Alexandra

Yesterday I was driving to work listening to public radio, when without preamble they did an extraordinary thing. They read the Declaration of Independence, with different radio personalities taking different paragraphs; the voice was always changing.
It was mesmerizing! I don't know that I've ever heard the whole thing read aloud. By the time it was over I was moved to tears.
We have a lot to be thankful for but most of all is this amazing country we live in. I hope everyone (well, the Americans among us, at least ) takes a minute or two this holiday weekend to think of our brave founders and marvel at their lasting achievement.
Have a wonderful holiday, everyone!! :D

Denise, this is just one of the requirements that MANY carriers have. It's not a "no," it's a "we don't have enough information yet."
DON'T GIVE UP!!! Worst-case scenario, you start a six-month relationship with your PCP tomorrow. If you've been seeing doctors over the last few years for ANY reason, get their notes. It's possible/likely that their notes include comments on your weight.
I had Aetna too, and what I supplied was notes from my OB/GYN from the two deliveries of my children, which had happened within the prior five years. So there were lots of notes on my weight, even if they didn't involve attempts at weight loss. And in 18 months prior to banding, I'd been seeing my PCP regularly to talk about weight loss, surgery, my thyroid, etc., and all of those notes counted as well.
This is a minor hurdle. Historical records from any doctor will do to support the five-year-history requirement. And if you can't supply the six-month diet attempt, get started NOW. Six months will go by before you know it.

Hi everyone,
I'm Alexandra, gleefully looking forward to being banded on August 20. I live in Northern NJ and am an insurance broker, so maybe I'll be able to help with those types of questions.
My story is an old one--obese since early childhood I've been over 200 lbs. since reaching my adult height of 5'10" at the age of 14. I've long ago come to terms with my size, but with the birth of my two children in the last five years I have found a whole new reason to lose weight. I'd never considered surgery before but last summer, when I realized I couldn't keep up with my growing children I started to look into RNY with lots of trepidation. Then I found out about the band and have NEVER looked back. A year later through lots of insurance mishegas I'm finally on the road to bandland.
See you here!
--Alexandra

Aetna still considers the LapBand "investigational/experimental" and excludes it completely on a company level. I have never yet heard of any cases where Aetna paid of its own accord, so unless or until Aetna changes its policy on the band being investigational the best bet is to see if you have an external appeal provision in your state. I did, and I won! Here's how it went:
The State of New Jersey, like many other states, provides for a third-party review of insurance carriers' decisions. That means there might be a law in your state that provides you with the right of EXTERNAL review if you have exhausted your company's appeal process and lost.
In my case, I took my Aetna denial through the third-party process, and my case was referred to an INDEPENDENT reviewer in accordance with the state's mandate. The third-party reviewer agreed with me that the band should not be considered investigational and that IN MY CASE it was a medically necessary procedure.
Now, I knew from the start that Aetna had a policy against covering the band, and I also knew that I couldn't switch insurance carriers until my company's next open-enrollment period almost a year away. So I decided to get started anyway investigating weight-loss surgery. The pretests and qualification criteria are the same for all types of bariatric surgery, so the carrier may very well cover what your primary care doctor refers you for in the early stages. Even if you have an exclusion for weight-loss treatment, perhaps some of the visits and/or tests could be covered simply as diagnostic procedures. Aetna covered the office visits (except for the psych eval, because the person I had to go to was out of network and I have an HMO), blood tests, nutritionist visit, and so on.
All of this took more than three months to accomplish. Then the cycle of request, denial, appeal, denial, stage 2 appeal, and final denial took another three months. Then I took my request to the state and waited *another* two months before the decision was finally made. Now it's almost a year after I started and if I hadn't won my appeal I would be switching carriers right about now with all my prequalification testing long behind me. I wouldn't have to start all over again with another carrier.
My point is that even if you know or think your carrier won't cover it, start anyway and proceed as though you are considering ANY type of weight-loss surgery. You'll be glad you got started, because it takes time to amass the tests and histories that every carrier needs to evaluate candidates for WLS. A year from now, Aetna and other behind-the-times carriers may very well have changed their tunes completely and you'll be that far ahead of the game.

I'd love to hear from and maybe get together with anyone who's a patient of either of these doctors. Dr. Nicholas Bertha was involved in the FDA trials so he's been doing banding for a relatively long time. But I've only found a couple of other patients of theirs--there MUST be more! Where are all the Jersey people?

