Ellisa

Just a quick update. I spoke to Anthem today and was pleasantly surprised that my out of pocket will NOT be $1500 max but rather $750. ($1500 is for the family, not individual!) Woo Hoo {Caution, this applies to my particular group policy, not to all Anthem policies.) I'm having my pre-ops on Friday, started low carb liquids yesterday. I'm starving! I had started low carb several days before, just because I thought it would make the transition easier. I lost 5 lbs. doing that. It's so nice to think I may never ever ever see that number on my scales again.

I like Slim Fast Lo Carb. Since I have to be on liquids for two weeks prior (December 18th) I started that today. But I also have unflavored whey Protein that I got from GNC 1 scoop around 22 grams. I don't notice an off flavor with it. I added it to my OJ this morning with yogurt. Melted dream sickle? I am also using SF pudding and Jello. Tomato juice, add whey powder, basil and sweetner for "soup."

Okay, I started a thread under lapband support for December 2007 banders to come in. See ya there!

Frisky, I have to be on liquids for two weeks prior, not fun. The day after surgery I go to pureed foods for two weeks. My sister's doc was like yours. The only thing my husband has trouble with is grilled (beef) steak. But he wants his meat cooked very well done, so therefore dry. Yuck. He can eat ground beef. He doesn't eat much white bread. He tries to eat his Protein first and veggies, and keeps starchy and sugary foods to a minimum. But he can eat just about everything. If we go to Texas Roadhouse for example, he'll order the appetizer ribs, it comes with fries, but he substitutes a salad or baked sweet potato without the sweet butter. He usually doesn't finish the side. That's the same man that used to order an appetizer and eat most of it, a full meal, and a lot of peanuts and rolls. Only once in two years have I heard him say "I wish I didn't have the band today." That was at a family reunion this summer when he looked at all the tons of food and knew he couldn't sample everything. LOL

Some things to consider. Are other family members on your company policy? Do they (or you) have preexisting conditions that the new insurance might not cover? Going out on a limb here, I think I'd find out how much the premiums were going to be, then check into the cost of financing the surgery through one of the companies that assist for medical procedures. My surgeon's office provided info on some but since I didn't need that I don't remember the specifics. Some insurance premiums can be very steep when you don't have a group plan. The loan payment might be better. Also once you have the surgery with the new company if you decide to drop it, you may not find a company willing to cover any future complications you might have. I'm no expert, but I sould make sure I researched the consequences thoroughly.

I'll be banded by Dr. C on the 18th. I'm driving nearly 3 hours one way, but he's the best. AND he's in network for my (and most) insurance. Justjuls, I sent you an email regarding Dr. Curry, and how to get intouch with him through is website at Trace W. Curry, M.D. Lap Band Surgeon :: Home

Frisky, Congrats! Welcome to the "12/18 club!" Frisky and Kelly, We need to start a thread in another forum for 12/18/07 "bandits." Where do you think would be good? I'm not too concerned about the food issue. My husband has been a bandit for 2 years. Some things will be different for me. When he had his done the facility had just started doing lap banding. They had previously only done open RNY. So the pre-op and post-op diet was basically the same as they had used for the RNY. I'm going to a different facility (to be in network with the insurance I currently have and the most experienced of those in network). But my post op diet will progress much better than his. For example, he was on Clear liquids for one week following surgery, then full liquids for a week or was it two? Then pureed then soft. I will be on clear liquid the day of my surgery, then go to pureed. We both have 2 weeks full liquid pre-op requirement. Let me know what you think about our own support thread.

Kelly, I have pre-ops on the 7th. But they didn't mention a stress test. They just said blood work (not fasting) and meeting the anesthesiologist. But it's a two hour appointment. I would have thought if they were planning a stress test they would have said to wear appropriate shoes right? :girl_hug: I better check on that... I started a low carb diet yesterday (not required) because I want to be eating enough Protein, and I feel better when I do. And I'm hoping it will make the transition to the low carb liquid diet easier. That is required for 14 days prior to surgery. I was not well with the fact that I've actually gained 10 lbs from the time I first decided to explore the possibility of WLS. That was probably around mid Sept. I really want to have that back off before surgery. Let me know how you are progressing. I'm still not nervous about the surgery, but I'm not the most patient person. When I want to do something, I want instant gratification.

