Alexandra

Hi Sonia, First, I can tell you that in general Horizon BCBS is very band-friendly. Of course, if your company is a large company and has a non-standard plan, that decision is in other hands. Is yours a large-group plan? How many people work for your firm? If you have a POS then you definitely do need a referral. And, as I said, you'll need the physical no matter what. But it's not your PCP's job to decide whether you're a good candidate for surgery or what surgery to recommend. All of that lies in the hands of the surgeon. All you need your PCP to do is write the referral to a surgeon based on your diagnosis of morbid obesity and Dr.s Abkin, Bertha, et al will take it from there. I think you're in very good shape for insurance coverage, based on the information you've shared here. Your BMI is in the 45 range, so you don't have to show any co-morbidities to be diagnosed with MO. (A BMI of 40 is the benchmark.) In other words, simply being at the weight you are is reason enough to investigate surgical treatment. Don't let your PCP try to push you toward the RNY. It's premature to make that decision, tell her, and that's why you want to talk with a surgeon. BTW, do you have the handout from Abkin/Bertha's office? You'll want to have that before you see your PCP for the physical, so your doc will know what tests to order. You get that handout at their intro meeting, which I can't remember if you said you've attended or not. (Sorry--mommy brain.) Good luck!!

Hi Hillary, I literally can't think of any "little" things that have bothered me. When I try to think of the negatives of having had this surgery, there was and is only one thing. For me, the fact that I have permanently lost the ability to eat without restraint--a ginormous bowl of Pasta, for example, or gorging at a free buffet--is the absolutely ONLY negative thing. And whether it is negative or not is clearly a matter of perspective. It's the only thing that has ever felt negative, but it's during those moments that I realize this is exactly why I had to relinquish control over my portion decisions. I had no ability to manage them myself. It's a hard thing to accept, but one that I absolutely had to in order to save my life.

Wow, that really moves me! I remember saying the exact same thing to bandsters when I was investigating banding, too. I can't believe someone is saying to to me!! It takes patience and perseverance. Happily, those are the qualities that make for successful bandsters, so *getting* the band is good practice for *having* a band!! BTW, I forgot to mention about the meetings. Abkin/Bertha have a monthly BANDSTERS-ONLY support group that meets on the last Wednesday of each month at 7:00 p.m. There won't be one in December, I'm sorry to say, but we understand. Hope to see you in January!!

Unfortunately I'm a little pressed for time at the moment, but I can tell you this much. The information the doctors have on the site is general info for all insurance. Each carrier is different and has different requirements for proving the medical necessity of surgery. A history of attempts at weight loss is usually required, but in my case that was a written history without any actual "proof." So whatever your carrier says is what goes, for them. Have you seen a primary-care doctor yet, and been actually diagnosed with severe (or "morbid") obesity? That's pretty much a must, and if you go now for a physical (which will DEFINITELY be required no matter what) tell your doc that you want to start immediately on a supervised diet plan. The doctor will probably hand you a printed diet and say call us in a month. Most carriers require some type of doctor-supervised weight loss attempt in the last two years, but it might only have to be six months long. So get started NOW and before you know it the time will have passed. Start by calling your primary care doctor and getting that physical, your diagnosis, and your diet plan.

Hee hee!! Not anymore! :D

Paula, I agree with everyone else. I had one episode of this, with Water, and one was enough for me. The solution is to make good and sure your pouch is empty before going to bed--no food or drink for at least a couple of hours before lying down. Medication will help relieve the discomfort of acid refluxing up, but if it's food or drink prevention is key as well. Good luck!

Hi Sonia, Nice to meet you! Feel free to fire away with your questions. Dr. Abkin's practice has several banding doctors there, and though he was my surgeon I've seen Dr. Bertha on many more occasions. Dr. Goldstein, too, more than once. It's really a group operation. Have you been to their orientation session? That's the first step if you're considering their practice. Newbandster, how are you feeling? That was pretty recent, are you back to yourself yet?

I'm so glad to hear this went well for you! And you've now educated one more PCP who will be better equipped to talk with his next patient interested in banding. Good on you!

