wendy645

I went to a center that does Lap Bands and did a free consultation. They said I was one of the best candidates they'd ever seen (given my weight, enthusiam, preparedness, etc.) but then when they called my insurance they denied it. They said there was an exclusion and there was no way they'd cover it. Am I just screwed? I can't afford to hire an attourney (which is why I was depending on insurance so much; I can't afford this!). This was the one light for me in turning my life around. I can't do this alone. I know it isn't a cure; it's a tool. A tool I need. I can't build a house without a hammer, y'know? I have a BMI of 45 so that isn't the issue. It's just that the insurance company (Mercy Healthcare.... not very merciful...) SUCKS. They're a company for small business partially funded by the state of Arizona and they're tanking. They are refusing to take on any new people, and they tripled our rates at the beginning of the year. I'm so frustrated. I cried my eyes out at the clinic and felt like a total moron. I'm sure the insurance lady had seen tears before, but I bawled. I felt like such a doof! Do I have any options when there's an exclusion? The insurance lady told me there was no other plan that covered it that I could buy, either, they simply refused to pay for it. Am I as stuck as I feel? You know what REALLY sucks? Since I'm so fat, I don't qualify for any other insurance without: a) quitting my job and drawing State Insurance :teeth_smile: paying $600/mo premiums WHAT THE HELL?! What is someone supposed to do? I feel so very very lost... I don't know what to do... I just need someone to talk to, I suppose. Anyone been there? Anyone gotten through Mercy Healthcare's bullcrap? :-(

I've told my mom, fiancee, and best friend I'm pursuing this, but nobody else. I plan on telling everyone I'm having hernia repair surgery. Then later if people ask me how I did it I'll feel out whether I say I watch what I eat and exercise (which will be true) or the truth. I'll have to play it by ear.

OMG I could have typed this message word for word! I wish there were replies, because I was wondering the exact same thing :-( Have you heard anything else? Please PM me if you do!!!

Thanks, you guys. I feel so down. My insurance company told me basically that with the exclusion there's no way they'll pay for it and they have no riders and essentially it sucks to be me. And I don't qualify for any other insurance companies because I'm too fat! I mean, I could get coverage if I paid, oh, 90% of my salary each month!:thumbup: I don't have the money to self-pay. I live paycheck to paycheck, which you'd think would mean I could lose weight but nooooooooooo somehow I just stay within the same, oh, 8 lbs or so. I am the only one who supports my family of 3. I know deep down that this would be the key to helping me change my life, but this really sucks. Oh, hey! Has anyone got any experience with having any other surgery and having the ins. cover it then paying for just the band itself?? Because I believe my ins. would cover a hiatal hernia repair (which I think I have, will look into it more soon) but if I can pay the difference in installments, I could sure afford that more than the whole surgery! Anyone? Please? :confused2:

Hi! My name is Wendy, I'm 24 and as of today, my BMI is 45.1. It makes me cringe to type that. But that's why I'm here! I've been lurking for a loooooooong time, finally registered in April, been hanging back and doing research and finally decided, after years of weighing my options, that Banding is right for me. I took a deep breath this morning, picked up the phone, and called a doctor who comes highly recommended in my tiny town for being a WLS consult. I went to the doc and she was impressed with me. I brought along a printout of the spreadsheet I'd created listing my attempts to lose weight since 1993. I was 10 years old :cry I listed when, what, how long, how much it cost, and what the results were. Yeah, it took some remembering, but I'm kinda OCD about it, and numbers stick in my head like crazy. I also brought along a copy of my filled-out patient intake report for the surgery center I figure on using (I called them, even they were like... you're getting ready to go to your first appointment with your PCP and want the packet??) I plan on going to the next info session put on my said facility next week. It's an almost 3 hour drive but better than the 5-6 hour drive I took last time to go to a session on WLS! Besides, I could use a trip out of town! We talked about what changes to expect in lifestyle and eating habits her patients have had to made, and what success she's had with approvals before. She's going to tackle my insurance company's policy and fight for me. She set me up with a referral to the nutritionist (who I've heard is a real bimbo) and I'm to check back with her in a month as part of our "doctor suprevised WL plan". She told me to start walking as exercise. She made me giggle when she said, "Start with 3 minutes, OK?" because I usually tackle a couple miles at a time when I go walking but I'll do what she says (well, I'll log what she says, and do what I want, which'll be at least a mile) because she knows her stuff and what ins. co's want. She gave me a Rx for Ibuprofin 800mg to take before I go walking, because I know from experience if I don't take one an hour before walking, my back seizes up and I can't make it home. I cried in her office a few times, which annoys me because I hate crying but this is something very emotional, so I forgave myself for it... that's big for me. I feel so relieved that I'm taking the first steps on this long journey, and that the 3 people I've told (only ones I'm going to tell) support me completely! :whoo: <-- and I finally get to use this guy!! Now I just need to figure out what my story's going to be to everyone around me. I'm thinking something with a hiatal hernia, which I have, but I'm not sure what, exactly. I don't want to lie, just be creative with the truth. Maybe... "Oh, I'm seeing a doctor for stomach problems, and need surgery to fix my hiatal hernia. There's a problem with my stomach's absorbtion levels." Yeah... it absorbs too much!! And I did see the doc for stomach issues, I may be getting another visit from my friendly Mr. Ulcer. Plus she said, if possible, we can ask the surgeon if he can fix the hernia while he's in there, which is not uncommon around LBT. My boyfriend supports me 100%; his only concern is how much everything's going to cost. But we'll figure that out. First step taken. And I'm on cloud 9! :bounce: I got to thinking about why I want to do this. I'm sure I just need to search to find a thread or six about this, but for the record, health is my number one reason. But coming in a very, very, VERY close second is emotional. I'm tired of being the biggest in a room. I'm tired of feeling like I'm constantly being judged by those around me. I have very weak ankles and a few times they've been sprained but I needed to go grocery shopping, so I'd use one of the store-provided wheelie carts. The whole time I feel like people are looking at me like, "Look, she's so fat she can't even walk!" :phanvan I'm doing this for myself, even though I have issues that I need to work past with eating disorders and secret wishes of showing up thin and making everyone wonder. See? I warned you in the title I'm long-winded! If you made it this far you get a calorie-free inviso-cookie! :hungry:

Ok so he's techincally not my fiancee but close enough after 9½ years together and the intention to get married eventually. Anyway, I was really hesitant because the last time I told him I was considering WLS he freaked out and got very upset with me. But after years of consideration (and gaining weight :phanvan) I came to the decision I want to be banded, and I told him last night. Me: "Hey hon?" Him: "What's up, sweets?" Me: "Umm... I was thinkingof something that's probably a long shot and maybe that's why I'm thinking of it, but..." (pause) Him: (raising an eyebrow like get to the point already) "Uh huh?" Me: "I want to see if my insurance will cover a Lap-Band." . . . Him: "A lap-dance? Why would your insurance..." (We both start cracking up) Him: "Well, it's worth looking in to. I love you." Then we talked about how I didn't want to tell anyone and he was supportive of that, too. As far as I'm concerned, it's him, my mom, and my best friend. That's all that need to know. I'm going to do a board search to see what others have said. I don't want to be untruthful, but I also don't want to share it with anyone. Not now. Maybe later. I cried myself to sleep... good tears... just amazed at how much he's supporting me and how great he is. :kiss2: Especially given his reaction last time. But then again, I was looking into GB last time, and weighed 60 lbs less than I do now. So... just wanted to share. I know some people have had horrible reactions when they tell people, like one lady's (doddie?) sister cutting off all ties and communication with her... I feel very blessed right now.

Oooh that was very helpful, thank you so much! We haven't heard if we're going with BC/BS yet but I love reading material. Thank you!!

Hi there. I have been lurking on this section because my employer is shopping for insurance companies and may possibly go with BC/BS. I'm in AZ. I see a lot of people posting about different states, so I was wondering how it varies from state to state? Why can't things just be simple and have freaking health care across the board?!?

Hi all! I've recently gone to my first consultation with my PCP about the band and she's behind me all the way. She wrote me a referral to the nutritionist that I need to call on again (I called before to ask if there was a charge and I got voicemail and never got a call back) and wants me to do a few months sup. diet before trying for a referral to the surgeon. My insurance sucks and will put up a big fight, I know this. I talked to another lady at the info session who has my same insurance and said you have to do 6 months diet first, then pursue an appt. with the surgeon, and they'll only cover it if it's life-threatening. Ok, so I know where I stand with insurance. This was night before last. This afternoon, my boss hands me a sheet of paper with a questionnaire because our company is shopping for insurance! I'm kinda excited about this, but at the same time, kinda nervous! How are things affected switching insurance companies mid-stream into the pre-request process? Am I going to have to start all over again once we find out new plan? I'm expecting so, which makes me want to just wait on seeing the doc again on the regular right now cuz the co-pay sucks, but what if we don't end up changing companies? Then I'm gonna have to start all over anyway! :help:

Tracy I just wanted to pop in and say thank yuo for posting your beautiful picture in your sig tracker! I think I would have a pig-out day, but only one among a pre-op diet. It would not be intense, just probably 3 meals I'd miss that I'm thinking I may not be able to do again. I have no clue what yet, snice I'm barely dipping my toes in the PCP visits thusfar!

gh0st I just wanted to say you look fabulous. Like a whole different person, and happier, healthier, and more radiant

I was wondering the same thing. How far away is that for you? My doc said the pre-cert diet is kind of a way to dissuade some people, and she recommends dieting only lightly so you don't appear like it's easy for you to lose weight so they have grounds to deny you. I'd bring up your concern with your PCP and see what s/he says about it. They know how to play the insurance game.

how are you 8/20 bandsters doing?