4jin, I hope it all goes as smoothly for you as for Dorr. I attended my nutritian class today. Several of us had Anthem. The same insurance coordinator sent in our paperwork. One went though quickly. Mine took 6 weeks because a couple of pieces were "separated," this happened to others too. Only what was requested was sent. But they requested a couple of things that had already been sent, more than once. So don't hesitate to keep on things at least weekly, because things can go wrong. I don't think it's intentional, more than likely just the mistakes that happen when departments get swamped and/or are understaffed.

It depends on the policy. It also depends on if your surgeon and hospital are in network or not. Some surgeons require "program fees" which are not covered by insurance, and aren't counted by the insurance company as "out of pocket." There may be other appointments and tests that may or may not be covered, such as psych evaluation, sleep apnea testing, etc. Some policies cover fills, others do not. You'll have to contact the insurance company and ask what your out of pocket expenses are for the surgery and the other procedures. Keep in mind that it's not just which insurance company you have, they offer a variety of policies. Some better than others. Hope this helps

Sounds like you've got a plan. One step at a time. My husband feels like he has a new life. I don't think he misses his wall of fat. We aren't particularly concerned about being "beautiful" at this stage of our lives. I figure I'm trading a large less healthy unattractive body for a smaller more healthy unattractive body. But probably considerably more attractive with clothes on, LOL.

I suppose I should be nervous about the surgery, but I'm really not, at least yet. My husband was banded two years ago and my sister was banded last week. They both got along very well. My sister said she felt like she could have gone back to work within a week. Her doctor is a little more lenient than mine. She only had to be on a liquid diet 3 days before her surgery and one week after then progressed to mushy food including moist meats one week after surgery. Mine requires 2 weeks of liquids pre-op. I have to use Medifast products for that. That's the only thing I'm dreading. LOL She's lost 17 lbs. in the two weeks since she started her pre op liquids. My husband has lost 135+ and is still losing. Yes, I'd like to stay in touch. I meet with my dietitian on the 29th to discuss the liquid diet etc. I haven't gotten a date for my pre ops yet, but it will have to be soon. Oh yeah the stress test... that'll be a stresser. :rolleyes

Kellym, Just wanted to say hi. We have the same date. I'll be going to Cincinnati. Wish you well. Ellisa

Angelsma, Hi there, I can't speak to your questions on this post. I'm not banded yet. I saw that you had read and responded on another post regarding Anthem started by Dustout. How far along are you in the process? Have you contacted your insurance company yet to see if you have coverage for the surgery? Have you selected a surgeon/facility? I noticed you are from Columbus. I live about 45 minutes SE of Columbus. I'm 53 years old 5'3" with 40+ BMI. Will be going to Cincinnati to Dr. Curry. Ellisa

I'm not complaining, just explaining. I totally agree that $1500 is not bad. Being self pay simply would not be an option at this point. I haven't been told yet how much has to be paid when. I've already paid a $300 program fee. I doubt that counts toward anything. That's just for the office to process your paperwork with the insurance company. The woman who does it is absolutley wonderful and I certainly got my money's worth. She not only makes sure that you have everything you need and tells you up front if she thinks it will be approved or not. She told me mine was good and I should have no problem. But then I got that "pended" letter and became discouraged. She was still confident that it would be approved. As you can read in my above posts, she was right. If I'd send her an email on a weekend or evening, and certainly did not expect a response until she was at work, she would usually answer within the hour. So even though I expect that money won't count, it was money well spent. Four years ago I had Med Mutual, I was kind of on my own trying to get everything together. I was denied, within days of my father being diagnosed with cancer and he died within the year. At the time open RNY was considered the safest WLS. I'm glad I didn't have the RNY. I really wish I didn't need to have surgery at all. What I wouldn't give to do this on my own. But if surgery is the way for me, I'm glad it's going to be lap band. The doctor I was with the first time was not in network and I would have had about $5000 to pay out of pocket, so this is much better.

