SpecialK

I'm going to vent just a wee bit..... The surgeon's office coordinator who does the submission to Aetna called and said I still don't have a 5 year weight history so you need to get it.! I told her the PCP office said they sent it and was willing to talk with her to show her where to look. She said you get them to fax me what I need. I faxed my PCP office and in less than 30 minutes they called me back and said, yes, they copied 6 pages, 1 page per year showing my weights in 2002-2007 and she faxed it to the surgeon's insurance submission coordinator by 4pm today. So then I called back to the coordinator, and left a VM to look for the fax and confirm with me as soon as she had sent it to Aetna. I'm getting a little feisty now but I think I deserve to be given that I've been cooperative and patient for too long now to have office staff pointing back and forth at each other. Okay, I'm done venting. Keep your fingers crossed something happens next week! I'm bummed I lost a whole week this week.

I did get a written letter that Aetna processed the request for surgery on February 6 after receiving it January 31 so that is pretty good on their part. I just need the surgeon's office to confirm they have sent the 5 year weight history. Waiting on a call. I'm trying to stay occupied with other things to keep my mind off it.

Okay, I realize you have to make money somehow but the site is starting to look really crazy with advertisements. The one I'm really having trouble accepting or dealing with is where you now insert an advertisement after the first person adds a new thread and this advertisement is so big that it scrolls off the screen that there is anyone else who has responded to the thread-- you have to scroll past the advertisement to find the real stuff you want to read. I think this is a really intrusive form of advertising, much worse than banner ads at the top or right hand panel side of the web site. Hope you'll rethink this.

Sorry one more thing-- the mother from the orange team -- I suspected they might turn on her because it was actually her that went on the offensive to see if she could line somebody else up to be voted off and I don't think the guys liked it. Then, it was HER that brought up will you promise on your spouse or your children's lives that you won't turn on me?" Well, that is a question she shouldn't have asked because she pinned them against the wall and they retaliated. It was good to see them apologize to the son on last night's show that they needed to have been honest and shouldn't have agreed to his Mom's statement.

I agree this season isn't nearly as good as others. They started out calling it the 'Couples' version and then voted off a few pairs, then suddenly switched to saying it wasn't about pairs of teams any more and then it was back to a Black vs. Blue teams where who you originally came with didn't matter. Its a weird version of things. Second, last night's episode where Jillian brought her mother, a professional psychologist, onto the show was very inappropriate in how they handled this --- they showed the psychologist actually talking with these people about very private things that should only be behind closed doors of a counseling session and definitely not done in front of a camera-- very bad judgement if you ask me for the psychologist to agree to participate, for the participants to agree to it, etc. It was interesting that Bob's whole team said No Way, not sitting in front of a shrink that is the mother of the other team's trainer and coach - too easy to give them a mental edge in the game. Last, it was amazing that the Black team won the weigh off by 1 lb!

I posted the attachment for the difference on a thread under Insurance I titled: Aetna Revises Policy downward from 5 years to 2 Years! Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications.

Aetna Revises Policy downward from 5 years to 2 Years! Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications. The whole policy is on their website with details for other weight loss surgery requirements for RNY, etc. but this is all the stuff that compares what was in effect Feb 1 to what is in effect now! Hope this helps someone. :mad: AETNA Obesity Surgery CPB Feb 8 2008 Revised.doc

Check out the attached pages that compare the old Aetna clinical policy bulletin to the new one they just posted on their website with a revision date of Feb 8, 2008 -- reduced the time for severe obesity wording from "at least 5 years" to "at least the last 2 years" . This was the ONLY change I could find in comparing the whole document with regard to anything to do with Lapband surgery qualifications. I'm going to post this in the Insurance Thread also.:mad: AETNA Obesity Surgery CPB Feb 8 2008 Revised.doc

Thanks Niki but no, no news today. I wondered if she didn't make it in the office but I did call her and leave another message today. I also found out that Aetna revised their Clinical Policy Bulletin on Friday Feb 8th and I faxed that to her today. It looks like they lowered the years from 5 to 2 years of weight history if I read it right.

I'm going to go check for that Clinical Policy Bulletin and fax to my surgeon's office this afternoon! Thanks so much for the heads up. We've got bad weather in Ohio today and alot of kids are off school so no word from the doctors' office - they could have closed due to snow and ice...wouldn't you know when I'm waiting on the edge of my seat!!

Same boat here! Aetna telling my surgeon's office bariatric coordinator they still needed 5 year weight history and I knew it was something the surgeon's office should have because I had to pay $50 to get the 5 years of records pulled from storage. She called me back and said, nope, no weight history for 2002,2003,2004. Turned back and called the PCP office and they immediately began reading off the dates of my appointments and weights in those years. So now I'm waiting for the surgeon's office and PCP to synch up so the surgeon can submit it to Aetna. Sure is a long and winding road but I feel I'm getting close.

