Alexandra

Katie, you are NOT WEIRD!!! :D Mushies seem like the greatest thing since, well, sliced bread after a week or so of liquids. Now is the time to explore the pate section of your local deli! Try to focus on Proteins so you don't get too hungry (and be tempted to gorge), and DON'T worry about counting calories at this point. Remember, you're still healing even though you're feeling better, and your stomach needs to rest. So stick with the mushies and keep yourself satisfied. Solids will be here soon enough, and they you'll start worrying that you're eating too much. (Normal, normal, normal!) Welcome to bandland. You're on your way!

Zoe, I LIVED at Trader Joe's on my mushy phase. I splurged on all the fancy spreads, pates, and cheeses that never before seemed like good purchases. My favorites were tzatziki (a yogurt concoction), and the seafood pate. YUM!!

Hi Kari, I went to my doc with the same request, and to my surprise she refused to prescribe something! My PCP is an osteopath and with her, drugs are the last resort. She just didn't think there was anything on the market that was safe and effective enough to prescribe. Let us know what your doctor says.

I was thinking of you today, Donali. I hope you and SO have a wonderful weekend and a great time feathering your shared nest. It's an exciting time, fer sher, and I wish you both the deepest happiness. And lovely evenings on the porch!!

Hi Shireen, There's no such thing as a "normal" first fill. Doctors have their own approach and some like to inch up on restriction while others go for it right away. Talk to the doctor about your not being able to get back frequently, and maybe he'll agree to give you a fill that will give you good restriction from the start.

Hi Cindy, First, let me say WELCOME and I'm so glad you came here and posted. I've been needing the same sort of wake-up call that you came here asking for, but have been hesitating about posting it. Thank you, thank you, thank you! I'm not gaining, but I have been very much slacking off on even remembering that I am trying to lose weight! The good news about that it that it shows it IS possible to not be constantly aware of oneself as a WLS patient--simply take a vacation, as it were. And when we're ready to take the bull by the horns again, to refocus and reapply ourselves, the band will still be there ready to help. So I'm ready!! I'm going to agree with Michele wholeheartedly about Protein for breakfast. I think if you make that one little change you'll be amazed immediately at what a difference it makes all day long. If you like the sweet stuff go for a Protein Bar and try to eat it slowly. I break the no-liquids-with-food rule for breakfast and eat my protein bar with coffee sips to cut the sweetness, and by the time I'm done my stomach is really FULL. And it really sticks with you MUCH better than cereal. So try to do that at most meals. Just think "protein first" as often as you can. I can't tell you to avoid carbs, but I think you'll find yourself doing that naturally as you fill up on protein and denser foods. It's a first step, anyway!

Kari, with your BMI of 53 the medical necessity part is, as Sue said, a no-brainer. No insurance carrier or PCP would try to say that a BMI that high does not require treatment. It's worth getting some info on banding for your PCP, but don't go in there all defensive. My PCP had never heard of it but was happy to read Inamed's patient booklet (which you can download from www.inamed.com). At this point you don't, I think, have to convince your PCP of the technical virtues of the surgery from A to Z or point his way to abstracts, etc. There will be time for that later if he's really balking. Your PCP's role is to attest to your battle with obesity and bear witness that other methods of control have not worked. If this is your first physical with this doctor, that's the information you need to be armed with more than anything else.

It's not supposed to be this painful, Bebbly. I definitely recommend calling your doctor for a slight adjustment. Better to have a slight unfill now than have major problems later!!!

Kari, your state's Department of Insurance can tell you if there are state mandates about coverage. It might also be under the Department of Health, but either way the information should be readily accessible. I know in New Jersey, there are lots of mandates about coverage for small groups, but almost all bets are off when it comes to large-group coverage. To find out what the situation is in your state, visit your state's website.

Kari, no, there's no reason to get a referral from your PCP to a surgeon if your insurer doesn't require it. "Referral" is a specific word with a specific meaning in the insurance world, and if you have a PPO it's just not relevant. Your PCP will have to be on board, though, if your insurer wants more than your surgeon's word that treatment is medically necessary. Most carriers do need a letter from the PCP attesting to the patient's overall health and weight history, etc. So definitely go through with that physical and make sure your PCP makes that all-important diagnosis. If your PCP puts in a claim for the appointment, that diagnosis code will show up and that's just more ammunition for you.

Kari, you are more than welcome. You're so smart to be asking these questions and not letting one reading of a muddled benefit booklet scare you off. Good for you!!