Thanks, Wednesday! I'm going to keep my goals more modest than a marathon or triathlon, that's for sure. They are:
1. Learning, again, how to ice skate.
2. Rollerblades!
3. Keeping up with the girls for a whole day, even if it involves roller coasters.
4. Having the remotest possibility of swapping clothes with my daughters, some day. I want to be their size--not the other way around.

Hi everyone,
I'm Alexandra, gleefully looking forward to being banded on August 20. I live in Northern NJ and am an insurance broker, so maybe I'll be able to help with those types of questions.
My story is an old one--obese since early childhood I've been over 200 lbs. since reaching my adult height of 5'10" at the age of 14. I've long ago come to terms with my size, but with the birth of my two children in the last five years I have found a whole new reason to lose weight. I'd never considered surgery before but last summer, when I realized I couldn't keep up with my growing children I started to look into RNY with lots of trepidation. Then I found out about the band and have NEVER looked back. A year later through lots of insurance mishegas I'm finally on the road to bandland.
See you here!
--Alexandra

Aetna still considers the LapBand "investigational/experimental" and excludes it completely on a company level. I have never yet heard of any cases where Aetna paid of its own accord, so unless or until Aetna changes its policy on the band being investigational the best bet is to see if you have an external appeal provision in your state. I did, and I won! Here's how it went:
The State of New Jersey, like many other states, provides for a third-party review of insurance carriers' decisions. That means there might be a law in your state that provides you with the right of EXTERNAL review if you have exhausted your company's appeal process and lost.
In my case, I took my Aetna denial through the third-party process, and my case was referred to an INDEPENDENT reviewer in accordance with the state's mandate. The third-party reviewer agreed with me that the band should not be considered investigational and that IN MY CASE it was a medically necessary procedure.
Now, I knew from the start that Aetna had a policy against covering the band, and I also knew that I couldn't switch insurance carriers until my company's next open-enrollment period almost a year away. So I decided to get started anyway investigating weight-loss surgery. The pretests and qualification criteria are the same for all types of bariatric surgery, so the carrier may very well cover what your primary care doctor refers you for in the early stages. Even if you have an exclusion for weight-loss treatment, perhaps some of the visits and/or tests could be covered simply as diagnostic procedures. Aetna covered the office visits (except for the psych eval, because the person I had to go to was out of network and I have an HMO), blood tests, nutritionist visit, and so on.
All of this took more than three months to accomplish. Then the cycle of request, denial, appeal, denial, stage 2 appeal, and final denial took another three months. Then I took my request to the state and waited *another* two months before the decision was finally made. Now it's almost a year after I started and if I hadn't won my appeal I would be switching carriers right about now with all my prequalification testing long behind me. I wouldn't have to start all over again with another carrier.
My point is that even if you know or think your carrier won't cover it, start anyway and proceed as though you are considering ANY type of weight-loss surgery. You'll be glad you got started, because it takes time to amass the tests and histories that every carrier needs to evaluate candidates for WLS. A year from now, Aetna and other behind-the-times carriers may very well have changed their tunes completely and you'll be that far ahead of the game.

I gotta say I love this format. View New Posts is my favorite feature and makes it possible to keep up with stuff. Check it out if you don't already use it: the link is on the top right of the home screen.
I'll be telling my contacts about it, don't worry!

Hi Roxanne,
I don't have any answers (obviously) but I wanted to say congratulations!! I'll be watching this thread to see how you're doing.
Good luck in bandland!!

I'm not un-jazzed about the band, just reluctant to spend so much time talking about *me* in general. Who knows--maybe that will change with weight loss too!

Barb, I want to commend you on your attitude! This could be an immensely frustrating time for many but you seem to be handling it with aplomb. Good for you!! You're a terrific example of how to ride out the pre-fill stage.
We look forward to hearing about a great, successful fill on December 2!!

Lori, I'm blushing! Thanks for the cheers!