I'm not unemployed, but I'm employed in the wrong industry. For the last five years I've wanted to return to nonprofit administration--the right opportunity eluded me, and well, life goes on in the insurance biz. So today I had a job interview. Everything was amazing: wonderful people, amazing location, beautiful physical plant (restored estate house!), interesting work for a noble cause (environmental preservation), schedule flexibility, and on and on. But the money just wasn't there. I'd have had to take not only a 25% cut in salary but also pay 90% of my own health insurance premiums and 100% for my kids. And forget about bonuses or 401K contributions. :rolleyes So I feel like a sellout, after having wanted this for so long. I spent 15 years working for a nonprofit so I know about tight budgets. But we've been free of the need to pinch every penny for a while now and I just don't want to go back there. My current job is not bad, but it's nothing I'd like to make a career out of. Yet time being the way it is, I'll turn around in 10 years and find out that's exactly what I did. Three years from now, someone remind me that I don't really like my job, OK? Thanks!

Ditto, ditto, ditto!! Last-minute deals are always a red flag, and if you were counting on her to do something on her end you have every right to expect redress. I know how hard it is when business mixes with friendship, but you should NOT be left holding the bag.

Hi Newbandster, First, congratulations!! Second, yup, this is normal. It seems to happen to some degree to just about everyone at this stage. Think about it--if you're only taking liquids in, only liquids can come out! (Gross, I know.) If you're also having cramping or bad gas, you might want to call your doctor. Some people find they have a new sensitivity to lactose right after banding and that cutting back on dairy products can help. Have faith that it will pass (no pun intended) and once you start mushy foods things will improve considerably. Good luck!!

Hi Judy, I saw the text you posted in the other thread, and sure, that looks like an iron-clad exclusion. However, those benefit booklets are standard language, and are OFTEN overruled by riders to the contract or state laws. I'm an insurance broker and I see contracts all the time that include provisions that are illegal in New Jersey. The benefits booklet is just the start. For example, the part you quoted only talks about "obesity" as a condition. But "morbid obesity" is a DIFFERENT condition, and that exclusionary language might not apply if you have that diagnosis. Have you seen a doctor? Have you established the diagnosis of morbid obesity? The first step is always, no matter what, a physical examination by a primary care physician to establish the diagnosis. Then you see a surgeon (whether you need a referral or not will depend on your plan), and at that time you can further discuss your options. You'll have to establish a history of medical care for your diagnosed condition of morbid obesity and your visit to the PCP is step one. The bottom line is that if we expect the insurance carrier to treat MO as a condition that needs surgical intervention, we have to establish that we are making attempts to treat it in other ways. Surgery is always a last resort, understandably, and getting that medical diagnosis and a record of treatment is crucial. So that's where you start.

This section is the place to get firsthand accounts from patients banded by the doctor or practice you are considering. Have questions about the process? Bedside manner? Hospital food? Nurses? Post a new thread with the name and location of your doctor, and invite people with experiences to share to post. As Big Bird says, asking questions is a great way to find out things!

Hi Judy, I know exactly how you feel. When I first started looking into this, my insurance carrier explicity excluded the band itself, under any circumstances. I was so ticked and was ready to find a high bridge too. But all is not lost. A lot depends on what state you're in and what the regulations are. Is your company self-insured? Is the plan a standard one from carriers? Read your exclusions carefully--lots of them say treatment for obesity is excluded except with a diagnosis of morbid obesity. Some of them say surgery is excluded unless this, unless that, etc., etc. So don't give up, just keep researching. Find out who wrote the policy and whether your company has any ability to change its provisions. Find out who regulates health coverage in your state (department of health? department of insurance?), and contact them and find out what your appeal options are. There is widespread medical agreement that morbid obesity is a disease that requires treatment. And surgical treatment is a widely accepted option. You may ened up wanting legal assistance before you're done, but even if you can't afford surgery you'd likely be able to afford that. There is always another step to take before jumping off that bridge!! Don't give up!

