Shellyac

Hi, I just wanted to say that I think that this list is great and even though I'm not getting the sleeve I feel that it still applies to what I will be facing. I hope you don't mind but I'm going to share this on the band site and I think it should be shared on other sites as well.

Hi,
I believe that one of the main reasons that people are being denied the sleeve is that they don't meet the 50 or higher BMI requirement. I was looking at BCBS Mid Atlantic's requirement information and found the following information.
The company's policy is based on a position paper from the American Society for Metabolic & Bariatric Surgery
Sleeve Gastrectomy, Update 2008, January:
Sleeve gastrectomy has been proposed both as a stand alone gastric restrictive procedure, and as a first stage operation for the extremely morbidly obese patients, e.g. those with body mass index (BMI) exceeding 50, or for those with serious comorbid conditions that would increase risk for morbidity and mortality with the initial use of a malabsorptive procedure such as a gastric bypass with Roux-en-Y anastamosis or duodenal switch. Bariatric specialists believe that with the initial weight loss and improvement of comorbid conditions following the sleeve gastrectomy, the malapsorptive procedure can be performed at a later time if necessary with greater safety. In June of 2007, the American Society for Metabolic and Bariatric Surgery (ASMBS) published a position statement on sleeve gastrectomy as a bariatric procedure. The paper states that sleeve gastrectomy may be an option for carefully selected patients, particularly those who are at high risk or super-obese, and that the concept of staging bariatric surgery may have value as a risk reduction strategy in high-risk patients. The paper also suggests that surgeons performing sleeve gastrectomy prospectively collect and report outcomes data in the scientific literature. Finally, the paper suggests that surgeons performing sleeve gastrectomy inform their patients regarding the lack of published evidence for sustained weight loss beyond 3 years, and provide information regarding alternative procedures with published long-term (>5 years) data confirming sustained weight loss and comorbidity resolution.
The ASMBS has updated their position as of October of 2011
I have posted the summary but the full report can be found here
Since this position paper is so new it is very likely that your insurance company has not used it to update their policy. I would encourage those of you who have been denied to forward this report to your insurance company as part of your appeal.

Since the iband is relatively new and there aren't that many doctors that preform it yet, I would like this thread to be a resource for people to find a doctor near them that preforms the iband. Please list your doctors information (Name, location, and contact number) below and I will try to compile the list. If you happen to know of another office feel free to add that info as well
FLORIDA
Dr Brett Cohen
Hollywood Bariatrics
1150 N 35th Ave
Hollywood, FL 33021
954-966-8559
GEORGIA
Peachtree Surgical & Bariatrics
285 Blvd. NE, Suite 120
Atlanta, GA 30312
404-881-8020

You may want to look into the iband also called the band with plication. With the iband your stomach is folded and sutured to form a sleeve in addition to getting the band. Like the band alone, this procedure is reversible. The benefits are that plication is shown to help prevent some of the complications of the band like slippage and erosion, you don't have to have fills as often (I haven't had a fill yet and I'm hoping to go without ever getting one), for some people their weight loss rate is faster than the average band alone patient. Also the plication serves as a back up to the band, for example I have had restriction from the start, I have never gone through "banster's hell" which is the period of time between getting the band and starting to feel restriction which can last several months.
Since being banded I have rarely felt hungry, I get full from small amounts of food, I have never had a getting stuck episode, I haven't pb'd or thrown up after eating (I've only thrown up once since surgery and that was a few days after surgery and it was on an empty stomach). The only negative I would say right now is that because I haven't had a fill yet, I still have a tendency to eat too fast which can cause me to get that over stuffed feeling, I'm sure if I started getting fills the band would help to stop that but I feel that it is a habit that I can work to break on my own.

I've only been banded about 2 months but I became obsessed with getting on the scale, as in several times a day both morning an evening. I decided to give up weighing myself during Lent, the only times I will get on the scale will be at doctor appointments. I've got my first one scheduled this Thursday and I'm anxious since it will have been two weeks since I had a weigh in

If you suffer from acid reflux and you are willing to go with the gastric sleeve plication, you may be able to have your surgery covered by insurance. The sleeve plication is a procedure based on the Nissen fundoplication which is used to treat acid reflux. My sister was unsure of having the band but was interested in plication as a stand alone WLS procedure. While plication on it's own isn't usually covered by insurance, the Nissen fundoplication is covered so her doctor will give her both at the same time and it will be covered by her insurance.
While plication as a WLS is relatively new it does show some promise, especially since one of the side effects of the fundoplication was weight loss. Plication is also being preformed with lap bands so far the majority of us that have had the band with plication done are happy with the results.
If you do decide to consider the plication be aware that not all doctors will bill it as a treatment for acid reflux, the doctor that my sister is using is in Miami so you may need to travel. One important benefit is if you do go this way, you won't have to jump through the usual insurance hoops and can pretty much have the surgery right away.
Another option you may have is to see if you have a hernia, if you do you could have the surgery to repair the hernia and then self pay to have the band put in which could save you thousands over paying for the band surgery on its own

