Alexandra

Mine was realizing that I was putting my two littls girls' lives in danger by not being able to chase after them. There was a horrifying moment where one of my daughters started running down our little street toward a busy avenue, and I started chugging along after her. But I wasn't catching up to her on her little 2-year-old legs, and my husband came racing down off the front porch to grab her before she got there. I was thunderstruck that I would literally be unable to save my baby were she to try that again when he's not around. That's when I started looking.

I don't think it is based on "safeguarding" the public's health. It's based on risk/benefit analysis, which is why it seems so way off for banding. The years of RNY and other bariatric surgeries are the body of experience they use to calculate such things. It will be several MORE years and MANY more banding patients will have to be studied before any changes are made. IMO, there should be a huge divide between RNY qualifications and those for banding. The current guidelines don't take into account the exponential difference in risk level. Someday, we can hope, they will.

I'd be willing to bet that BCBSCA will cover you, but maybe after a year or two has passed since surgery. And they might want to exclude complications related to surgery. But I agree, your overall health has improved to the extent that you should be insurable. Also, not every state has this type of medical underwriting. New Jersey and New York have guaranteed-issue individual health policies, for which you cannot be turned down. I swear, the range of rules about this sort of thing is horrific, and what makes ANY conversation about "national health insurance" an utter joke. Unless a decision is made in Washington to standardize health insurance rules from state to state, it will never get any better. :angry (Pet peeve of mine, can ya tell?)

Sherri, medical expenses are medical expenses, no matter where the money was spent. The money spent on surgery and even the travel to get there is deductible as such, to the extent that any medical expenses would be deductible. (I think that is to the extent that the amount exceeds 7.5% of your income, or something like that.)

Congratulations!!

Cashley, you're right that the opening post didn't mention insurance. I'm sorry, I just assumed that's what Wheetsin was talking about. Oops!! As far as nudging the "system" to get a band if one isn't MO by AMA's standards, I see it as absolutely no different than any other service that can be purchased. There's nothing "immoral" about having a lot of money and wanting to better oneself surgically, if you can find a doctor who will do it. If one won't, there is always another who will. If you're self-pay and want to lie to your doctor to "qualify," your doctor equally wants to be lied to, believe me. He's not fooled by a couple of rolls of quarters in the pockets, not really. I imagine Inamed and medical oversight boards are the parties to which he'd have to justify a given procedure, if he were asked, and of course there are always liability issues. But in the end it's a judgment call by the doctor, and they're human.

Operative words: if they truly need the surgery. YOU may feel that at a BMI of 39 you "need" bariatric surgery, but you were otherwise perfectly healthy. At that BMI, the entire medical establishment agrees that surgery is not routinely indicated for healthy people. And it's those guidelines that the insurance industry uses to make determinations. (Doctors, of course, can and do make other determinations for self-pay patients.) As I said, a line simply must be drawn somewhere, and that's where it's drawn. The line may change in future, as evidence mounts that prevention is more efficient than the vastly more expensive treatments obese people need. But for now, it is where it is. Maybe you weren't as healthy as you thought, though. If diabetes is indeed in your future, you might have tested now for a pre-diabetic condition and that could have served as a co-morbidity. If you have a family history of diabetes, hypertension, or hypercholestemia, those would also have served. But for the purposes of insurance coverage, perfectly healthy people who happen to have BMIs of 39 really don't need insurance to cover their surgeries right now. There are other, sicker people in line ahead of them. And that's the way it should be.

Yep, I agree with bandedmama. It's a medical diagnosis, not meant for social usage. Hell, I would NEVER have characterized myself that way, but I completely accept that having a BMI of 47 placed my life in mortal danger. My obesity was a disease, and that disease was causing an increased chance of dying. Quite plainly: morbid.