Aetna still considers the LapBand "investigational/experimental" and excludes it completely on a company level. I have never yet heard of any cases where Aetna paid of its own accord, so unless or until Aetna changes its policy on the band being investigational the best bet is to see if you have an external appeal provision in your state. I did, and I won! Here's how it went:
The State of New Jersey, like many other states, provides for a third-party review of insurance carriers' decisions. That means there might be a law in your state that provides you with the right of EXTERNAL review if you have exhausted your company's appeal process and lost.
In my case, I took my Aetna denial through the third-party process, and my case was referred to an INDEPENDENT reviewer in accordance with the state's mandate. The third-party reviewer agreed with me that the band should not be considered investigational and that IN MY CASE it was a medically necessary procedure.
Now, I knew from the start that Aetna had a policy against covering the band, and I also knew that I couldn't switch insurance carriers until my company's next open-enrollment period almost a year away. So I decided to get started anyway investigating weight-loss surgery. The pretests and qualification criteria are the same for all types of bariatric surgery, so the carrier may very well cover what your primary care doctor refers you for in the early stages. Even if you have an exclusion for weight-loss treatment, perhaps some of the visits and/or tests could be covered simply as diagnostic procedures. Aetna covered the office visits (except for the psych eval, because the person I had to go to was out of network and I have an HMO), blood tests, nutritionist visit, and so on.
All of this took more than three months to accomplish. Then the cycle of request, denial, appeal, denial, stage 2 appeal, and final denial took another three months. Then I took my request to the state and waited *another* two months before the decision was finally made. Now it's almost a year after I started and if I hadn't won my appeal I would be switching carriers right about now with all my prequalification testing long behind me. I wouldn't have to start all over again with another carrier.
My point is that even if you know or think your carrier won't cover it, start anyway and proceed as though you are considering ANY type of weight-loss surgery. You'll be glad you got started, because it takes time to amass the tests and histories that every carrier needs to evaluate candidates for WLS. A year from now, Aetna and other behind-the-times carriers may very well have changed their tunes completely and you'll be that far ahead of the game.

Froth is just another way of saying "carbonation." Carbonated drinks are strongly advised against, so maybe the froth on a capuccino should also be avoided. Seems to me you're basically just swallowing air, and that fills up your pouch almost immediately!
Did the coffee itself bother you?

Hi Sultana,
Usually the band is not filled at all at surgery. So the band that's in you now is empty and is not creating any restriction to speak of. What little restriction you have felt so far is probably a result of your stomach beling swollen after surgery. As your stomach heals the restriction fades.
Now it's time to inflate the band a little to create restriction again. My experience with the new restriction was a lot like it was right after surgery, minus any pain.
There is no "sick" involved, even when things get stuck. PBing is not at all like vomiting, though it can be painful if the stuck episode is prolonged. All that's needed to avoid this completely, though, is care. When I'm paying attention things NEVER get stuck. It's only when I'm eating too quickly and not chewing enough that anything ever gets stuck.
You're right about not being able to lose weight if the band is not adjusted--some people can but obviously it's designed to be inflated and that's the way it's supposed to be used. I need more than a mental barrier to overeating, so I had my band adjusted and will be going for my second adjustment on February 19.
Don't worry! :confused:

Oxford's been wonderful for banding. I've only heard good things about their quick approval process.
There are docs in both the Freedom and Liberty networks who do the surgery; whether or not a referral is needed depends on the type of plan you have, not the doctor. yep, for Band candidates, Oxford insurance is a wonderful thing. Sadly, as far as I know it's only available in NJ, NY, and CT.
In NJ (and maybe elsewhere, I don't know) they also offer individual plans, which are actually competitive with group plans in NJ. Amazingly, the premium went down in August!

I'm so glad you asked this question! This is such an emotional process as well as a physical one. I'm feeling like I'm about to step off a precipice into the unknown--much the way I did when expecting my first child. It was impossible to actually imagine the days, weeks, and months after THE BIG DAY.
There's fear, certainly, so the current insurance fight is actually proving a semi-welcome distraction. This Thursday I go in for my presurgical appointment. (I guess that's where we'll finally nail down that "before" number.) Once the ink is dry on the insurance agreement there will be no more doubt--August 20 is the day my new life begins. I think it will turn out to be as important a day in my family as our anniversary and my children's birthdays.
I've told several family members and almost all of them have had extremely positive responses (once I can explain what the band is all about, of course). No one who knows me at all has given me the old "why can't you just eat less?" speech, thank goodness. I'm starting to think about what I'll tell my coworkers who don't already know. I'll probably just tell them the truth because I can't lie and I don't want to try to hide anything from them--the truth is always easier.
The sense of shame you describe I've felt too, but it passes in a moment or two. This is MY life, and MY body, and I can't care what anyone else thinks. The only person who has to approve is me, and I do.
When I allow myself to imagine a more slender future, emotionally I board a magic carpet. I don't do it too often or for long, but I can get teary just thinking about how even a simple thing like looking at ALL the clothes in a catalog instead of seeking the ones with the "W" will be a dream come true.

