circa

My husband knows I have considered this, as does one of my sisters. No one, and I mean no one knows. I'll keep it that way as long as I can. I do have some nosey relatives that work at the hospital (thank god for HIPPA - they won't know I'm there) I'm hoping i can get this done while they're on vacation so it won't be a concern anyway. I'm not ashamed of being banded. I don't want to hear the whining from my mother because she keeps failing to follow the doctor's orders to get her WLS. I'm tired of hearing her compare herself to me -that we're the same. I'm not the same as her. I didn't choose to get sick. Sure, I didn't make the best choices, but I certainly didn't choose to have that all land on my head. I'm just ready to be me again, and i can't do that how I am now. I'll have a short vacation from work and just have it done. If people ask and are genuine people, I'll tell them. I just don't feel that I need to volunteer the information - UNLESS I feel it can help someone else.

Thanks for your story. You really give me the extra bit of evidence that I need to tell me that I CAN and WILL do this :glare:

Thanks :glare: it looks like you're off to a great start I hope I do as well as you

I got an email from my doctor yesterday - she has submitted to my insurance company for my approval. Now I'm just waiting to hear what the decision is. I can't imagine that I'd be denied. My BMI by the insurance company scale is 54.9, which hopefully will be considered 55 (never thought I'd be happy about that) - just means I can go right to surgery.

I got an email from my doctor yesterday - she has submitted to my insurance company for my approval. Now I'm just waiting to hear what the decision is. I can't imagine that I'd be denied. My BMI by the insurance company scale is 54.9, which hopefully will be considered 55 (never thought I'd be happy about that) - just means I can go right to surgery.

I'm gathering a positive attitude. I've gotten so much taken care of, I'm off the steroids, I'm only on the necessary medications now. I feel a sense of relief knowing that there's a light at the end of the tunnel. My doctor has submitted for my approval for the surgery. Waiting on the insurance company now. After that, I get referred to the surgeon. I'm excited to get this going. I don't want to get my hopes up too far, but my BMI is high enough that I should be able to just go have the surgery done (never thought I'd be happy to have a high BMI). I wasn't going to have the surgery done locally because I live in a small town and there are a lot of nosey people around here. But I'm going to. Unfortunately, they don't do the surgery outpatient here yet. Though I might ask for it to be. We'll see. For as heavy and unhealthy as I am, I'm still pretty agile and strong. I don't have issues with breathing, no real co-morbities other than the ones my medications caused. I'm looking forward to this. To getting my life back. To strapping on a pair of running shoes and actually running again. I even bought a new pair. They're waiting for me.

I'm gathering a positive attitude. I've gotten so much taken care of, I'm off the steroids, I'm only on the necessary medications now. I feel a sense of relief knowing that there's a light at the end of the tunnel. My doctor has submitted for my approval for the surgery. Waiting on the insurance company now. After that, I get referred to the surgeon. I'm excited to get this going. I don't want to get my hopes up too far, but my BMI is high enough that I should be able to just go have the surgery done (never thought I'd be happy to have a high BMI). I wasn't going to have the surgery done locally because I live in a small town and there are a lot of nosey people around here. But I'm going to. Unfortunately, they don't do the surgery outpatient here yet. Though I might ask for it to be. We'll see. For as heavy and unhealthy as I am, I'm still pretty agile and strong. I don't have issues with breathing, no real co-morbities other than the ones my medications caused. I'm looking forward to this. To getting my life back. To strapping on a pair of running shoes and actually running again. I even bought a new pair. They're waiting for me.

Hey folks - I was around about a year ago, battling with my insurance company, etc. Since then, I have moved and many things have occurred. Bottom line is, I'm working on the journey again. This time, however, I will succeed. I have seriously gone downhill health-wise, unfortunately. I've found a new PCP that is amazing. She listens to ME. I was so afraid of not being able to find a doctor that was comparable to my last one. I really like her. Anyway, she's already started the process for getting my insurance approval. Then I get referred to the surgeon. I'm excited. I'm looking forward to restarting my life.

