Mariposa Bella

Mariposa Bella,

I completely understand what you are going through. I had a lap band in July 2007 By Dr Aceves in MX.. I lost 65 lns & felt wonderful.. however things got difficult when I couldnt eat chicken, meat,salads, etc.. food kept getting stuck. I had the band removed in the US, my insurance covered it in July 2010. I have also gained over 30lbs.. My insurance has denied gastric bypass because my BMI is 37.6 with no co-morbidities & my doctor doesnt do bands!

I am now trying to get surgery for the sleeve in MX.

Good luck to you, I really do understand what you are going through!

Thank you Lulugirl.

I am having the same issue, was self pay in Mexico because of a low bmi, and now on the same boat. I was told I need to gain about 15 lbs.

I cannot afford to do self pay at this time or I would go do it. Maybe my friend the accountant can loan me the money, lol....It is very frustrating, he is correct, I need to eat right and excercise, so why can't I do it??? Seems like the harder I try, the more I set myself up for failure. I think I'm depressed because of the weight gain. I refuse to give up, someday I will Killl the fat monster.

I wish you luck and advice you to do something about the weight gain now, it is 30 lbs, do not wait until it is 60 like me. Stay in touch

From another perspective the lap band is not intent to diet, versus being forced to reduce food intake. With Sleeve you have a reduction in stomach but very possible to still overeat. Everything else you say sounds like weak excuses, the diet doctor and pills - those are cheats and doesn't show you will reduce intake instead it says you want something else to make you lose weight instead of your own willpower.

If you are serious at wanting to lose weight then start counting calories, increase exercise to at least 3 days per week of 1 hour each and walk another 1/2 hour 4 more days. Forget the fads the pills, do what you really need to do, eliminate fatty foods. Go to leaner cuts of meat, eat vegetables when snacking, go from whole milk to low fat or non fat. Change cereals from high calorie to low calorie, reduce breads....

Sorry if I sound mean but it sounds like you want an honest answer as to why insurance may not see your attempts as proof that you will do what needs to be done versus using the lap band or sleeve which will not resolve your problem until you make a genuine commitment.

Wow, really?? I have lost weight many times, sometimes the right way others through fad diets and doctors assistance and then gained it back like most of us with weight problems. Having the band was a HUGE commitment, I was able to maintain my weightloss for 5 years until it eroded through no fault of my own. Having the band I was forced to reduce intake but isn't that what the sleeve has done for you? I have struggled with my weight my whole life, I was 190 lbs when I got my band and lost 60 lbs. I loved it, looked great, felt great. It wasn't easy but it helped me eat with moderation. Which is something my mind and body apparently don't know how to do on their own. I had to eat 6 small meals a day and followed all the rules. If I hadn't been committed I could have been eating ice scream or milk shakes and junk food which as so happens are band friendly vs eating healthier options of food. Why are all of us on here then if we can achieve weightloss on our own with diet and excercise. Do you think I'm so stupid that I don't know that is what I should be doing??? Why did you get the sleeve couldn't you just follow your dieting advice from above? Just saying? I don't know why I choose to be fat? If I had the answer to that I would not be here. You wouldn't be here. I am 200 lbs and I don't want to gain more, I do try. I diet, excercise, do it for weeks, don't see results or stuff goes bad in my life and I quit. I don't know why, why doesn't my brain get it??? Wish I knew, I have been on a journey to find those answers and don't know why I was born without the will power and ability to eat healthy and moderately on my own without the need to have a band or sleeve. I'm glad that you have shown true commitment and didn't need the sleeve because you were able to diet and excercise on your own....oh wait, I forgot, you did get the sleeve. I wish you nothing but success in your journey. As for me, I still struggle with the fat monster who for my entire adult life seems to get lost, but then finds me again. He must be online and keeps track of me through Facebook....LOL

Before I had my lapband I went to 2 doctors at different times that both prescribed phentermine, I was unsuccessful so got the band as a self pay in Mexico in 2004. My band eroded in 2009 and have gained 60 lbs and want the sleeve. I tried doing a Dr diet back in November but when I started I broke my foot and couldn't continue with the expense of the broken foot and the $100 wk to the diet doctor, so I quit. I went back and tried again, but just could not afford it. I also, on and of have purchased Herbalife weightloss products and was unsuccessful. I have bought My Alli, which of course I didn't keep receipts. So my question, why wouldn't the fact I had a Lapband be proof of intention or sort of diet...don't know if anyone understands what I'm trying to day...hope so. .

If I was unsuccessful before the band, why would I be successful with dieting now for 6 months to prove to them that I will fail?????

