CandyB

I have UHC PPO. My surgeon was out of network. My hospital was in network. My anesthesiologist and radiologist were also in network.(You need to check with these doctors before your surgery, but if your hospital is in network, your anesthesiologist and radiologist are most likely willing to accept what UHC pays). Since WLS for morbid obesity is an approved procedure in the policy purchased by our workplace, my surgery was covered. Hospital and in network doctors 100%. Surgeon 70% after meeting my deductible. The balance owed to the surgeon I negotiated with him. I was lucky. He accepted the difference between what the insurance company paid him (about $4,500) and what he "needed" to receive for the surgery ($6,000). I paid him $1,500. But I was fortunate. His office usually asks for $2,500 up front for out-of-network patients. He made an exception for me, and I'm very grateful. I am not a woman of means.

Hi Tanya, I just wanted to let you know that I have United Healthcare PPO, and they approved my surgery. (An aside: My doctor was out of network, but they paid well. I didn't owe him too much money afterwards. I did ask him, before surgery, how much money he needed to receive totally from the ins. co. and me combined. I'm glad I did that because, after the surgery, his office billed me for more that he had told me, and I questioned the amount based on what I had been told prior to the surgery. After letters back and forth, he decided to accept the original figure - whew!) Back to your question. My insurance approval was not without a specific glitch, however. But the glitch (and hence postponement of surgery) was for two reasons: 1.The surgeon's office was supposed to contact UHC one month in advance of the surgery date for approval. They only contacted them two weeks in advance, and when there was a question of eligibility by the ins. co., the answer couldn't be sorted out in such a short time. 2. The employer through which I have my medical insurance goofed on their end as far as their coverage of weight loss surgery. They told me that they covered it, but the ins, co. did not have it on their approved list of procedures. I had to get the patient advocate at work involved to straighten it out. Eventually, it was all OK'd, and everything was fine. So, be aware that it is not always the insurance company trying to be difficult. In my case the surgeon's office dropped the ball in their timing (They knew better, and yet they tried to blame the ins. co.) And the employer had dropped the ball, too. They had not given an accurate listing of approved procedures to the ins. co. Also, be aware that each employer has many options in the plan they purchase from UHC or any other health care provider. So your UHC and my UHC may not provide the same coverage at all. I hope this information was helpful to you. You should call UHC to find out if there is a problem in approving your surgery. Don't wait for them. You won't feel as frustrated if you are actively involved in the process. Best of luck, CandyB.

Me, too. Me, too. The psychiatrist who prescribed Zoloft for me a few years ago warned me that she wanted me off it by the 2 year mark because, if you take it longer than 2 years, you can expect weight gain. So, with therapy and stuff, I was off at the 2 year point - gained weight, though. I think it was actually that last bunch of pounds that put me into the WLS mode of thinking. I had been hovering at about 30 pounds less than now for several years. But I think it may actually have been the Zoloft that sealed the fate of my already sluggish metabolism. Darn, that Zoloft really worked well. I could have stayed on it forever if not for the side effects.

To any of you who live in the Monmouth County, NJ, area, please keep your eyes and ears open for me, OK? My husband got the bad news on Monday that he (and many others) has been down-sized out of his job as of 9/3. It's a very scarey feeling - we've got all the usual expenses, and I, for the most part, have been at home with the children for 10 years. He has been an order administrator with a DSL chip manufacturer for the past 41/2 years. Before that he worked 16 years as a warehouse supervisor. He is a smart, loyal, hard-working guy, and a very responsible employee. If anyone in our area knows of any job ideas or leads out there for my husband, please email me. 8 weeks severence won't take us very far. After that it's unemployment insurance and paying for our own healthcare insurance. I'm working on becoming a teacher and, for now, am subbing, but that's not very steady. HELP! I'm trying not to panic. Thanks, Candy PS My honey's true calling is as a lifelong musician. He's a talented songwriter and pianist. And, actually, that's his second job. What a guy!

