Mystyblu

Just a quick note to keep you up to date on my approval process. I called Dr. Powell's office back just after the new year. I think the ins coordinator had a good new years becuse she seemed much more willing to help. She gave me a short list of things that were missing from my file like my nutritionist visit and previous medical records and report from my current PCP. I have contacted all my previous Dr's offices (the ones I can remember) and requested my medical records sent. Once the coordinator gets all the reports and records she will submit the information to Aetna. If I get approve it GREAT, WONDERFUL but if I don't I plan to whole heartedly fight it. I will not give them the satisfaction of denying me the life I need, want and deserve.

About six months ago I decided to give myself a second try at getting approved for the lap band surgery. I knew that my ins would be difficult. Aetna POS (piece of sh!t). No one told me they change the rules in mid stream. When I first visited AIGB they gave me a list of all of the tests and documentation I needed to have in order to get my approval. I completed them all except the 6 months of Dr. supervised weight loss. I visited my PCP and she was more than willing to assist me. In November I called AIGB to let them know I had 1 month left for the dr supervision and they let my know that I had been approved by Aetna and I need to schedule with Dr. Powell’s office. I was so excited that I could possible be getting my band by the end of the year. I called the dr’s office and let them know what AIGB said and they stated they would have my file faxed over to them from AIGB. I called a couple days later to insure they had gotten my file which they had and the insurance coordinator was getting all the paperwork to the ins company. November came and went with no word from the Dr’s office. November is also open enrollment for insurance. I didn’t want to change my coverage because I had already been approved. I thought why change and have to start all over. I started calling Dr. Powell’s office to see where we were on getting my appointment scheduled. I was told my file was with the insurance coordinator. I called and left several messages for her and after 3 weeks today I was finally able to talk to her. She started listing several co morbidities I had never heard of before. And said without one of them I would probably not be approved. I told her that no one had ever told me about these before. She said that I should call Aetna and find out what pre-qualifications were needed for lap band surgery. (isn’t that her job??). I don’t want to say that she was disinterested but that’s the way I felt. I felt like I was alone in this. I called Aetna and talked to a very nice member assistant. She told me that my company’s policy did cover the lap band surgery. She also gave me an 800 and said that the dr’s office can call that number and get all the information needed. She also looked at my file and stated that no one had called or sent any information regarding surgery or pre-qualification. So the ins coordinator had not even tried to get an approval. What exactly has she been doing for over a month and a half?? I called the Aetna 800 # to see if they would give me the info. They wouldn’t. She just directed me the www.aetna.com. To my discovery their guidelines have changed. I have met, or exceeded, the requirements for RYGB but in order to get the lap band the following is required. Vertical Banded Gastroplasty (VBG) and Laparoscopic Adjustable Silicone Gastric Banding (LASGB or Lap-Band): Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) or laparoscopic adjustable silicone gastric banding (LASGB, Lap-Band) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following co morbid medical conditions: Hepatic cirrhosis with elevated liver function tests; or Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or Radiation enteritis; or Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV) (see Appendix). http://www.aetna.com/cpb/data/CPBA0157.html I DON’T have any of these. These were NOT listed 6 months ago. This information had defiantly let the wind out of my sails. The woman in the Dr’s office seems unwilling to even submit the request let along willing to help me fight for approval. I qualify for RYGB but that is not the surgery I want. Do I try another Dr’s office that is more willing to help?? Would that require starting over again? Open enrollment doesn’t come around again until November 2006. Where do I go from here? I feel like I am so close but I don’t know what I can do next or where to look for help. Just feeling rather defeated and outdone, Oh gosh, didn’t mean to talk so long. Thanks for listening to my rant. Any words of encouragement would be grateful.

It at all possible try stopping by Texas Da Brazil Mmmmmm!!!

WoooHoooo Congratulatins !!!!