4jin, Your policy is excellent! We have a higher "out of pocket," I think $1500 per year. And I'll have to pay 10% of the procedure, up to that amount. I was disappointed to find out that what I consider out of pocket and what Anthem considers out of pocket are two different things. To me it was all medical expenses I've paid to date, which is several hundred dollars. I thought that co-pays and other expenses that I've paid from my flex spending account would be counted. But the allowed amounts they counted toward "out of pocket" I've paid comes to under $3 this year. Yes I said under 3 dollars! Oh well, it could be a whole lot worse. It'll be worth it. Stay in touch,

Right on! The first step that I took was to make sure there were no exclusions on my policy and which bariatric procedures could be considered. The customer service reps were extremely nice. Each week when I'd call, I'd think that I was going to get tough because I couldn't seem to get anything but the voicemail loop and no one was returning my calls. But the reps were so nice and professional that I'd let them put me right back in that loop. LOL The issue was that my paperwork had been faxed and a confirmation received, but the data base wasn't updated for a month. Then I received a letter requesting information that had already been sent. The last time I called the customer service rep decided I needed to talk to a nurse. Now we all know, you don't become a nurse unless you are a really caring and thorough person. And that's exactly the kind of nurse who returned my call within the hours and got to the bottom of things. She called me again the next day to tell me I was approved. She didn't want me to have to wait on the letter. Now how nice was that? The funny part was, when I took the call I happened to be uploading software for another employee. So while my insides were jumping up and down and screaming with joy, my outside person was calm and polite. I hope that wasn't too much of an anticlimax for this very special and caring nurse. LOL She even explained that somehow my paperwork had gotten separated and that I shouldn't have received the "pended" letter. I don't know about the rest of you, but for me when someone admits mistakes were made and apologizes and remedies the situation my respect for that person and organization soars. I'm not saying that they should approve a case that's clearly not within the guidelines, but checking into it and making sure that it is considered is awesome.

Dr. Curry, Cincinnati area. It's about a 3 hour drive for me, but worth the peace of mind.

Wow you do have a great insurance rep! Most people are getting their approvals within a couple of weeks from the time their paperwork is turned in. I had a snag with "separated" paperwork. But it's over now. The waiting for approval has to be the worst. I have Dr. Curry in Cincinnati area. He has a wonderful person (Tracy) who handles insurance claims. She's on top of what is required and makes sure ever everything is in order. The paperwork issue wasn't her fault. She also was there every step of the way reassuring me that it was going to be approved. Hope it all goes well for you!

Congrats! I just got approved too, and will have surgery on the 18th. It took nearly 6 weeks, but that was because somehow my paperwork got "separated." But all's well that ends well right? I'll be anxious to see how you do.

Circa, Send what you have, includiing the ones without the weight listed. Is there something else in the report than can help your cause. Did the doctor or nurse note obesity? Was your BP high? Were you short of breath? I know one person who was unable to produce her medical records for several years with her PCP. He has swithced practices and they were not with him, but the previous practice claimed not to have them either. She submitted what she had, OB/GYN, etc. She also included photos. The PCP confirmed that he had been her PCP but that her medical records were missing and he confirmed that she had been obese for the time he had seen her and also that he had treated her during several weight loss efforts. She also wrote a letter explaining her battle with obesity and efforts she had made before deciding to consider surger. She was able to get approval. Hang in there, it's not impossible, just requires more effort.

Usually the doctor will have you check with your insurance first to be sure there are no exclusions on your policy for bariatric surgery.

Yes you will do amazing, but don't expect more than 2 to 3 lbs per week. It really does add up fast. My husband did very well before his fills too, but by the time he had his first fill, he was beginning to gain. There was a problem with the facility losing the doc he had and having to wait on someone to be trained. But once he got a fill he began losing again. But thank you so much, you were right all along!

Approved today! They had misplaced part of my paperwork, but it was found, along with several other copies that had been mailed and faxed. Approved today.... oh my oh my. I can't hardly think! Dustout and others, thanks for your support!

I got my approval today. Six weeks from submission to approval. No I'm not as calm as this sounds... I'm waiting on pins and needles for a call to schedule. Thanks to all who have provided support and listened. Ellisa