Just wondering - does GT Surgery do outpatient lap bands? I really don't want to stay at the hospital, or even have the surgery at the hospital - I would prefer the surgical center. I just know too many really nosey and gossipy people that work at munson - and you can quote HIPPA all you want, some people still shoot their mouths off and I don't want people to know my business.

So I'm starting to go through the steps again. Starting to get everything together to get this done and I keep wondering to myself: Can I do this without the band? I haven't answered that question yet. I think I need to.

i'm starting over with my journey to have this surgery done. I thought maybe I could do it without -but I'm so heavy now, I don't even know where to start. I'm so lost in a sea of fat, that I can't find my way out by myself. I'm angry. At myself, at the insurance company, at doctors, at the people that screwed up the first time around and I wasn't able to have the surgery...but its a new day and I'm setting that anger into action to get things done better this time. I have a new insurance company (I have 2 of them, in fact!) So one way or another, I'm going to get my life back. It wasn't that long ago that I was happy and healthy. I need to be that person again.

i'm starting over with my journey to have this surgery done. I thought maybe I could do it without -but I'm so heavy now, I don't even know where to start. I'm so lost in a sea of fat, that I can't find my way out by myself. I'm angry. At myself, at the insurance company, at doctors, at the people that screwed up the first time around and I wasn't able to have the surgery...but its a new day and I'm setting that anger into action to get things done better this time. I have a new insurance company (I have 2 of them, in fact!) So one way or another, I'm going to get my life back. It wasn't that long ago that I was happy and healthy. I need to be that person again.

Its not a political issue - its an issue directly affecting you. You're not a political issue to be played with. Something's gotta give. I won't get into my political viewpoints but DAMN - something really has to give. I pay good money for my private insurance and I couldn't get a procedure done that would LOWER my insurance company's costs for me - because it wasn't the standard treatment for my condition (a condition that, mind you, only 30,000 people in the ENTIRE WORLD have been diagnosed with - so yeah... I'm sure they have a "standard treatment" - anyway - I'm allergic to the typical treatment, so we went the old school way - which they did readily - well, that's not working so well. In fact, its not working AT ALL. but they wouldn't do any other treatments that are available - so instead, they're willing to let me suffer, go into liver failure, then I can have a liver transplant. Yeah. I'm quite glad i don't have them for an insurance company anymore. Fortunately, because my coverage never lapsed, I don't have to deal with pre-existing condition issues and as of next week, I'll be double covered with BCBS and Priority Health. YAY! One way or another, I'm getting this friggin surgery done AND getting my other surgery done so I don't have to worry about it anymore. ....and not to rant but I wouldn't NEED the lapband surgery if they had realized that after 6 months of the old school treatment, that I was getting worse and just done what they should have done, I wouldn't have this problem. I wouldn't have gained all this weight. I would be FINE.

holy crap that was fast lol.

I'm trying again. I've gained more and more weight from steroids, complete exhaustion and pain. My illness has gotten worse - so all the crap they've put me through to make me "healthy" hasn't gotten me any better. Thanks to the insurance company refusing certain treamtents, I've not been able to get better. Now not only am I still ill, now I'm morbidly obese. Thanks insurance company! Well, now i have a different insurance company, live in a different state, and I HOPE since my condition has worsened even further, I'll have better luck. Yes, in just under 2 years, I've gained 130 lbs. Fun, huh? Thank you, Aetna. You're da bomb! I now have priority health. My BMI is over 45, and I do have a comorbidity - which, according to their stipulations, isn't even required. I have to start seeing a local doctor for this - so I'm going to find one that will green-light me to have the surgery as soon as possible. My specialist has okayed it - it won't affect my treatment since I can just continue with my injections and any pills I have to take can be crushed. So cheers to yall who have managed to get where you need to be, good luck to those of you who are trying to get there - and wish me luck to stay in this fed-up frame of mind and make this happen :thumbup:

Has anyone heard of this band? its supposed to be inflated to a certain restriction with a machine - no port, no needles, no injections to fill or unfill - uses air or something... anyone know anything about this?