Hi Debi, I think doctors have preferences, just like patients and insurance carriers do. But this is a decision that ONLY YOU can and should be making for yourself. Put everyone else's experiences and biases aside--they do not matter for this, your first step. Think about your eating habits and your relationship to food. Weight loss will occur with either surgery as long as you make the required lifestyle changes, but they work in very different ways. Banding keeps you from eating too much at one sitting--you will have to learn to live with that and you will have some time to do so. The adjustability of the restriction allows you to go at your own pace, and there is a significant learning curve involved. RNY keeps you from eating too much AND keeps you from absorbing much of the nutrition in what you do eat. You will have to adjust to the changes immediately, and compensate for the decreased nutrient absorption for the rest of your life. Not everyone with RNY is nauseous all the time, but there is indeed a significantly higher risk of complications. Think about your eating habits now and whether you will be able to manage eating less. There are a million ways to look at it, but only you can examine your personal behaviors and preferences to see how they fit in to the big picture. Keep asking questions, and good luck!

Cashley, we're not talking about whether a doctor will do the surgery on someone with a BMI of 39; that's a professional decision any doctor has the right to make. You can ALWAYS find another one who will. The question at hand is whether it's right to deceive an insurance carrier into footing the bill. And I believe it is not right--it exacts a toll on society at large. Insurance fraud, because it's so rampant, hurts EVERYONE. Earlier I said that for someone with a BMI of 36 who is otherwise perfectly healthy, bariatric surgery is not medically necessary. I should amend that and say that it's not medically necessary for the purposes of insurance coverage. It may indeed be advisable for the person to be banded; that's a medical decision she and her doctor should make. But *I* certainly don't want to pay for a surgery that, according to the rules currently in place, is considered cosmetic. But no one is saying that anyone who wants one shouldn't pursue getting banded. It's just a matter or whether insurance--i.e., someone, everyone ELSE--pays for it. And for that, there MUST be lines drawn.

Then you should call the department of insurance or the department that manages HMOs in California. I'm sure the person you spoke with was giving you the party-line reaction to RNY surgery, and it may be that the medical underwriters take a different approach to banding. Find out what the law says they can and cannot write out. You really just won't know until you apply. No one is going to give you a blanket *yes* or *no* beforehand. If the state doesn't have rules of guaranteed issue individual health insurance (like NJ does), they can exclude for medical reasons. But the BCBSCA website made it look like there would be other options even so, whether it be higher premiums or condition exclusions or whatever.

You can go to your User Control Panel (User CP) and click on Change Options or Change Username. I know it's in there somewhere and you can just change it without re-registering.

Talking about nudging the system is a bit specious. It is never a matter of 5 lbs or 1 BMI point that keeps medical necessity from being established. People just don't get declined for this sort of reason if they truly need the surgery. I mean, if someone has a BMI of 36 and is otherwise perfectly healthy, then no, surgery is NOT medically necessary. If someone's BMI is 38 or 39, they probably DO have some accompanying co-morbidities that would "nudge" the case into qualifying territory. Bottom line: The surgery must be medically necessary for a carrier to cover it. Between the patient and the doctor this determination can be made. Fooling a doctor or lying to the carrier is NOT the way to do it. Being honest with ourselves and our doctors about our health is the very first step in the process, and the medical necessity will be provable if it's there. Believe me, I'm not one to defend insurance carriers. But they must follow medical guidelines and draw lines somewhere. The system requires rationing, which is true in countries with universal health care as well.

These rules vary considerably from state to state. I doubt California allows that sort of exclusion, but you'd have to check with the insurance laws in that state to be sure. (I just checked out the Blue Cross of CA website and they are actively marketing individual insurance. There is medical underwriting, which means they can decide to charge people more who have significant medical conditions, but they DO cover treatment for morbid obesity so they probably don't exclude people on that basis.) Visit bluecrossca.com for more information.

Unfortunately, our healthcare system invites this sort of skullduggery. Lines are drawn and treatment is given or not given based on these lines, rather than on the judgement of medical professionals. As a health insurance broker I encounter this sort of thing all.the.time. It's never OK in my book. If there is a legitimate medical reason for a treatment and a medical professional can make the case, carriers should pay in accordance with the contract. If the decision isn't what we want, there are avenues for appeal. There's never an excuse for lying or cheating, and it's completely unwise as well--if fraud is discovered, the least of what can happen is being held responsible for paying back the paid claims.

