annanyc

A sleep apnea diagnosis sounds like the path of least resistance and I'd definitely continue with that- fingers crossed for you! But if there's no 2 year >40 BMI requirement listed in your policy terms, and assuming United has no discretionary right to deny coverage even if you meet all the requirements, I'd fight the decision. Just because you've exhausted internal appeals, doesn't mean there's not more to do. Insurance policies are contracts. You and your employer are paying the premiums and it sounds like United isn't honoring the bargain. And the involvement of a lawyer, or at least a firm assertion of your rights, may be a good option here. Many times, whether car, home or medical insurance, first level attorneys and administrators are pressured to deny expensive claims to save money, because valid or not, if you create enough hoops, only so many people will jump through them. Kind of like me waiting on hold for 75 minute to cancel Time Warner Cable tonight. In the end, it just wasn't worth it, and though I'm even less happy with the TWC tonight than I was last night, they got what they wanted. I'm still paying for the product.

Sorry if there are threads on this, but the search function doesn't seem to be working so well for me today. I've seen a lot of people mentioning high vs low profile ports, and that a lot of people who started with the former ended up replacing with the latter. Are there medical reasons one is better than the other? Cost? Is the physical placement similar? Thanks in advance for any feedback.

I believe at the OCC they're offering plication as a sole procedure, without the band. I've decided to go the band route. But I do think it's an interesting option, just maybe a little too extreme for what I'm looking for. I also welcome lap band's continued adjustability depending on how much help I'm needing and where my weight loss is. Plication does sound like a really promising option to the normal sleeve surgery though. Supposedly, complications so far have been dramatically reduced. If subsequent data backs this up, I bet it will become an additional option. Thanks for all the comments/help!

Yeah, if you google it's called "stomach saving gastric plication". They don't use staples, and it's supposed to be about as effective as a gastric sleeve plus reversible and without required adjustment follow-up like the band. They fold your stomach up over itself and stitch it so it remains contorted in place. You don't bypass anything, you can still absorb all nutrients... It doesn't sound bad, really, except it does sound more "dramatic" to me, and the fact that there aren't a lot of long-term results out there is also a little unsettling. I'm probably still going to go for the band. But the center seems to be such a fan of gp, I wanted to make sure I wasn't missing out on a much better option for no good reason.

Right. I can fluctuate that much in a day. You don't even really need to gain that weight for real. Just drink 2 liters of water right before the weigh in. (4.2) pounds, wear slightly heavier clothes, and come in after eating lunch. You've gained weight. But you haven't.

Does insurance typically cover aftercare if they don't approve the surgery? I'm very close to the border in BMI for qualifying for the surgery, and while I've submitted my paperwork, I have a feeling (confirmed by the hospital staff) that my insurance is going to decline paying for the surgery. If they do pay for it, the paperwork is clear that they cover all follow-up care like fills, surgical readjustments, etc. While I do realize I need to discuss this with my insurance provider, I don't want to bring it up to them while they're actually considering my file. So any general feedback here? It seems like insurance would at least have to cover necessary surgical adjustments, no? But maybe not fills? What are your experiences, and if you had to pay for fills, how much were they? Also, did anyone have trouble finding a different doctor/hospital to administer the fills than performed the surgery? There's a good chance I'll move in the next year or so, and I'd like to make sure this is seamless. Thanks in advance!