I don't think that it is really fair to compare regular banders and ibanders because those with the iband have two ways to feel restriction (the band and the plication) whereas those without plication are only dependent on the band.
Generally it seems everyone gets that full feeling in the first few weeks because of the swelling associated with getting the band. However after the swelling goes down, those without plication may not feel any restriction because they don't have that much (if any) Fluid in their bands and that is where the restriction comes from. Once the band starts getting filled, food has a harder time getting past the band and if you continue to eat the food with then start piling up and that is what causes most of the complications (PBing, throwing up, slippage) Also during the fill process if you haven't gotten restriction food is going into a regular sized stomach, so you aren't really going to feel full on a tiny portion. Also slider foods will be a problem even if you have restriction because they are also going into the full sized stomach.
However with addition with the plication, even without having the band filled you will feel full on a small meal because the stomach is now much smaller so even without band restriction, there is only so much you can eat before you feel full. The one problem i have is that since I don't have any Fluid in the band I can eat faster than I probably should which means that while I don't eat near as much as I did before surgery, by the time the "you're full" signal gets to my brain I'm way past satisfied to post Thanksgiving dinner full and I'm uncomfortable for about an hour or so, and if I try to drink anything in that state it can get painful. I know I need to work on eating the right amount from the start, this usually happens when I eat out and order a regular meal

I was banded on the 6th and I have 5 incisions. My biggest worry was keloids and so far I seem to have avoided that. My doctor used dissolvable stiches and covered the incisions with surgical tape that stayed on for a little over a week. The biggest issue I have is that they are darker than my skin so right now I'm using skin whitener and some over the counter scar treatment cream on them. My sister also gave me some perscription stuff that she had but I haven't started using it yet.

I think that you should just give your body a few weeks to adjust to the new routine. It could be that your body isn't used to the increased calorie burning and is just holding on to the weight. You may find that in a week or two things might improve

I think that you should just give your body a few weeks to adjust to the new routine. It could be that your body isn't used to the increased calorie burning and is just holding on to the weight. You may find that in a week or two things might improve

The process of getting restriction with just the band can be difficult. The benefit of the plication is that you get restriction right away, but you don't have to worry about being too tight, it's like you never hit the red zone. But as some of the people who just have plication can tell you, they sometimes feel that they loose that feeling of restriction after time and that is where the band comes in, when you go through the process of getting fills, you will start to feel restriction again but the danger is that you can still become too restricted. In addition to the restriction issues, plication also helps to prevent cheating the band, even if you eat slider foods or haven't started getting fills you only eat a limited amount. It could even be possible to get to goal without a single fill.
In addition to the restriction benefits, early studies have shown that plication may help to prevent complications such as slippage and erosion which is a huge benefit on it's own.
It's true that this is still an investigational procedure but not many people have an opportunity to get this done and I would encourage you to take the leap, I don't think that you will regret it.
Michelle

It's just extra insurance and no extra cost. While many people are successful with the band, the reality is that there are many people who aren't successful either through their own fault or through no fault of their own. Plication gives you a greater chance to be successful, yes there is the added benefit of possibly losing weight faster. On one hand I can understand that if that was your main concern you would have chosen a different procedure, but I think of plication like a free hit in blackjack, it doesn't hurt your hand but you have a chance to improve your hand and possibly come out ahead in the end

I don't know one person that has lost no weight with a band. Yes there are lots that do not lose as much as they would like or put it back on but the same is true with the other surgeries as well. The problem with the sleeve is that as it has only been around as a stand alone procedure for a couple of years we do not yet know whether the majority that have it will stay successful or if they will also regain.
What is obvious from reading the sleeve board is that there are people who are struggling, who have not lost as much as they would have liked , that still struggle with hunger etc.
Fluffy we know that you for some reason have not been successful with the band. This seems to make you bitter and determined to put everyone else off having the band. Whether you mean to or not you come across as some kind of missionary trying to convert people away from the evil band.
It would be better if you posted your opinion in a way that outlined facts and did not come across as so judgemental. Trying to scare the c@@p out of people who are struggling to make a decision is not helpful.

I have the band and I would never recommend the band to my worst enemy. Never have I wasted so much money before. I might as well have just flushed that $15,000 down the toilet.
I have never known of anyone who has not lost weight with VSG. The band...........I know lots that have not lost any, or have lost no significant weight. Then there are the slips, erosions, leaks, port problems, esophageal dysmotility, etc. You get the picture.
One thing to remember is that a good many ppl NEVER reach restriction. Most Drs./band ;mills will not tell patients that prior to getting the band. If they did...........there wouldn't be anywhere near as many ppl getting banded!
Had I known then what I know now............I NEVER WOULD HAVE GOTTEN THIS POS!!!