Yep, I'm down there on the lower left, too. No surprise to me! Economic Left/Right: -5.88 Social Libertarian/Authoritarian: -5.90

I take Synthroid for my hypoactive thyroid, and as far as I can tell it hasn't gotten in the way at all. As long as your thyroid levels are regulated you should be fine.

5'10". See sig. :cool:

When you go out to eat at an Italian restaurant what do you usually eat? chicken tortellini soup; eggplant parmesan; veal piccata or francesca When you got out to eat at a Chinese restaurant what do you usually eat? Eggplant with garlic sauce; shrimp with lobster sauce; egg drop soup; chicken with whatever sauce When you go out to a Seafood restaurant what do you usually eat? Sashimi!! Whenever I get the chance. Otherwise, poached fish.

These are feelings that differ from person to person, Nellie. As Morsaille said, it's times like these that the band is doing its job! If we want to get away from morbid obesity, we have to EAT LESS. There is just no getting around that. If we're not prepared to do that on a regular, consistent, permanent basis, WLS surgery is a huge waste of time and money. Being banded makes eating less easier--PHYSICALLY. But it's not able to erase the mental attraction or compulsion that some people may have toward food. Personally, I found it MUCH easier to just walk away when I was no longer hungry; being banded created a feeling of fullness in me that let me put down my fork before I'd eaten the house. But not everyone finds that to be the case, and only you can know if being banded will do it for you. You have to be completely honest with yourself and decide if you are ready to walk away from the table. If you're not ready--and it sounds like your friend wasn't, not quite--I think you're right to wait on surgery.

Musis, you are having reflux. If this is the first time you're having it, you may be able to manage it with behavioral changes. Propping up the bed is a good idea, and not eating OR DRINKING for several hours before bed should also help. It's odd that it happens some nights and not others. Can you figure out what the determining factor is? Are you having an allergy attack those nights, for example? Any specific foods that set you off? If it doesn't seem to be getting better, or is getting worse, DEFINITELY call your doctor. It may be that you've irritated your esophagus or stoma, and this won't get better without treatment. You should stay on liquids for a while, really baby yourself, and perhaps get Prevacid or some other med to help things settle down. And of course, a small unfill can help. Don't panic, but DON'T ignore your symptoms. They mean that your food is not going all the way down, and that your relaxed muscles while sleeping allow what's still in the pouch to reflux back up. It's not necessarily a slip, but that is indeed one possibility. Find out why it's happening and you should be just fine. Good luck!!

Oh, my, Penni, what a shock! Best wishes to her for a total recovery. My thoughts are with her. Fingers crossed!!

My PCP had never heard of the band, and was very much on the fence about bariatric surgery for me in any event. I wasn't "sick" and all she knew about was RNY, so she didn't feel it was justified in my case. When I showed her the booklet from Inamed and she did a little reading up on it she was a lot less ambivalent. Since then she's been very interested in my experience and has recommended it to others.

Check out this thread: http://lapbandtalk.com/showthread.php?t=7959 for more answers on abbreviations.

In case it's of help, here's the text of the letter my PCP wrote in support of my surgery: Alexandra *** has been a patient of *** since November 2001. When she first presented to this office, she gave a long-term history of severe obesity. During the past year she has continued to suffer with severe obesity, as well as thyroid disease, bordeline hypertension, hyperlipidemia, and knee problems. We have discussed multiple treatments options for her obesity, most of which she has already tried and failed. These would include Opti-fast, hypnosis, Weight Watchers (several times), Atkins' diet, low-carbohydrate diets, nutritional consultations, hospital-based weight loss programs, and even "diet camp" as a teenager. Ms. *** has lost some weight, but still remains severely obese, this hampering the treatment plans for her co-morbidities. At this time, the only reasonable alternative for treating her obesity and improving her general wellness would be obesity surgery. I believe that Ms. *** is a prime candidate and would do extremely well with this procedure. Obviously this only pertains to my history and my medical situation, but I think you get the idea of what the PCP has to say. Good luck!