Hey, at one of our support group meetings, we were subjected to a virtual commercial by a plastic surgeon speaker. He showed way too many slides on a huge screen. Slides of naked post weight loss bodies - whew - not a pretty sight. But, alas, I know I will look just the same someday. Anyway, he said that tummy tucks after weight loss surgery are often covered by insurance. I think he said they are considered medically necessary because the - ahem - "apron" (stomach flab) can cause all sorts of nasty infections of the skin. So, at least I may be able to get some of my excesses removed. He suggested having the surgery when you are 15-25 pounds from goal. He also said that the excess tummy skin and flab can weigh 7-30 pounds! Just thought I would tell you what I learned, CandyB.

To Alexandra and to Gail: What you're saying is conflicting. Alexandra, you're saying that the "stuck" feeling comes from a full pouch where food presses on the bottom of the esophagus. Gail, you're saying that the "stuck" feeling, according to your surgeon's office, in no way indicates fullness in the pouch because sometimes the sensation happens after one or two bites. I don't know what to think! I love you all for trying to help me sort it out or for just giving me encouragement. I am an analytical person, not a faith-based person. That's why I must understand how it works. This band is a physical, scientifically conceived tool. I need to know how it scientifically and medically works. Until I understand it on those terms, I have to keep asking questions. I know I will figure it out to my satisaction. In the meantime, the band is in place, forcing me to deal with it and, hopefully, losing some weight no matter what. Thanks to all who have replied and encouraged me. What wonderful people I have pulling for me!

Let me tell those who are interested that I have a therapist. We explore whether I am having "head hunger" or not. When I tell him what I eat, when, circumstances, he is sure that I am not eating out of habit, boredom, or a need to "fill myself up." I don't actually eat all that much, and I am not craving to eat huge portions. That is why I'm losing a little bit. I am not discounting the accomplishment of having lost 29 pounds. (Believe me, just the fact that I don't snore my husband out of bed anymore is a big NSV to me). But 3 or 4 lbs. in 11 weeks? I do need to exercise more, but that does not explain away my main question about the band. My main problem doesn't have to do with rate of weight loss. The primary thing that is bothering me is that I do not believe the band is working the physical way it is supposed to, and I'm wondering if it ever will. Is it or is it not supposed to keep the food we eat in the pouch for a few hours, and keep us feeling satiated for a few hours? I don't think it is doing that at all. And how do I get to that point? A few days after a very restrictive fill (doctor had to back some saline out after he filled me to 2.5cc. I was closed off at 2.5. So I went from 1.5 to 2.0 at that fill) I could again feel the food passing right through the stoma into the large capacity part. I'm either stuck after a bite or two or I'm completely unrestricted. I would be perfectly happy to feel satisfied with one slice of pizza. That's the ideal. My problem is being able to eat only a few bites and then having to deal with being stuck. And this problem can happen with any food, tuna salad included. The inconsistency is what is driving me nuts. I never know when I will be able to eat unrestricted (not good), or when my food will get stuck after a few bites (not good). I do include chili and other easy foods just to be able not to deal with being stuck. But I know that I can't do that all the time because the food is just passing through. The guidelines from the surgery center say to eat one cup of food per meal. That doesn't make sense if the pouch supposedly holds no more than half a cup. If properly restricted, how could I eat a whole cup? If food is getting stuck in the stoma, then I must need more restriction is the way I've been thinking. I want to get to the point where food is staying in the pouch, not passing right through or getting stuck. I have no idea if this is do-able. It should be do-able, correct? I can't even talk to my sister about this, anymore, and she is my main support person. She is closed to thinking it will ever work the way we were told it works. It has been six months, and I feel as though I may not be able to get it to work the way I am supposed to. I'm happy for all who are finding success with the band. I hope I can, too.