Its hard to believe what any insurance company says. BCBS of Alabama didn't pay for birth control pills because "it is not a proven safe and effective method - it is still considered experimental" - yes, that's what they told me. The pill has been around longer than *I* have. Companies CHOOSE to include or exclude WLS from their policies. I'm someone who, 3 years ago, heck even 2 years ago would tell you to just back away from the table to lose weight and get on the treadmill and off the sofa. Yeah. That was until I got sick. They put me on steroids, and I have now gained 130 lbs. My body weight has almost DOUBLED. I try to get off the couch, but I can't. I'm too weak, tired and sore. Its not as easy as just putting down the junk food - I don't really even eat it. But I realize how much work it takes to be fit, and that sometimes, the physical activity needed isn't POSSIBLE. So yeah - now I'm fat, still not healthy from the illness I had - in fact, its gotten WORSE - and now I'm 300 lbs to boot. Thanks insurance company for your CHOICE in my treatment options. Arseholes.

Well, unless i can come up with the funds to cobra my insurance, I'm done with Aetna and probably done with attempting to get the surgery. We'll see what happens (I was fired from my job because it was found out that I was going to be reporting sexual harassment - yes, I'm looking into a suit)

I'm starting completely over because the surgery center messed up on my first submission, messed up both of my appeals and now i'm going elsewhere to try again with the comprehensive presurgery preparatory diet and exercise program. So 6 months after starting the procedure, I'm starting over.Fun.

Welp. I got denied on my appeal. My doctor's notes weren't thorough enough. I'm trying to see if he'll add additional notes, as they said they would take those. We'll see.

It really depends on how its presented to Aetna, would be my guess. If your doctor has documented 6 months of weightloss visits (3 of which are consecutive) in the last 2 years. If you have that, you'll meet the requirements

Have you gone through the 6 month weightloss with a physician? Do you have the 5 years of documentation of your BMI being 35+? If you do, they can't deny you. It follows the clincial policy bullitin Obesity Surgery Selection criteria: Presence of severe obesity that has persisted for at least 5 years, defined as any of the following: Body mass index (BMI)* exceeding 40; or BMI* greater than 35 in conjunction with any of the following severe co-morbidities: Coronary heart disease; or Type 2 diabetes mellitus; or Clinically significant obstructive sleep apnea (i.e., patient meets the criteria for treatment of obstructive sleep apnea set forth in Aetna CPB 004 - Obstructive Sleep Apnea); or Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management); and [*]Member has completed growth (18 years of age or documentation of completion of bone growth); and [*]Member has attempted weight loss in the past without successful long-term weight reduction; and [*]Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen): Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record. This physician-supervised nutrition and exercise program must meet all of the following criteria: or [*]Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions: Consultation with a dietician or nutritionist; and Reduced-calorie diet program supervised by dietician or nutritionist; and Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and Behavior modification program supervised by qualified professional; and Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.) Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records;

Has anyone else had a problem with the Surgery Center submitting your information to the insurance company? Mine neglected to send everything that was needed, which caused me to get denied which has caused me to end up in an appeal situation. This happened even after I walked them through every single document that needed to be submitted, then the person that screwed it up tried to blame it on ME and then tried to blame it on my advocate who gave her the information 7 times at least. I know this because I was BCC'd on the email that she sent to the person 7 of the times with the documents attached. I just wonder if anyone else has run into this.

Aetna doesn't pay for fills because they've negotiated them in the full price they pay for the surgery. I'm glad to hear your approval came through! Hopefully mine will go the same way! Mine is similar to yours - something was forgotten when the submission went - Hmm - wonder if we have the same person? lol

In dealing with Aetna and knowing what they're expecting according to their bulletin, you've gone above and beyond. I think you'll be doing just fine. You might need a few more months of diet and exercise, as Aetna requires 6 months in the past 2 years, but only 3 have to be consecutive (this is for a typical standard approval) Now, you may have extenuating circumstances that may change that - but you look like you're pretty well set.