Congrats !!! I am glad to see it is all working out for you. Rest, and take care of you

Tina, Here is a piece of a web site I found that has a good list of the comorbitities "<!--StartFragment --> An individual is morbidly obese if he or she is 100 pounds or more overweight or has a body mass index (BMI) of 40 or more (insert BMI Calculator link). The term morbid means unhealthy or diseased. Excess weight has many negative effects on a person's health. Morbid obesity may cause or accelerate the development of diabetes, hypertension, arteriosclerosis, heart attacks and strokes, lung disease, arthritis, various types of hernias, gallstones, varicose veins and phlebitis, skin conditions, infertility, and injuries. Morbid obesity may increase the rate of complications in pregnancy, surgery, and injuries, and the incidence of certain cancers in women (breast and endometrium). Morbid obesity may also lead to sleep apnea and Pickwickian Syndrome. In a study of several hundred men at the Veterans Hospital in Los Angeles, it was found that in morbidly obese men between the ages of 25 and 34, the risk of death was 12 times greater than their normal weight peers. The same study has not been performed on women, although similar results would be expected." More of this artical can be found at: http://www.weightlosssurgerycenter.com/aboutobesity.php#mo

Wooo Hoooo !! congratulations

I can understand plumping a butt or a boobie, even moving a foot or changing a background but why make the faces soo cartoonish?? Except for the couple of guys the faces are all flat and without personality. For the faces I liked many of the befors much better

If you are in Dallas a good place to start is American Institute of Gastric Banding(AIGB) http://www.aigb.com/ They are located in Richardson in an office right behind Surgery Center of Richardson (SCOR). They answered all of my and my husbands questions. They also have a list of all the doctors in the area that preform banding, and co-ordinate with them for all of the testing. They also know which doctors work with different insurances. I called Dr. Benavides' office and was refered to AIGB. They are a great group of ladies.

This thread points directly to the freedoms giving to us in this forum. I believe all of us that first came to this site were looking for information and someone to talk to that has either been banded or is pre banding. I believe we are mainly here to share information about a subject we all share. The friendships that are made here are an added bonus. I agree 100% with Kare I want and am in titled to all the info I can get whether good, bad or indifferent. Whether we realize it or not being banded is a MAJOR surgery and it can be life threatening. If someone posts a message about their own experience, if it’s true, it can not be classified as slander. We also have to face the fact that we are all emotional creatures. Many of us have gotten to know others here and encourage one another so when we hear of one of our fellow bansters that has experienced problems then we are allowed to express our feelings about what is happening to them. The messages that are posted here about personal experiences with this doctor or that one are all about choices. Giving everyone looking into being banded the information they need to make the best choice for them. The moderators here would be remised and committing a grave disservice to all of us if they only allowed the good and happy posts to remain and remove any that may be negative. That would take away my ability to make my own choice. Suppose I encouraged a loved one to see a specific doctor based on only the positive posts and something were to happen to that loved one and only to find out later that the not so positive posts about that doctor had been removed so I was unable to access the information needed to make a different choice or at least let me know what to look for. And for every negative post about a certain doctor there are also positive ones. There are several posts here about that doctor and what a wonderful experience they had. I would also like to thank Christina for asking Dr. Pleatman to post here. I had forgotten about the post so I went back and read it. It was a very professional post. Self-serving?? Not hardly. I followed the link to his web site. He has posted a lot of good information. I applaud any doctor that takes time out to answer questions from people who are not his patients. It might be a good idea to encourage other Dr’s to post here to be available to answer questions. Sometimes I think of questions that I don’t remember to write down to ask my own doctor. I would encourage anyone that comes to this forum to read more than just one or two threads before judgment. Everyone that posts here gives a little piece of themselves to share with everyone else. We give what ever advice we can, we give encouragement with every Fiber of our being, and yes we do get emotional. Thank you to our moderators for the wealth of information and to everyone that gives of themselves. ________________ Not banded yet.

Hello Wiffle I also live in the Dallas are. Dr. Powell in Richardson will be preforming my surgery. I have 4 more months before it will be scheduled. But I am watching the clock and flowing my PCP's advice. Hopefully the time will pass quickly. Welcome to the board and Good Luck !!!!

Billy, I have Aetna EPO also and when I called and talked to them the representative told me they do cover WLS and directed me there information site. They cover both forms, RNY and the band. My doctor’s office specializes with several insurance companies and Aetna is one of them. They just told me that Aetna is kind of strict about the paperwork. That’s why I have to complete the 6 months of doctor supervises weight loss program to complete my documentation. After that I should be good to go. Give Aetna a call and see what they say. Maybe you have a doctor’s office in your area that has already dealt with Aetna and knows how to work the documentation. Good luck _____ Not banded yet. 5 months and counting.