Hi Marie - I had seen a post of yours on the OH website forum and its nice to see you post here. Gosh I am so sorry to hear about what happened with your gallbladder - I had a very acute episode in August 2007 and was leaving to go to Alaska for 2 weeks of all things about Sept 3 so I was worried if I'd make it through my vacation okay but I did. They immediately scheduled me for laprascopic gallbladder surgery, outpatient, at Mt. Carmel East when I got home and it was a breeze for me. Surgery on a Wednesday and back to work on a Monday, so I feel so, so bad for your experience. I wish you all the success in the world for a healthy recovery from your band surgery. I'm waiting on Aetna to approve and according to Charlene, she will get them the 5 year history info (hopefully today) and then it should be approved. I hope to get banded by early March maybe. Several of us have said they need to get a second person to help process paperwork and consult with patients in the approval process but I think I'm so close now, I just need to get across the finish line!

Called Charlene at the surgeon's office this a.m. and Aetna has asked for my 5 year weight history and I told her she already has it. She started looking through the big stack of paper medical records from my PCP and said she couldn't find anything for 2002,2003, 2004 so I immediately called my PCP office and thankfully they hadn't sent the box of records back to storage yet and she was able to tell me that the weight of multiple visits in 2002, 2003, and 2004 was on what was sent to the surgeon's office. I called Charlene back to give her the exact dates on the doctors progress notes to look through and she should be calling me back this a.m. to confirm she's got it. Then I hope she faxes it to Aetna today!!! She said that was all Aetna was asking for. Its getting so close I can feel it!

Second, it was all "good" until the very last paragraph which states: "Client would be a better candidate for bariatric surgery if she took time to prepare for sugery by addressing psychological issues. Major areas of concern to be addressed would be potential for symptom substitution once food is no longer an option and eating behavior that causes reflux. I recommend that client seek psychotherapy prior to and after surgery to address these concerns." I actually don't think this sounds all that bad and I'd let it go. If you are obese, severely obese, or even morbidly obese, there is no doubt all of us have issues with using food as a substitute for dealing with other things in our lives. Yes, we will have to learn how to manage eating for eating sake and not abuse food. I would recommend, and I plan to continue, to see a psychologist/counselor to continue to talk through the feelings I know I will have with dealing with having to limit my food intake and not eating to celebrate, eating when sad, etc. What the letter doesn't say, which is very good, is "I do not recomend this patient have bariatric surgery." they could have been that straight about it and since they didn't I'd just get busy going to a few appointments with a counselor like the others have suggested to document that you are getting prepared in advance of surgery, and that you are willing to work on what they said to do.

Here Here! What a nice bunch of ladies and gentleman! Thanks for taking time out of your busy schedules to share your experiences.

Yes, as far as I know those from Allergan - the AP/VG bands, and the Realize band from Johnson & Johnson now (formerly swedish adjustable gastric band) are the only 2 I have found that are FDA approved for use in US hospitals.

No news on my insurance approval yet :-( Jury duty is over and boy am I glad. I can now let you know I was on a civil murder trial and for 4 straight days I heard more ugly stuff than I ever wanted to hear. We deliberated for 7 hours and I was exhausted when I got home. I was the jury foreman to keep them all working to a conclusion and to communicate with the judge. It is an interesting experience and my boss very kindly let me work from home a half day on Friday as I really didn't feel good because I couldn't sleep Thursday night with all that stuff in my head. To be honest, I think it takes awhile for this stuff to settle out of your head. Anyway, I believe the jury system works and if you get a chance to serve, I hope you will.

There is a whole group of people who discuss their experience with the vertical gastric sleeve on Obesity Help - Weight Loss, Surgery, Support Groups, Forums, Surgical Procedures web site forums.

These are some graphics I have been collecting to explain to family and to have for myself. I am basically going to allow my surgeon to pick the right one for me since I've heard they are both equally good. AP New Band Type picture.bmp Bands filled and unfilled.bmp

Sorry but I didn't have the graphic of the Realize band when I posted the first entry above and I can see the second picture was a little grainy but you can hopefully see the difference of the inner circumference of the two types with this second picture.

Here are the pictures I've collected for my own info. AP New Band Type picture.bmp Bands filled and unfilled.bmp

I think I have some pictures. Let me see if I can upload them. The AP or Inamed/Allergan band has puffy pillows (non medical term!) and the Realize looks smooth to me all around the inner circle where the fill water goes.

Okay ladies, still no word on my insurance approval. The waiting is hard. Jury duty is going well. Got put on a jury by 9:30 a.m. on the first day and its keeping us going. It looks like that will wrap up by maybe Tuesday next week so its definitely not going to interfere with surgery if I get the call I've been approved. Just taking it a day at a time.

Hi there to Canal Winchester. When we met in December we just had a roundtable discussion with each other since we'd never met. Introduced ourselves, what stage we are at in the process, what challenges we are having, how supportive or not family and friends are being, etc. This time it looks like we'll get to meet many more than we had in December when there was only 3 of us the first time -- someone has to go first! And several ladies are talking about bringing their good usable clothes in sizes they've lost and no longer need to share with others who may be just getting to that stage. Since this is all informally organized, we'll just play it by ear. Are you banded yet or checking into it? If banded, are you in the Barix, Mt. Carmel, Riverside or OSU programs?

For those of you who are in the 'I don't care who wins category' here's a funny one for you.