Hi,
I'm scheduled to have the iBand on Jan 6th. I'm really looking forward to hearing how things go for everyone else

You may want to check with your doctor offices to see if they would be willing to take the insurance payment as payment as full, it might not be possible in the 50% case but they may be willing to take the loss of a few thousand dollars. A few of the people on the lap band board mentioned their doctors doing that so it might be useful to check out the insurance and financing board over there for more info

Hi,
if the reason that your insurance company isn't approving you is that your BMI isn't high enough, you should forward this position statement to them. http://asmbs.org/2011/11/a-pathway-to-endoscopic-bariatric-therapie/
BCBS based their requirement of a BMI of 50 or higher on an earlier position paper from this organization that essentially said that the sleeve is recommended for people with a 50 or higher BMI but further research is needed before they could recommend it as a primary method. However in the statement that I gave the link for, they now recommend it as a primary surgery. This statement just came out at the end of October so insurance companies have probably not updated their surgery requirement to reflect the change. I know that you are probably tired of the appeals process but this might be a good shot at being able to get your surgery done close to home and paid by your insurance.

I will have to disagree with this. While overall the US does have a high standard for healthcare, there is an unfortunate segment of "healthcare" providers that are allowed to operate with little to no regulation. Look at the recent case of patients dying as a result of having lap band surgery in out patient surgery centers that were associated with 1-800-Get-Thin. Regardless of what you think of the outcome, the lapband is considered the one of the safest surgeries you can get. Can you imagine what the death toll would be if these clinics tried to preform bypasses and sleeves? Do not fool yourself into thinking that just because your surgery is done in the US you will get the best care possible. We all need to make sure that do as much research as we can about the procedure we choose, the doctor who will preform the surgery, and the facility where it will be preformed.
I have to disagree with your statement that plication has a high failure rate, if you can point me to the research that supports this statement I would like to read it. In the research that I have done, I did find a study where two methods of plication were studied and one method produced much better results. Since at this stage it is considered an investigational procedure I don't think it is fair for anyone especially doctors who are not involved in the research to make blanket statements about the procedure. The American Society for Metabolic and Bariatric Surgery recently released a statement about both plication and the band with plication calling for continued research under controlled conditions, informing patients of it's investigational status, encouraging doctors to report their results. It's also interesting to note that the ASMBS only just recommended the sleeve as a primary procedure in October of this year when they updated their position from 2007 and 2009 based on updated research.
I will hopefully be undergoing the band with plication next month. Based on the limited results I have has seen I think that this surgery will be a viable option for people who are unwilling (like me) or unable (due to insurance or other financial reasons) to have the sleeve. The reason that I'm on this board also is I think that I might have similar experiences as sleeve patients. I am not here to convince anyone to not have the sleeve but I will try to provide as much unbiased information as I can about the procedure to those that are still exploring their options.
Michelle

These are not typical results of plication. It sounds like they are the typical results of a doctor who is more concerned about getting in as many self pay patients as possible rather than giving quality care to each patient. From the sound of the after care that she received it may be a blessing that she had plication done because I would shutter to think what would happen if she had a more evasive procedure done.
This story serves as a warning to is all, research your doctor and the facility where the surgery will be done in addition to the surgery you are having. I think that we should all be asking for as much information as we can from our doctors, including how they plan to preform the procedure, what tests will preformed to check for complications, and I'm sure there are other things that I'm not thinking of.
We should all be aware that slight variations on how each of the surgeries are done. From what I have remembered reading, for the sleeve some doctors remove a different amount of the stomach, for plication there are different ways to put in the sutures, and with the band there are different band sizes and some doctors will give a partial fill at the time surgery and some will wait until at least a month after to get a fill.
I wish that it would be simple to say that this is the result of going to a doctor in Mexico but it reality this can happen anywhere. I have seen some stories of patients dying from clinics in California that were associated with a company that advertised on billboards. I think that the people who are most at risk are the self pay patients who have to choose between finding a doctor they can afford or having to remain obese and "live" with the related heath problems.
You are correct but first of all WLS is considered successful when 50% or more of excess weight loss is achieved, and when you put it in the context of plication patients tend to lose between 40-70% of their excess weight in one year it is not the fair to put it in the negative light you intended. Plus when compared to the expected first year weight loss of the bypass (75-85%), the sleeve (between 30-70%{most sources had it a 50-70%}) and the band (45-50%) plication is on par or even better with several procedures. As a disclosure to the figures I just quoted: I went to several websites to find and verify these figures Because plication is a new procedure there aren't many long term results, I wasn't able to find any figures for results more than a year out. Most of the sleeve results that I found mostly reported 2 year results but the few where I found 1 year results are responsible for the low end of the estimate.