Dear Gail, Believe it or not, your posting this problem, which seems to be the norm, is so far the most helpful thread I've read since I've been banded! My sister and I were banded almost 6 months ago, and we're continuing to have the "stuck" feeling at all sorts of unpredictable times. She is more restricted than I am, has had three fills, and usually cannot eat anything solid for Breakfast or lunch, and seems to be totally open at dinner time, where she makes up for lost time, eats too much, and is not losing any weight. So, her "stuck" times are more predictable than mine are. But she is so miserable that she is seriously considering having her band unfilled. She is ready to give up on the whole thing. I have had two fills. I never know when my band will restrict me. Some mornings I can eat a bagel(!) Other mornings I can eat only yogurt. Lunch and dinner are much the same. I never know when I will be able to eat unrestricted and when I will be stopped (uncomfortably) by my band. I never feel full. I experience two extremes, and it's driving me crazy. I can either eat 2 or 3 bites and feel "stuck" or I can eat without end, never feeling full. The placement of the band is supposed to help with hunger, but so far that has not happened with either of us. I think if the restriction was more consistent, I would learn to change my eating behavior, but since I never know when it will happen, my old behavior and psyche have me testing all the time. I have lost a total of 29 lbs., but since my last fill, 11 weeks ago, I have lost only 4 lbs. I realize I have not made a successful adjustment to banded life, and I'm wondering if I even have it in me to do so. I know I need another fill to get the restriction I need to lose weight, but I don't know if I can handle it. I don't know if I want to handle it. The feeling in the chest happens so often, it has made mealtimes tenuous for my family and me. My children are quite aware that I am running off to the bathroom several times each week. It's not good for my seven year old daughter to be aware that I often can't keep my food down. I feel like I'm teaching her how to be a bulemic. The result for each of us seems to be discouragement. Neither of us expected this factor of banded life, and it seems to be common. We have been fearing that "stuck" equals full. The more experienced bandsters seem to have mastered when to stop eating. That seems to be the key, but I'm nowhere near even approaching it. And I have no idea how the band helps with hunger. From reading this website, I realize that some people are very successful at controlling how they eat, and they seem to feel full on less food. This idea is still a mystery to me. I actually made a phone call to the surgeon's office to arrange to have my band emptied. I needed a break. But I know I need more saline. This is probably the hardest thing I have ever done in my life. I know that with a fill, I will be forcing more discomfort on myself. It will be worse than it is now. I guess what disappointments us most is that we expected, with proper restriction, to eat less food and feel full. That's not the way it works, we fear. Will we ever get to the point where our food is sitting in the pouch, making us feel comfortably full? That's the way it's supposed to work. Not feeling food "stuck" or feeling it pass right on through into the lower part of the stomach. If I didn't have my sister going through the exact same scenario as I am, I would be convinced that I must be mentally ill!

Sweetie, I hate hearing how much emotional turmoil you're going through. I'm glad you are so open in sharing what's going on inside you. You are a voice we all love hearing. I think we all fell in love with you right away. You've given us all so many laughs. That's why we're all sounding so passionate about what you're dealing with. And we're all pissed-off for you! And I'm sure you will weigh it all out before you come to conclusions and take any action. And I fully understand how you feel about your home. Mine is heart-wrenchingly special to me, too. It was the home my parents found and rented for 4 years when we moved from Pa. to NJ. After having lived in the original "little boxes on the hillside" (Levittown), we all loved it - it's a fine old Arts and Crafts home built in the '20's with all of the quality those days offered:solid as a rock, brass fixturing on all the doors, glass or brass door knobs throughout, custom double front doors, stone columns on the porch, matching stone fireplace in the living room, funny staircase that goes upstairs or down to the kitchen from the landing, three original stained glass windows, plaster walls - that's a good and bad thing. Oh, did I mention that for all of it's charm it will be a money pit until we die? It sits on about an acre of land, and we love it. I would never want to leave it. We bought it a few months after my mother died. I felt like she was leading me back to this house the day I sat and cried in the driveway and called the realtor to make arrangements to see inside it. It had been 30 years since I had been in it. (My parents had bought a house in another town). So I know how you feel about your home, like it's almost worth putting up with your husband's crap just to not disrupt your lifestyle. Well, that's a decision we all have to make for ourselves. I am not judging. I know it's hard to have the courage of our convictions. Selling our first home was the hardest decision I have ever made, but it was a no-brainer once I realized that I was working to pay a mortgage, and I wasn't even in the home all day. My baby was in day care in someone else's home all day. I realized that I didn't have a child to be away from him all day and miss out on the most valuable time in my life. The realization made the decision for me. The mortgage had to go. We had to sell the house. I grieved over that for a long time, but I knew that I had made the right decision. I had to choose once-in-a-life time with my child over materialism and societal expectations. I have never regretted selling that house. What makes you think, though, that you would lose your house in a divorce settlement? With your husband's financially irresponsible pattern, I'll bet the judge would declare that the mortgage would be safer in your hands. Can you swing it on your own? Or do you have a friend who could move in? I'm not saying that you should divorce the guy but that you should keep your options open and not feel trapped. And you should take steps to protect yourself financially. As far as cutting your heart out goes, we've all gone through a couple of those experiences and lived to tell about it and learned from it. I hope you are working on these problems with your head a little bit more than your heart. Your heart might keep you in a forever-doomed-to-repeat-itself situation. Your head is what has allowed you to be the problem-solver you have always been. Good luck in these next few confusing weeks. Candy