My family knew and I regret telling some of them as they were critical and said stupid things regarding it, like, oh your taking the easy way out, yeah, there was nothing easy about having my band. I told my best friend and asked her to keep it confidential but when she saw how good I looked and all the compliments I was getting she decided to tell ppl which I was pissed off about. My body, no ones business, but mine and my husbands. If I get the sleeve I'm not telling anyone but my husband and kids, sick of the comments whether well or bad intentioned, just don't want to deal with it.

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A port infection that isn't immediately post-op should be a huge red flag for possible erosion. The bacteria from your stomach love to travel down the tubing and start little colonies around the port. Hmm, another person in the 5 - 7 year range losing their band... can't say I'm surprised.

I believe Medicare doesn't cover the sleeve at this time. THere has been some confusion because they have the CPT code (used for coding and billing), but that doesn't mean it's approved.

My band slipped, and was removed yesterday. I'm pursuing the sleeve. If I couldn't do it on my own in the last 20 years, I have no reason to think that has suddenly changed. I know I need help to get to a healthy weight, and my family understands that. Your family's reservations are understandable considering the dangers of erosion and sepsis. Help them see the logical side of it. Right now they're stuck in the emotional side.

Sleeves don't erode, either.

Do you remember me from lapband talk, I was part of your little group back when the site was small, after my removal when I returned found this huge, very different site and lost track of some of the originals. Penny, DeLarla, you and me and don't remember so many more. Well here I am again to sleeve or not to sleeve?

I had the band and had a full slip. It was terrible. I was very hesitant to get the sleeve because of my nightmare. I can tell you it was the best decision I have ever made. I lost 95 pounds in 8 months and I am thrilled. I am 102 pounds down from my highest pre-lapband weight. Good Luck

So awesome, gives me hope and inspiration.

I want to express my thanks to all of you who have shared. sometimes you help somebody in an indirect way... even if you don't know it!

I have a slipped band and don't really have bad symptoms. I am terrified of surgery and haven't exactly been thrilled to move forward with my band removal. Let's be honest, my anxiety is escalating daily. I rescheduled once from Sept 1 because I got a cold and I am freaked about breathing/coughing anyway.... and I was just scared by having surgery when I had a cold.

Reading this thread helped cement my resolve to face my fears and get this dang band OUT before I have even more serious problems. My surgeon told me that a slipped band can result in emergency surgery if it shuts off the stomach completely.

i am scheduled for Sept 28th band removal surgery. I have done my final blood work, am doing medifast to lose a few pounds presurgery (not required by surgeon, but makes me feel better about it). Now, I just need to not chicken out!

Please don't postpone it any longer. I don't know what the difference from a slip and erosion is but my erosion was very severe and life threatning. My band was almost all into my stomach and so much infection it traveled all the way to the port and found an exit. If I hadn't pinched that little zit I would have never known. I didn't have any symptoms. I loved my band and loved being thin and hott, I looked so damn good, but I love being here for my children more. I have been looking into getting the sleeve, I have FL share of cost Medicaid with a share of $881, I found a Dr close by that takes if but my bmi is 38...Dr wants me to gain 12 lbs which I can probably do....I have mixed feelings about that and my oldest daughter does not want me to have surgery, she was old enough to know the severity of when I lost band and she said she'd rather I don't. I'm going to give it my best try to do it on my own, once last time. I am at 200 lbs and I can't say I've put in a real effort since I lost the band, so for her I'm going to. Wish me luck. I started Monday, so too soon to say. :/ keep me posted on your removal, are you at your goal weight? As soon as you recover from removal, work on maintaining the weight you have lost, don't be like me and let 5 lbs gained turn into 60...well good luck, and maybe soon ill be having to get the sleeve I refuse to continue to gain and feel so unhealthy and so ugly.

Florida Medicaid does cover it, I've spoken to several doctors already and Medicaid will pay if your 40+BMI or lower with 2 co-morbidities.

Tanya, Congrats on all the weight you'be lost. Maybe I should try getting on that phentermine stuff and see if I get results....oh yea, I forgot I'm poor, can't pay $75 Dr visit....ugh,