Oxford's been wonderful for banding. I've only heard good things about their quick approval process.
There are docs in both the Freedom and Liberty networks who do the surgery; whether or not a referral is needed depends on the type of plan you have, not the doctor. yep, for Band candidates, Oxford insurance is a wonderful thing. Sadly, as far as I know it's only available in NJ, NY, and CT.
In NJ (and maybe elsewhere, I don't know) they also offer individual plans, which are actually competitive with group plans in NJ. Amazingly, the premium went down in August!

Linda, I think BandAid is right. It's been several weeks since your banding so you should be able to handle solid food by now, but you may be like so many others who are never really able to tolerate bread products. These kinds of foods can swell once they've gone down, so a bite that seems one size in your mouth can get larger as it goes down your esophagus.
Please be careful; vomiting is something you want to avoid. If you know it always happens with biscuits, then just avoid biscuits. Waiting between bites is also a very good idea.
Good luck with your fill!!

Shireen, it's true that the band itself is filled to a certain degree and that's it. But your stomach tissue is soft and constantly changing depending on lots of things.
The phenomenon of a fill "kicking in" might be due to your stomach wall initially reacting to the added pressure of a fill by thinning out. Fluid leaves the area as your stomach attempts to counteract the pressure of the band and keep the passageway open. As time passes and your body gets used to the pressure, the tissue returns to its normal state and voila, restriction! This can take hours or days or weeks (for me, it seems to take 2-3 weeks).
My guess is that sinus problems don't cause added restriction, but rather are a function of the same thing. When there's extra fluid in the sinuses it could also be present in other organs. Everything is connected, and one's level of restriction depends on much more than just the amoung of saline actually IN the band. That's why the specific amount of liquid in the band is utterly irrelevant compared with other people.

Hi B,
Advice from others is usually not worth much with regard to insurance issues, because the only thing that really matters is what your policy says. If your policy is like many standard plans, treatment for morbid obesity is covered if you qualify medically. It sure sounds to me like you do, but only your carrier will be able to tell you what their specific criteria are.
The place to start, in any event, is with your primary care physician. If you haven't had a physical recently, get one, and have him note in your records a diagnosis of Morbid Obesity (the code for which is 278.01). Assuming that condition is covered by your carrier, all your testing and so forth should be covered as well. But the first thing to find out is what your carrier's position is on treatment of morbid obesity.
Dig out your coverage documents and find out what they say. If they're not clear, call the carrier or your h.r. department (if your company is self-insured) for clarification. You're entitled to know.
Good luck, and let us know how it unfolds!

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!

You can "ignore" any user. Just go to your User CP and click on Edit Ignore List on the left-side menu. Adding people to your "ignore" list hides any posts from those people so you will not see them.

Do you really feel that way? I guess I dont read every thread here, but I always felt that people who were struggling were treated compassionately even if it was tough love.
Personally, I'll always argue with what I perceive as a warped attitude - I'll always have something to say if someone posts that their band just isnt working and then goes on to display some spectactularly self defeating way of thinking. I always start gently but you can guarantee when you point out that someone might *just* be sabotaging themselves they'll come back aggressively and defensively and then it can become heated.
Its just that you can so often read something so clearly in what someone says that they just cant see themselves and if they COULD see it, you know it would be really helpful, but of course, they have to want to see it. I just figure if they're here asking about it then they are ready to accept constructive criticism, but its not always the case.
From my own point of view it would never be my intention to belittle someone who was struggling with weight loss. But having had a few A-HA moments along the way myself, I really do feel I've got some information to share that will be helpful to some people - and that simply offering sympathy and commiseration is not really a positive contribution.
I do think too that if the band was (like for ALL of us, lets face it) your last ditch effort, then if its not working, to go through a stage of being very anti band is probably natural, and getting it out of your system on a forum is probably helpful to some.
Is that what you mean? That if you come out and have a good ol whinge about it, like everyone needs to do at times, that you'll get a lot of argument, negative remarks etc? I've seen many threads that begin with "I dont want a lecture.... I just want to complain" and those nearly always are met with sympathy and compassion, by me too, outspoken as I am. Make clear that you just want to know that others are feelign the same way and you'll get the support you want, I'm sure.