Dear Lisa, Before I start in on you, let me forewarn you that I am extremely practical about money. I have to be. We hardly have any! 11 years ago I chose to stay at home with our children, giving up over half of our income, and learning to live with less stuff. We actually sold our home and rented a cottage for 7 years so that I could afford to be a (mostly) stay at home Mom. I've always worked part time evenings, though. Anyway, we eventually bought another home, and are of course saddled with all of the bills and work and headaches and pride that parenthood and mortgage-ownership implies. So, we're still strapped, more than ever before. (After all, we live in NJ, where everything is taxed, even tooth whitening procedures. We are the state with the "Smile" tax. And that is just the tip of the iceburg of corruption in our state). Sorry, I digressed. I wish everybody would stop rationalizing and down-playing what your husband did in making a huge purchase that you didn't approve together beforehand. That's a marriage deal-breaker, and you're fooling yourself if you think it isn't. Even if you could have afforded the Harley, his buying it w/o your agreeing would still be a deal-breaker. Reading about how you've bailed him out before and how responsibly you've handled money shows me that he is someone you have allowed to treat you this way. Love has a great deal to do with responsibility to each other and it has everything to do with trust. Unfortunately, you can't trust the guy. I don't care how cute he is or how much fun he is or how good it is when it's good. Without mutual trust and mutual respect and mutual responsibility there is a lack of true marital love. Sorry, Babe, I think he has proven himself unworthy of you. Don't be fooled by his sudden energy. He doesn't want to lose you. You are VERY valuable to him, but in what way? I hate to say this, but I wonder about the choices we make before we are all grown up. Sometimes they turn out to be good choices, sometimes not. Do we have to stay with the choices we've made even when we realize we've made a huge mistake, that we made them before we really knew what we were doing? You have no children to complicate a marital split. Marrying for better or worse does not mean remaining married through every rotten thing a spouse can do to you. It means weathering the storms life presents both of you together. I wonder if you will feel as forgiving of your husband's outrageous behavior when you feel better about yourself. As far as allowing yourself a revenge-financial splurge, I doubt you will do it, and of course you shouldn't. Maybe it would be more constructive for you to keep your anger focused on the rightful subject. I feel bad for your troubles. Lord knows my own life is full of many, but after reading this thread today, I am going to show my husband a lot more appreciation for being the financially trustworthy husband he is. I'm thinking about you, Candy

Oh my God! I can't go an vacation and stay away from this web-site for 4 or 5 days without missing a ripping hot comedy routine. DeLarla, where do you come up with this stuff? You're going to be required to do at least an hour of stand-up if we all ever meet. Your replies to Donali about restriction are priceless!!!!!! You get even funnier when you get bored, Candy

Ahh, Don't cry, Donali. DeLarla must be a natural-born comedienne! You're going to have to "settle" for being crowned "MOST PROLIFIC AND CONSISTENT INFORMATION-GIVER", and a bandster we thank god we have reading and responding to our posts. Love, Candy

DeLarla, You are a pip! You're the funniest person on this site, and just what I need right now. I'm struggling so with my eating (too much). Probably need my third fill. But I'm just being so bad about learning to eat a new way. I swear I'm going to have to find a band-related therapist (hypnotist would probably be what I need!) to get me on the right track. I'm not feeling discouraged - just learning that this is really up to me. I was banded in February. I'm still a plebe with a lot to learn. Candy