I work for the welfare department and give people medicaid daily. This is how it works: there are programs for children that have a higher income limit so kids can have medicaid without a share of cost, in other words, free medicaid. This is so children can get medical care more easily. Now the way they figure out an adult's share of cost is like this: Total income to family per month minus the maintenance need determined by the federal government for a family of 3 which is $930 (approx) then anything left over is your share of cost. So in other words the standard that is in place currently set by the federal government expects a family of 3 to live on approx $930/mo and be able to put ALL the rest of their income toward their medical bills. There is NO way around this. So, I know what the lady meant when she told you about the ER but first let me explain how share of cost (SOC) works. It is like a MONTHLY deductible, it is NOT like a monthly premium. You only pay $ out of pocket when you receive medical care. So for example, you go to the ER on the first of the month and your bill is $5000.00, you pay your SOC, in your case $881 and medicaid pays the rest. So for that month you can get unlimited medical care the rest of the month and pay nothing more because you have met your monthly deductible (SOC). Now in this case the $881 is a blessing, so much better than the $5000 ER visit or God forbid something worse and more expensive. This is not a great thing if you only go to your PCP for a check up and a RX refill because unless they add up to over $881 you will be paying the doctor and pharmacy out of pocket and medicaid pays nothing. So bottom line, you pay the first $881 each month out of pocket and medicaid pays the rest no matter how much, but your SOC re-sets the first day of the next month. I know it's a huge hurdle but $881 is better than $15000 the surgery likely costs. Sometimes doctors or hospitals will let you work out a payment plan but if not just save your pennies until you have the money. The other thing is if you think the amount is wrong you can have the medicaid department re-evaluate your share of cost. You said you have unemployment and said how much and so you SOC seems a little high based on just that income but if your kids are receiving child support or there is any other source of income it will all count. Let me know if you have any more questions.

Tanya

I don't receive any other source of income at this time. Seems a bit ridiculous to expect someone that is jobless to pay such a high amount. You know what probably really happens, people go to ER, for either minor or major and if they can't afford their share, they are not paying anyways. So it comes back to the taxpayers again. And yes I've always been a working taxpayer, so it bothers me. I certainly cannot afford to live on $275 week with 3 kids, but I am very grateful that I am receiving the unemployment. Even when I worked I couldn't have afforded that. With my children and I being self-pay until now, going to Dr is a luxury and must be extremely necessary. Everyday I'm out looking for a job, have callled numerous contacts, have been on tons of websites and nothing. Yet there are ppl that get cash assistance, food assistance and full Medicaid and sit on their a** and get it all even housing. They event want McDo nald's too, lol...I'm glad they are going to start drug testing, so these lazy a**es can get clean or stop mooching. When someone like me that has always worked tries to get help, you get a slap in the face. Sorry to vent, but thanky you for the information, I really appreciate it.

I did call and speak with someone yesterday and they said the amount was correct with that amount of income. :'(

A port infection that isn't immediately post-op should be a huge red flag for possible erosion. The bacteria from your stomach love to travel down the tubing and start little colonies around the port. Hmm, another person in the 5 - 7 year range losing their band... can't say I'm surprised.

I believe Medicare doesn't cover the sleeve at this time. THere has been some confusion because they have the CPT code (used for coding and billing), but that doesn't mean it's approved.

My band slipped, and was removed yesterday. I'm pursuing the sleeve. If I couldn't do it on my own in the last 20 years, I have no reason to think that has suddenly changed. I know I need help to get to a healthy weight, and my family understands that. Your family's reservations are understandable considering the dangers of erosion and sepsis. Help them see the logical side of it. Right now they're stuck in the emotional side.

Sleeves don't erode, either.

The doctor I found in Miami said the sleeve could be covered by Medicaid but I was given share of cost which is different.

Not sure about the ER thing - certainly there should be some website or something that could explain it? If your band is giving you problems, then you should visit the ER. You don't want to have it erode too much further - that can be very dangerous. My reply will bump this message back to the top and hopefully someone with some medicaid experience will reply.

What about the county you live in? I live in California and found out that the county government also has a medical program. Contact your local county government office and see if there are additional resources available to you - especially for emergency situations.

And take it easy on the wine :-) Can't be good for a damaged tummy... or maybe I am just jealous because I can't really drink it anymore :-)

good luck---

My band eroded and was removed back in May of 2009, don't have it anymore, wish I did. i want to get sleeve as weight plus dome has come back.

goold luck, may God bless you with a speedy recovery.

Okay I forgot to tell you, woman that I spoke to said, most ppl on share of cost, go to hospital (ER) on the first of the month then have full Medicaid coverage for the rest of the month....does this make any sense? So if I do that, which I have horrible back problems how would that work??; yesterday I fell and am black and blue all over, ankle all swollen, scratched everywhere, sprained wrist....maybe I should go to ER? Ugh. Well going to call coordinator tomorrow to see what he says, hopefully ill drink rest of wine out of happiness not depression...but if you know of a bariatric dr who takes share of cost, please share info....thank you.

