riisey007

We must always keep in mind that not everyone will experience problems and when listening to others and their experiences we should really be cautious. Some of these blogs that I have read on different sites should come with warning signs all over them. Always remember when receiving second hand information or third hand that you never know the entire story. People only tell you what they know which may not be much. I Actually had to call some out on you tube that posted a video of how the lapband failed her and that no one should get it, of course there were quite a few people who were apprehensive to have the surgery after watching her rant and rage for 12 minutes. My question to her was did the lapband fail her or did she fail the lapband?, Wls is a tool and if we dont get off of our butts and use or tools by getting in the gym, walking, lifting weights, cutting out fatty foods etc, we will fail at wls. I asked her how she was with exercising and monitoring her food intake and I never received a reply, I even inboxed her. So this is the problem, people are not being accountable and it is continuing after wls and this causes wls to not work. I told my doctor that during my 6 month diet I had a lot of changes to make because I have a big sweet tooth and it was not under control, I have to say 3 months into this 6 month diet I know that I can eat fruit, make a smoothie, or even have yogurt instead of having a twix, cheesescake,etc. Every surgery poses a threat to your life, but as it stands right now my life is being cut short daily by being as big as I am. I have read stories and I fortunately have witnessed with my eyes a lot of success stories. I just talked to a dear friend from high school that just told me today that she had no problems at all after her wls surgery and now 4 months later. Sorry for the long post but just be mindful that second hand info does not always give you all the information.

I would hope so but it seems that the insurance companies are faced with so many revisions as well. I have seen on so many forums,Obesity help, face book groups etc, that so many people are having revisions, so many people gaining all their weight back, etc. That can't be good as far as insurance goes. I would think if they all or the majority start to pay for it then it will most likely mean stricter guidelines and perhaps lesser coverage money wise. I was talking to a pharmacy friend the other week and she was saying how weight loss surgery really helped her sister but that her sister is back to her old ways and eating like crazy. She is still very proactive and is fighting for my company to cover bariatric surgery in both plans that they carry. I have also seen where people have made a decision to get lap bands but were not seeing the results they expected. If insurance ends up paying double for surgery and revisions it may not put us in a good place. I am a medical professional, I see people that have insurance pay for home cpap's, bipap's etc and then when I ask if they are wearing them they say no and I say why ? they say, I don't like it. These type of things are what will make insurance purse strings even tighter. I truly hope though that it does not become prejudiced for those of us who need the surgery now and for those in the future. I want everyone to have the chance to live a healthier life, reach their goals and maintain them. I wonder if some people go into the surgery thinking the surgery is the answer instead of a tool, this may be the issue. I have already mapped everything out and started buying equipment her and there for my "no excuses" campaign because I don't want to hear NO excuses from me when the time comes.

Yes, the insurance company can be very evasive. I found out in May that my band had to come out. When I found it out the surgeon and I discussed the next step which was RNY. I explained to the case manager that effective 6/1/13 I would have different insurance and told her which one. She said I would have to have three months of weight management, so I started the process. Band came out 5/23/13 had one weight management through my PCP done and will have my three months of that completed in July. Started with the dietitian in June will complete all that by August. So I actually started what my new insurance wanted prior to ever having the insurance. One good resource is your bariatic surgeon's office. If you have a good group they can tell you what your new insurance requires, that is if they accept that insurance, as they get to know every insurance they accept and know exactly what the insurance companies want. Requirements for most all insurance is at least 100 lbs overweight, BMI of 40 or more, or a BMI of at least 35 with co-mobidities (diabetes, high blood pressure, sleep apnea and the list can go on). The other is that you basically have tried dieting over the years but what you lose you put back on plus. So you can start your diet now (my doctors had proof of last December but needed two more, went ahead with three since by doctor also requires a dietitian and a class on do's and don'ts and what to expect with RNY). But if you want positive reassurance exactly what that insurance wants talk with the bariatic center's, as I said they know. Hope this helps.

Hi Theresa - This is my opinion and best educated guess: Because your current insurance plan does not cover bariatric surgery, there is a very real possibility that when you switch to your new insurance plan during the open enrollment they will require you to start from square one. There are two distinct scenarios here and I will give you both: Scenario 1 - Your insurance is effective January 1, 2014 and you have done mostly all of what you need to do. Your surgery will be scheduled soon after. Scenario 2 - Your insurance is effective January 1, 2014 and you have done mostly all of what you need to do. Then, you find out you have to start all over again. All insurance companies won't lay things out for you so that's really why you need to rely on your surgeon and his office to take care of your stuff so that 1rst letter of approval will come through. Do you have a surgeon picked out already? Have you gone to an informational session? More importantly, seeing a nutritionist is a wonderful thing to do however, most surgeon's offices have an on-site RD that you are REQUIRED to meet with at least once before your surgery. As far as photos go - the more ammunition you have for the insurance company, the better. But, keep in mind that your visits to your PCP MUST include your documented weight/health at the time of the visit. They need to be for at least 6 months in conjunction with your PCP and/or RD. You sound a LOT like me when I started: I am a planner, I don't like surprises and I like to get as much out of the way as possible. So, it practically killed me knowing I had to wait...and wait some more...and more. This is what I can definitely promise you: As each day passes, you will be more sure in your decision to do things. My surgeon's office said the quickest they have seen someone go through the process has been 3 months. Insurance approval is completely separate from what a surgeon's office asks of you. They are all different. I have heard someone having to write 5 or 6 different essays, contacting post-op patients, etc. You will also need clearance from multiple doctors in different areas of specialty. For most patients, they need an upper gi series, an ultrasound, an endoscopy. Some need pulmonary, cardiology, sleep testing. For all patients, they need labwork. All of these obviously go beyond insurance requirements and approval. The best thing you can do is: Pick a surgeon if you haven't yet, go to an informational session, support groups, find out about this new insurance as much as possible so that when January does come - you are at least 10 pounds lighter (you will need to lose weight anyway before surgery so your liver is the healthiest it can be) and you have ammunition for the surgeon/insurance company. Unfortunately, there is no real yes or no answer. This is a life changing decision, so remind yourself every day that it will take some time to get everything figured out. I hope this helps a bit! And, good luck and love to you. All my best. -Lindsay

Just wanted to say welcome and I hope everything works out in your favor because I know what it is like. went from a job that the insurance stop covering the surgery right before I started in 2000 to my present jobs insurance just did a pilot program and I was one of 100 that was granted the chance to have surgery april 10, 2013 was my new journey's beginning.

I have BCBS of Alabama and will be submitting the first week of July. Please pray that it is approved the first time, and quickly, because I need to get the surgery before school begins on August 20th.