Yes, you should write it all down. My list of failed diet attempts was three pages long. Start making notes now of your weight history, diet attempts, results, and aftermath. Like so: "1981-2: Weight Watchers for 9 months, lost 20 lbs, gained 40 back in the next year. Ended 1982 at 250 lbs." You have to be proactive here, but the exact next step depends on your insurance plan. You'll need to identify an appropriate surgeon no matter what. (You can do that in several ways--I started by searching Inamed's list of banding doctors to the list of participating surgeons in my carrier's network.) Then, if your plan requires referrals, ask your PCP for a referral to one of the doctors you've found who does banding surgery. Once your PCP has recommended bariatric surgery for you and you've found a good surgeon, the next step is to meet with that surgeon. It's your surgeon's job to request precertification for surgery from your carrier--not yours. Yes, these seminars are designed to educate the patients quickly and efficiently. Some doctors make them mandatory (like mine, for example), but it's a one-shot deal. It's not a consultation and is not personalized. You will need to make an appointment for examination with the surgeon. There's no "process" with the insurance company yet. Your first steps are to get medically assessed and have the surgery prescribed for you, and that alone will take some time. It's not until the surgeon has made his determination about you as a patient that anyone makes any formal requests of the carrier. Any medical visits you have should be handled like any other medical care you receive--just do what your carrier requires per usual. Start with the physical and see what's next. In my case, my PCP first recommended an evaluation by an endocrinologist, because she found evidence of hypoactive thyroid. So there was treatment for that. There were followup visits, and so forth. All of this takes time, but I made sure that every doctor I saw knew I was trying to tackle my disease of morbid obesity. That was the condition for which I was seeking treatment. I didn't make the decision to have surgery; that was recommended by my doctors BECAUSE other things had not worked. Getting your carrier on board involves getting your doctors on board FIRST. So start there. And keep us posted!

Tall Guy, there may be isolated instances of US insurers reimbursing people for Mexican surgery, but on the whole it's not common. Most US insurance policies explicitly exclude non-emergent treatment received in other countries. If you have a carrier that covers treatment for morbid obesity, and you can qualify on medical grounds, you have a good chance of getting surgery in the U.S. Good luck!!

Hi Kari, First, what you've posted seems contradictory. In one section it seems to go straight from a list of what is covered to a list of exclusions. This looks like a list of what IS covered, right down to the line I've marked: HOSPITAL-INPATIENT MEDICAL CONDITIONS Hospital inpatient charges are covered as provided below. Hospital confinements should be verified through the hospital verification system. Days of care that are not verified will require documentation of the need for inpatient care in order to be considered. FOR: Admissions for a covered surgical procedure, an illness (including pregnancy) or the medical treatment of a life-threatening medical emergency or an accidental bodily injury Hospital room and board charges for a semiprivate room, coronary care unit, intensive care unit, special care unit and isolation Hospital extras during a covered hospital confinement Charges of a skin bank, bone bank and other tissue storage banks Prosthetic appliances, either surgically implanted or external Confinement solely for physical therapy for rehabilitation following a hospital confinement for the same illness or injury Hospital confinements for laboratory testing and x-rays when medically necessary due to a concurrent hazardous medical condition Respiratory therapy by a licensed respiratory therapist ==>Charges for a private room in excess of the semiprivate room rate ==> Rest cures... Those two lines and everything BELOW that would seem to be things that are NOT covered, at least in most normal plans. If that's reproduced correctly, I think you should question the accuracy of your documents. Secondly, that phrase "unless morbidly obese" is your key to everything. It represents a loophole through which you can jump right into banding. Your doctor will declare that you ARE morbidly obese and surgical treatment is necessary. He will very likely have to make the case that other treatments have failed and are likely to fail again (that's why you'll need a detailed diet history), and that you are a good surgical candidate (that's why the physical and pre-op testing). Based on what you've copied here you are still in the dark because it's self-contradictory. I think your next step is to call the carrier and ask for clarification of the surgery exclusions. Mention that you see the qualifier "unless morbidly obese" and that you want to confirm it is true.

Sheena, eggs are fine at any time IF you can eat them. Some people can, even after a fill. I haven't been able to since the day of banding, no matter what time of day it is. I've tried and tried. It's a very personal thing, evidently.