So unfortunately last month I lost my job making over $40k, was barely making it. Now cannot find a job, Florida in a very dark place..so I applied for Medicaid, didn't have benefits at job so thought time to get up to date on medical for my kids and I while I find a job. Kids were approved but I was given Share of Cost. $881 a month..Which I couldn't afford with my job, so out of the question now. I put the cart before the horse and was sure I'd get Medicaid and found a great Dr in Miami who I was ready to start all steps towards getting sleeve...(Band eroded read my previous posts).....I was stressed sleeve would not be covered. So I called surgery coordinator, he said Sleeve could be paid by Medicaid, to call him tomorrow (Fri) to make appt.....So I called Medicaid to see if I was approved and was told I have Share of Cost.....because my income is too high... because I just got unemploment (What a blessing) $275 wk.....not enough to cover my bills, and cover the first $881 before they will pay any medical....wtf???? I've paid thousands of dollars into system for others and when I need it, I get slapped in the face. Any suggestions??? Are there bariatric doctors in central or south Florida that do Share of Cost??? Don't even know how program works (need to research)..... I need to get this surgety and get healthy for my 3 kids sake, I need them but most importantly they need me....help me, what

Do I do?

Depressed tonight, drank half a bottle of wine, can't live this fat unhealthy life anymore........:'(

just throwing in my two-cent experience. i was banded in march 2008 and had a really good experience with the band for the first year. i lost about 55-60 lbs and felt pretty good. at that point, i could have stood to lose another 60 lbs. out of the blue one day, i had a particularly bad pb and everything got really, really tight. i ended up going to the ER because i was coughing up blood--not very pretty. the next two years were filled with constant fills/unfills - anytime i got tightened, i got WAAAY too tight. it was horrible. i gained back about 40 of my 60 lbs lost because i was sick of the fills/unfills (and paying for them each time i went in).

nevertheless, i'm not sorry that i got banded in 2008. i lived a very different life than i would have if i hadn't gotten banded. i was out-of-pocket pay at the time and the sleeve wasn't really being offered around chicago at that time. i couldn't afford rny so i went with the band. i was fortunate enough to have insurance pay for my revision to sleeve (surgery was last tuesday!!) in an actual hospital that kept me overnight for two days and took really, really, good care of me (vs the lap band clinic that sent me home mere hours after surgery). i feel like i'm doing things the long, hard proper way this time. i also feel very fortunate that i was able to do the revision (financially and physically).

i'm looking forward to this new life

I wish you tons of luck, please keep me posted on your progress. Hope to follow in your foot steps.

Living in Fla and being in the Medical field I can tell you that Florida Medicaid does not cover it because it is NOT covered by Medicare- Florida Medicaid. Having said that there are some things that Medicare covers and Medicaid doesnt for example some types of medical equipment, supplies, proecdures, tests etc...

Unfortunately every patient I know on Medicaid has had to go out of the country to be able to afford it because a) if you are able to save and have it here in the US you run the risk of losing your benefits because obviously you can cover the cost of your care and b)it is less expensive and follow up is hard to get done because very few specialists accept the plan which is why most medicaid recipients utilize the ER for their care. It's a catch 22.

Do they cover the gastric bypass? I'm desperate, I don't want to keep gaining more weight and becoming unhealthier. :'(

I am not a fan of the lap band. I had one errode in 6 months and I am getting ready to have a sleeve. I am really torn between scared and excited. I am hoping this works better.

Calling Dr tomorrow to start sleeve process, I'm up to 200lbs...ugh, need do this now.

Thank you guys makes me feel better in pursuing the surgery knowing that others have been through this. My tummy will be more scarred...had laproscopic band, then gall bladder, then scar tissue removal, then band removal, oh my....making doctors appt tomorrow. I will keep you updated on what he said and the probability of being approved. If not please start putting your pennies in a jar, so I can head to Mexico again, lol.

I think...and I may be wrong (highly likely)... that the FDA recently (in the past year) approved it for a lower BMI than they had in the past, therefore more surgeries are being approved by insurance companies.

I pray you are right, I've gained 70 lbs in the last 2 yrs, way too much. I'm 5'1 or 5'2", way too short for that weight. I'm glad they lowered the bmi. Thanks.

I was probably reading old information then, thank you, hope I can get it covered.

I heard that FDA has not approved Sleeve and therefore not coveted my Florida Medicaid, is this true?

Very mixed feelings about my band. Sometimes I loved it other times I hated it. But it did help me lose 65 lbs and i loved it for that, loved how hott I looked, but hated that sometimes I pd'd on myself sitting in my car and countless times running to the bathroom to do the same. But it eroded and now I'm fat and hate myself. So I miss it but I'm ready to move forward with the sleeve.