Natalie, that's wonderful!! Congratulations!! Staying away from things you know will cause PBing is a good thing for you on MANY levels. Keep at it, bandster! :D

What an inspiration you both are! Wow, it's wonderful to see such success stories. Thanks for sharing!! :D

Hi Doug! I just posted to you on the other thread, but I didn't realize you were already scheduled. Wow, that's soon!! I had a challenge preparing my spouse (my kids are too young to worry about it), but he eventually came around. I'd definitely NOT recommend having your kids at the hospital; though it's only a half-day you still want to concentrate on yourself and not them. How old are they? Unless they're adults and can drive you and act as your support, I don't think having them there does you or them any favors. Morristown Memorial Hospital is a great place to have this surgery. You'll be home (depending on where you live) by mid-afternoon.

Hi Doug, Nice to meet you! I'm sorry I missed the November meeting but the weather was such that it just didn't make sense to go out. And sadly there won't be a meeting in December. But I'm DEFINITELY going to the one in January. As far as pre-op diet changes go, I don't think the docs make any specific recommendations for most people. Your mileage may vary, of course. And of course smaller meals are always a good way to go, especially since once your surgery is scheduled you'll probably experience "last meal syndrome" and start overeating. Anything you can do to avoid or counter the effects of that puts you ahead of the game. Have a good meeting tonight. Be prepared for an overwhelming number of RNY people and a presentation focusing primarily on that operation. But there are prospective bandsters in the audience so don't be afraid to speak up and ask your questions. And of course, come back here and ask whatever new questions come up.

Cat, if your coverage is through a NY company then the rules of NY state will apply. But they are pretty close to those of NJ so I think you're in good shape. I know of another Bertha patient who had Empire BCBS of NY and she had no problems at all with her coverage. Lauri, unfortunately states each call their own shots with regard to health insurance regulations. If you want to get authoritative information on your options, contact your state's department of insurance (or health, which may be the department governing health insurance). I wish i could help!

Michelle, I'm so glad it was nothing big!! We can all benefit immensely from your experience, and what a joy to hear that you're OK and doing fine. :)

Shmeier, you've gotten great advice here from wonderful people. I don't have much to add except that if you do NOTHING else try seriously chewing each bite to smithereens before swallowing. Then put your fork down for a count of five before taking the next bite. Eating that slowly and deliberately does a couple of things that could help: --making it less irritating to eat, and more enjoyable --slowing you down so you can feel full before taking that one-bite-too-many that might result in a PB --making your meal take more time and effort so that when you are full your hands and mouth can also experience the sensation of "enough" along with your stomach It is very hard to really internalize the changes banding makes on our eating habits. Believe me, I know. I've gone right back into gulping and taking giant bites now that I have almost no restriction after an unfill. And I've been banded a while. Successful weight loss with the band is a team effort--us and the band--and takes a leap of trust to allow it to teach us the right way to eat. You are not alone. But you can do it...we all can.

Hi Shrinking! We have the same doctors and I'm glad to "meet" you! Have you been to any of their support group meetings yet? Congratulations on your banding!! BTW, I can assure you that the state of New Jersey has a law that states that services provided in network hospitals all have to be treated as in-network. Rest assured, BCBS will have to pay enough of MIA's bill to satisfy them--you won't have any responsibility for the rest. "Usual and customary" does NOT mean you will have to pay the balance. Don't worry--you're in great shape with BCBS! And welcome to LBT!!

I too have heard of at least one other instance in which this happened. It's probably the rarest of the various complications...luckily it should be relatively easy to repair. Good luck, and please let us know how it goes!

Michelle my fingers are crossed for you! Good luck!!

Hi Sultana, When I had my symptoms they were very subtle. What it felt like to me was that food was sitting in my pouch for a while, making me almost uncomfortably full for a long time, and then suddenly it would go through. That's what I meant about having "new" restriction, since prior to that I'd been feeling perfectly normal and having no unpleasantly full sensations after eating. I didn't experience reflux at all except for that one nighttime episode with Water, and that evening I had drunk about 64 ozs of water in the three hours before going to bed. But when the doctor had me drink barium under fluoro, he used the word "refluxing" to describe the motion of the liquid. It was rising up a little before going down, although I didn't feel it happening. It does sound as though you're having some of the same issues to a greater degree. Good luck!!