Personally, I fall into the first part of that... just don't want the comments. I think I'm strong enough to handle them, I'd just rather not The number of people who know has grown to my mom's best friend and mom's therapist, but it's OK because I know they both support me, and neither is going to say anything. I think I should nip it in the bud with my mom, though. I understand she wants to share this major thing with two people she vents to, I just want to make sure she isn't telling everyone, she kind of has a tendency to do that. I have to say, though, I was blown away by someone's comment they weren't telling their husband. I can't imagine NOT sharing something like this with your spouse/sig other. But, that's just me, I guess. No judgement, just a wide eye kinda like that guy LOL

I just wanted to pop in and say hi, and wish you all well. I'm 24, and glad someone started a 20's thread, because I have this weird identity crisis thing goin' on... I know logically I'm in my mid-20's, but still feel like a teen on the inside. Anyway, I've been overweight since I was 7 years old, and really suffered through school emotionally because of it. The fact that you guys are taking control of your health earlier on in life is awesome, and I wish you all the best, because stupid people will try to bring you down over flaws, but at least you know you're doing something for yourself, and the self-esteem that comes from that is priceless!

Last night in an intimate moment, Chris told me he'd be glad when I had my Lap-Band. At first blush, I imagine people would think this was an insult, but it was because I'd finally be more confident and happy with myself, and closer to seeing myself as beautiful as he sees me, and be able to enjoy myself more in bed because of it. I didn't even think of it as an insult, and it led to a nice talk about the band between the two of us I love him more each day! On another note, I really hope that my employer figures out our insurance situation soon, because Chris may be going to the Bahamas for work and I'd love to have some confidence when I visit him!

Thank you for sharing that! As a pre-bandster, every word of information and experience I can gather is extremely welcome! Please do keep up updated in similar fashion your recovery and progress!!

Awww I totally wanted to see your beautiful self, WasA! I'm kind giong through this in a backwards fashion. I've gone through eating disorders so I already know my self-perception is messed up. I can look at someone who's 100 lbs or more over my weight and see my exact self, but when I look in the mirror, while I obviously see a blob, I'm not THAT bad... at least not in clothes lol... but then I realize my BMI is 45, and it shocks me... I am THAT big? I mean I knew I was big but THAT big? No wonder I see myself the same as the person who is 100 lbs heavier than me! I can't even begin to describe how it would feel to walk to the plus-size section and realize that nothing will fit because it's too big, not because it's too small. *wipes tear*

I'm just afraid of bringing it up with my bosses... I don't want to get a lecture or that psuedo-helpful "advice" we've all gotten a zillion times. heh. I took a snoop around the BC/BS website which we MAY go with, and it looks like they'll cover GB, but I don't want that... I wonder if it includes banding? Hmm.

I'm glad you're proud of yourself, you darn well should be! Your health is better and you're in a smaller size which feels great... good for you! We're proud of you too!

I'm not banded but at the info session I attended the doc sais if pouches get stretched, they put you on a liquid diet for several days to let it get back to normal. If nothing else, just be sure you get protein and nutrients (I guess with protein powder and vitamins?) to keep your health up. Plateaus happen, and I wish you the best in breaking it :mad:

Alexandra, I saw this title and squealed in glee for you! I'm so glad you're back to bandedness (is that a word? It is now!) cuz I know it was buggin' you. Yay!!

While I understand from a medical point of view, the way he went about this pisses me off too. Did he give you any indication of what would be a good way to lose it in that amount of time? Any guidelines, or are you going by a "borrowed" diet? This surgeon does not take life into account and that worries me. Are there any associates that you could talk to? Also, after all is said and done, you should seriously tell him that if he requires pre-op loss, he needs to require a pre-op diet!! That being off my chest, good luck, we're rooting for you!!

I'm so happy for you!!! It gives me hope to read each and every single approval posting, because I'm very nervous about it. Yay you!!! :mad:

Thank you so much for the words of encouragement, they mean a lot!! My employer is shopping for insurance and may be looking at BCBS.. do you know if the state makes a difference in coverage? I'm in Az. If not, or is BCBS AZ would cover, I'd be willing to try to pursuade my employer to go with them... I'm sure I could find something to make it not look so obvious as HEY I'M GETTING WLS AND NEED THIS PLAN!!! With neon lights all around it and stuff LOL Thank you, this helps keep me going