medical decisions; your insurer's only decision is whether they will pay for it. If your contract says that treatment for morbid obesity is covered (not just "obesity") then you are already well ahead of the game. Proving medical necessity is not a "loophole." Your doctor will have to make the case that your health depends on losing weight--and if your BMI is over 40 that will be a very easy case to make. THEN he has to make the case that lapband surgery is, in his judgment, the best treatment for you. If he's done other band surgeries and gotten insurance approval for them in the past, he'll know how to phrase his request. But you also have to write a letter and make a case that other treatments have failed in the past and explain why you believe this particular treatment is necessary. Get a letter from your primary care doctor as well. What state are you in? It's also a very good idea to contact your state department of insurance to find out what your rights are with regard to appealing your insurance carrier's decisions. It doesn't matter what happens with other Blue Cross organizations around the country, they have nothing whatsoever to do with you. And your plan, as an individual plan, may indeed have very different contract provisions than those of group policies. But don't give up! You are just beginning and must stay positive. We're here for ya!

That makes good sense to me as well. I've had fills "kick in" a good month afterward myself. Who knows why? Hormones, Water, stress, whatever. The reason it happens doesn't matter but it has to be handled once it does. Really stay on liquids this weekend, Angie. I'll bet by Monday evening you'll be feeling better and able to tolerate very small, well-chewed portions of food. Take it slow. Good luck!!

The point of the first fill is to make the SECOND fill more effective. IMO, it makes great sense to let restriction happen slowly, over a fill or two. Think about how difficult it would be to wake up the day after your first fill and suddenly be able to only eat a ver few bites at one sitting. Better to let your mind get used to the idea of lessened intake over several weeks or months. Why make it so hard on yourself?

Add me to the list of refried-beans devotees. I also loved hummus, tzatziki, salmon mousse, fish pates, and all the other fancy spreads and dips that are too expensive to buy on a regular basis. But when I was living on mushies they brought much joy to my life!

...then you have died from the uncorrected problem, not the treatment. There's just no logic in adding those deaths in with the treatment's mortality rate. In case you need to hear it, Sue, I think it's wonderful that you are posting this information and sharing your story. Please don't go away. It is absolutely true that banding won't work for everyone, and knowing the potential pitfalls and what the options may be down the road is CRUCIAL to making an informed decision. Thank you once again for sticking around. :)

Hey Allie, Go to the FAQs and References section and look in the thread called Abbreviations and What They Mean.

Sorry, I don't agree with this. Treatments that "fail" are not considered treatments that "kill."

Desertmom, no one will tell you it's OK to ignore symptoms for any length of time. Symptoms may already be an indication that something serious is wrong. TALK TO YOUR DOCTOR! An unfill may be all that's needed to resolve your reflux, but resolve it you must because it can damage your esophagus. You really don't want to go there if you can avoid it! Don't worry about getting an unfill. It really doesn't mean you will never have restriction again, never again be able to control your intake. It just means that you're taking good care of yourself, because right now your system is inflamed and you need to let it heal. Many people have reported that after an unfill it takes less re-fill to make them reach a good restriction level, so don't stall on that account. PLEASE take care of yourself, because band loss is what you want to avoid. If you have a situation that is unhealthy, that may be the next step. So go find out what's going on, and get it fixed! Oh, and an endoscopy may not be required just yet. I'd suggest an unfill first and see what that does to your symptoms. If it doesn't help, then demand that endoscopy.

Jonathan. It's good to see your face! The band is forgiving. It has not gone anywhere, it's waiting for you to make the changes you'll need to make to let it help you lose weight. Take a deep breath, and have a talk with it. And we're still here, too! Ready to listen and ready to relate. Go get your fill and then be very gentle with yourself. Physically and mentally gentle. You're not a failure and your chance with banding is not blown. You're back!

Yikes!! Thank goodness she and her family are OK!

The fact of the matter is, sweet tooth or not, having a band makes it easier to resist inappropriate amounts of food. Whatever the food is, if you eat less of it you will do better at losing weight. And not being hungry makes that easier. It is possible to eat around the band, of course, and if someone is obsessed with sweets they may be more inclined to do that. But now we're talking about eating disorders, not your run-of-the-mill sweet tooth. If you've been able to moderate your intake of sweets just by telling yourself you're on a diet, you'll be a great success as a bandster!

My goodness, aneffie, that really is unusual! I've had amazing customer service in the past, but flowers? That's really terrific.

Mel, a LOT depends on what your insurance carrier's requirements are. If your PCP already recommended bariatric surgery to you then you're on your way. Your PCP should be able to refer you to a surgeon in your network--even if formal "referrals" aren't required by your plan, getting your doctor's suggestion is preferable to picking a doctor out of the yellow pages. If your PCP can't help, call your carrier! You are looking for a bariatric surgeon, or a general surgeon who does bariatric surgery. Depending on where you are in the country and your insurance situation this may give you none, one, or many choices. Then you make the appointment with the surgeon and take it from there. Ultimately it's the surgeon who will make the formal request for precertification from your carrier, but he will need lots of supporting information from your other doctors. If you have multiple medical conditions this may be a time-consuming process, so get started. And good luck!!

Congratulations!! :(