Kari, when you're at your doctor's for the physical just tell him or her what you're hoping to accomplish. With a BMI of 53 you really won't have any problem meeting that medical-necessity yardstick, and if you tell your doc to give you the diagnosis I promise you he or she will. The code may not actually appear on anything YOU read, but if your doctor is an in-network provider his office will have to code everything in order to get paid. Just mention that you definitely want that code and/or that diagnosis in the insurance record.

Angel Eyes, I'm with everyone else in not having much negative to report. But I'll throw one 'bad' thing into the pot. I was a quantity eater and it didn't take long to accept the fact that pigouts are over forever. FINE!! That's what got me here and I'm happy to give them up. But even at over a year out, there is still one thing that catches me up sometimes and makes me a little sad for days past. Breakfast. I miss weekend breakfasts of eggs with all the accoutrements. My husband is a cook and would happily whip up eggs Benedict if I wanted, and he often did. But now I have the combined issues of being tight in the mornings PLUS never being able to eat eggs, and that pretty much kills breakfast for me. Most days, of course, that's not a problem at all. Protein bars in the car on the way to work do me JUST FINE, since I never had time for breakfast anyway. It's just the weekend mornings that I miss it. Like today. But that's just about the WORST thing about my banding experience. And in return I've been liberated in ways I haven't yet even realized. I can live with it.

Kari, the good news is that just about every state in the Union understands that MEDICAL decisions shouldn't be made by your insurance carrier. It's your DOCTOR'S place to make the "medically necesary" call, not your insurer. Sure, they might say he hasn't made the case sufficiently to convince them to cover surgery, and that's their right, but then all the doc has to do is supply more information. The American Medical Association has published guidelines on diagnosis and treatment of just about everything, and doctors and insurers rely on those guidelines. According to the AMA, Morbid Obesity is DEFINED as a set of conditions (BMI over 40, or BMI over 35 accompanied by two co-morbidities) that if present, require treatment. That's why you often see exclusions worded as I described earlier. So, if you have the condition--and that diagnosis code of 278.01 is present in your record--you really can't be told treatment is not medically necessary. I think you're in very good shape, insurance-wise. Get thee to your primary care doctor for a physical as soon as you can and open the conversation about bariatric surgery. Your carrier might very well require evidence of prior dieting experiences, or at least one more attempt at a doctor-supervised diet of six months or so, but nothing will ever get off the ground unless you get that physical. Keep us posted!!

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.

Ryan, I'm with everyone else in being glad for you that your ulcers were diagnosed now rather than later. That's what all the pretesting is for, people! Much better to find minor things now and have them treated than to have your surgeon discover something while you're on the table. Imagine waking up after all the preparation and fear, only to find that not only are you not banded but they discovered something ELSE is wrong! Brrr. Have a great, mind-clearing time at the Lake. I'm jealous.

Kari, one of the reasons I fought my insurance carrier for almost a year was that I was VERY concerned I could get local care. Having a proper level of saline (or "fill") in one's band is crucial for success. A band that's too loose does no good, and one that's too tight can lead to problems. Cautious as I am, I felt it was necessary to be close to a doctor who would be able to competently adjust my band as often as might be necessary. At this time I think it's most common that banding doctors themselves do fills. There are some practices where adjustments are done by another staff member--a nurse practitioner, for example--but those are rare and seem to be limited to those practices who have been doing banding the longest. So while it doesn't have to be the exact person who did the surgery doing the fills, it does need to be someone very familiar with the process. That means a banding surgeon rather than your internist, for example. As to how many adjustments you might need, well, that's very individual. An average during the first two years seems to be 2 to 5 or so, but really there's no way to predict. If one seems slightly too tight there's little recourse than to have some Fluid taken out, and that's an adjustment as well. So wherever you get banded, BE SURE you have easy access to a COMPETENT person for adjustments. I think that's absolutely crucial, not just for success but for general security and peace of mind as well.

Gail, I'm so glad you're feeling better! What a difference .25 can make, huh? This is the phenomenal thing about the band, folks. Minor issues can usually be resolved by minor procedures. And we're back on our way in short order. Yay!!

Thanks, Donali and Sue, for posting that information!! Not that it does anyone much good, I guess, but it's really nice to know the infection is responsive to antibiotics. Yet another argument for handwashing...

Good luck, NancySmiles (love your handle!!). Good luck and best wishes for a smooth surgery and recovery! :D

Normal, normal, normal, normal. Don't worry!! You're doing great and the fact that you're hungry is a GOOD sign about your gastric health. Patience!!