I will have to disagree with this. While overall the US does have a high standard for healthcare, there is an unfortunate segment of "healthcare" providers that are allowed to operate with little to no regulation. Look at the recent case of patients dying as a result of having lap band surgery in out patient surgery centers that were associated with 1-800-Get-Thin. Regardless of what you think of the outcome, the lapband is considered the one of the safest surgeries you can get. Can you imagine what the death toll would be if these clinics tried to preform bypasses and sleeves? Do not fool yourself into thinking that just because your surgery is done in the US you will get the best care possible. We all need to make sure that do as much research as we can about the procedure we choose, the doctor who will preform the surgery, and the facility where it will be preformed.
I have to disagree with your statement that plication has a high failure rate, if you can point me to the research that supports this statement I would like to read it. In the research that I have done, I did find a study where two methods of plication were studied and one method produced much better results. Since at this stage it is considered an investigational procedure I don't think it is fair for anyone especially doctors who are not involved in the research to make blanket statements about the procedure. The American Society for Metabolic and Bariatric Surgery recently released a statement about both plication and the band with plication calling for continued research under controlled conditions, informing patients of it's investigational status, encouraging doctors to report their results. It's also interesting to note that the ASMBS only just recommended the sleeve as a primary procedure in October of this year when they updated their position from 2007 and 2009 based on updated research.
I will hopefully be undergoing the band with plication next month. Based on the limited results I have has seen I think that this surgery will be a viable option for people who are unwilling (like me) or unable (due to insurance or other financial reasons) to have the sleeve. The reason that I'm on this board also is I think that I might have similar experiences as sleeve patients. I am not here to convince anyone to not have the sleeve but I will try to provide as much unbiased information as I can about the procedure to those that are still exploring their options.
Michelle

I'm sorry but I think it's a bit rude for you to tell someone that they should just save close to $10,000 just so that they can get the procedure done in Europe. Frankly by the time someone could save up that money they could have gone through the insurance process and would have only spend a few hundred dollars in co-pays. Plus they will not have to deal with the added ordeal of having to fly half way around the world, to a country where they probably don't speak the local language and then have to deal with making that same flight again a few days after surgery. Plus if there are any complications there will be the added expense of having to stay longer.
I know that there are many people that go to Mexico but at least you are much closer to home than you could ever be in Europe.
Finally from what I have seen on here, having the Lap Band requires several office visits in order for it to become effective. Surely you're not expecting people to travel back for each fill, or if they decided to have fills done here it is likely they will have to pay for that out of pocket also.
And frankly, I think the process that the insurance company put you through only aids in you being successful in the long run. Going through the 6 months of seeing you doctor shows that you are willing to commit to this long term, seeing the therapist makes sure that you are mentally prepared for the change that you are about make in your life. Yes it would be great to make the decision to have the surgery and be able to schedule it for the next day but that's just asking for trouble, especially for those people who decide to have procedures like the bypass or sleeve.

I think even if you aren't required to do a liquid diet before surgery you should start replacing at least one meal with a Protein Drink so you at least get used to having them since they will be a part of your diet for some time to come. You can look at this as your chance to try to find which ones you like. From what I hear your tastes may change after your surgery but at least you will have an idea what to expect.

Why would that be fraud? The doctor is the one that is losing money, he gets the same from insurance regardless of if he waives the 15% fee or not. It would be fraud if the doctor or the patient lied to the insurance company in order to get the surgery paid.
Plus the doctor isn't charging the patient a different amount, he is just deciding whether on not he chooses to collect on what he is owed.

I'm sorry but I think it's a bit rude for you to tell someone that they should just save close to $10,000 just so that they can get the procedure done in Europe. Frankly by the time someone could save up that money they could have gone through the insurance process and would have only spend a few hundred dollars in co-pays. Plus they will not have to deal with the added ordeal of having to fly half way around the world, to a country where they probably don't speak the local language and then have to deal with making that same flight again a few days after surgery. Plus if there are any complications there will be the added expense of having to stay longer.
I know that there are many people that go to Mexico but at least you are much closer to home than you could ever be in Europe.
Finally from what I have seen on here, having the Lap Band requires several office visits in order for it to become effective. Surely you're not expecting people to travel back for each fill, or if they decided to have fills done here it is likely they will have to pay for that out of pocket also.
And frankly, I think the process that the insurance company put you through only aids in you being successful in the long run. Going through the 6 months of seeing you doctor shows that you are willing to commit to this long term, seeing the therapist makes sure that you are mentally prepared for the change that you are about make in your life. Yes it would be great to make the decision to have the surgery and be able to schedule it for the next day but that's just asking for trouble, especially for those people who decide to have procedures like the bypass or sleeve.