Its’ been a while ago but I was watching one of those shows. (20/20 or 60 minutes can’t remember which) They had a segment where they took a couple cute skinny young women and they sent them to several different places. Places like restaurants, stores and job interviews. Then later they changed their appearance and dressed them up in suits so it looked like they were at least 100lbs overweight and sent them to the same places. Just imagine the shock and horror of finding out that weight discrimination really exists in the world. (Oh my, I could have told them that.) Now these were the same bubbly, energetic and outgoing woman on the inside as before but those same people treated them different now that they were perceived as overweight. As the show went on women’s personalities began to change. They weren’t feeling as self-confident as before. _____ Hopeful January 06 banding

You'r undies have just droped JITTS

soft mattress Curling in front of a fire or camping under the stars

Geeta, I had a similar experience happen to me not too long ago. A very close friend of mine (well at the time she was) told some co-workers some very personal things I had told her in confidence. Naturally the co-worker being the gossip she is came running to me about it while the “friend” was on vacation so I had a little better than a week to calm down and think of how I was going to handle it. I realized it was not about confronting her with what she had done. It was about my need to express my feeling so that I could move on with my life. When she got back I had a long talk with her. Ok I admit I did most of the talking. I just let her know plainly and calmly that I learned of what she had done and said and let her know how that made me feel and how it diminishes our friendship. I let her know how it had hurt me and our friendship and that what she planed on doing from here on out was her decision. She is still a friend of mine but I don’t feel the need to tell her personal information any more. She told me she was very sorry for what she had done and I accepted that but we don’t talk much any more. Trust is a VERY big issue with me. Regardless of your “friends” reasons for telling your personal information. It’s your info to tell, not hers. If you can’t trust her with this, what can you trust her with????? Sorry for the rant but this issue hits close to home for me. __________ Not banded yet. Hopping to be banded in January 06

Dine out (no dishes to wash) Roller coaster or fairies wheel

Pompous Usher In Rear Window GMLAC

ZETKL: Zealous Elementary Teacher Kids Leopard BMNOT

Beth – I know the feeling. My ins. co wants 6 months of doctor supervised plan and I started it last month so I have 5 more months to go. Right now my ins. covers the surgery but who knows what will happen with open enrollment for next year. But all we can do for now, is to do what ever we need to now to get approval and worry about things that may change when they happen.

Uphill I have not yet been banded yet, but from what I can tell form reading posts here I doubt that the band can be broken. It is more likely in your case that your band has not been adjusted enough to allow for adequate restriction. The amount of fill that is needed depends on the person. For some just the band alone is enough restriction in the beginning to reduce the amount of food a person is able to tolerate. For others it could take 1, 2, 3 or more fills to achieve appropriate level. Hang in there. Watch what you eat so at least you don’t gain any weight. Talk to your Dr about it, let him/her know you are not feeling any restriction and ask when your next fill will be. Let us know how it goes.

Congratulations.....

lovecats Dr. Powell will be doing my banding. but I wont be getting it until next year.

A few years ago they were advertising this drink that helps you loose. For the life of me I can not recall the name of it. You were supposed to drink 8oz’s of it before bed each night and lose weight while you sleep. Lots of local radio hosts were touting it and stating great weight loss. At first I just ignored it as a “get thin quick scheme” and newest fad, but so many people were trying it and loosing weight so I thought I would give it a try. My WH in an attempt to be supportive tried it with me. After about 2 weeks of taking the stuff I noticed something rather unsettling. It had been 2 or 3 days (I wasn’t sure) since we poo’ed. Needless to say we both stopped taking the diet drink and started taking Milk of Magnesia. It took another two weeks to be able to poo regularly again without M of M. I called the company to complain and they suggested that I drink more water with the product. About a year later I heard something about a class action lawsuit against them. I guess a lot of people didn’t drink enough water either. :cheeky

I am watching the Discovery Health channel. They are playing Ann Wilson: From the Heart. Its her telling her story. I know we all have our own story and struggles with our weight issues but I can only imagin how stressfull it is in the harsh light of the public eye. They also have Carnie Wilson talking about her weight loss. I have to applaud the Discovery channel. This is a very well done story. They only give breif information on both serguries but its enough to give the people that previously did not know what lap band is know that there is an alturnative to rny. I hope they play it again so I can watch it from the begining.