Sandy3

Thank you all for your responses and support. What good advice leatha G. Maybe God felt I wasn't ready to use the band as a tool and work with it. Who knows. I only know that I am the only one who can make the healthy changes I need to make (w/his help of course.) It would be too hard to stay away from this site. Too much info and support. Afraid I might miss something important. I do believe that a resolution will come from something I will read on this site. I don't plan to stop searching, just putting things on hold for now. Trust me you will be the first to know if God changes his mind and let's me get banded. Sandy

Well I just wanted everybody to know that I am ready to stop beating a dead horse. I just got notice from my employer that they are not financially able to add the ryder that I would need from the insurance company in order to have the surgery. Initially Paramount HMO (my insurance company in Ohio) said they had an exclusion. Now I believe they do allow the surgery if the employer adds the ryder. So now it appears that my employer is the one with the exclusion. I haven't talked to HR one- on- one as I just got the notice yesterday. I plan to see what's up. Right now self pay is not an option. I had made a decision to turn this over to God and said I would accept whatever the answer was. I feel I have done everything in my power, so it appears that for now the answer is that the surgery is not for me. The good thing is that I met a wonderful therapist and addressed some issues. I will be seeing a Pulmonary Specialist and be having a sleep study as I believe I have sleep apeana. I am involved in aquatic exercise. I plan to focus on getting healthy, but I am done with the obsessive need to lose weight. I think leaving all of that in God's hands is the best thing. I will let Him guide my next steps. My philosophy will be "I can't. He can. I'll let Him." Thanks for all your support. Best wishes to all no matter what stage of the process you are in. For some reason, I don't feel defeated. I feel my prayers were answered. This isn't the answer I wanted but I prayed for His will and not mine. Can't argue. If it is meant to be, it will happen, in His time and not mine. I'll check in periodically. sandy3

I am probably going to ramble a little. Over a year ago I attended a seminar with Dr. Duckett in Maumee. Paramont is my insurance. Dr. Duckett's office said they were in the process of signing a contract with Paramont for lapband. I was told to keep calling the Dr's office as they expected to sign soon. Finally in Sept. they reportedly signed and Paramount will now pay for lapband through Dr. Duckett.....they neglected to say that only 25% of the company policies will cover with 75% not covering even if it is a Paramont covered service. Additionally, NOBODY seems to know that Paramont will cover the surgery as long as it is not excluded from your employer policy. Of course it is excluded from our company policy because, as our insurance broker said, "it has never been a covered service and is excluded from all paramont policies". So, I said to the Dr.'s office rep that I have spent the last year gettiing all the documentation ready for when it was a covered service. I had my psych eval (a year ago on 10/5/05); I hve continued in therapy to address eatiing disorder issues; I have been visiting my PCP monthly for the last 6 months for medically supervised diet; he is willing to write a letter indicating it is a medically necessary procedure as is my cardioligist and my therapist (who is affliated with the surgeon). So the office manager says "Why have you been doing all that stuff when the procedure wasn't even covered during the time you were doing all that stuff? You were just wasting your time!" And I sez, "Well, each tiime I called your office during the year I was told "call back next week ....call back next month...we're very close to signing!' She sez, "Well that's what we thought", I sez "If I hadn't done anything while waitiing you would have said "well why didn't you prepare?" I AM SO TIRED!! Soo..I am gettiing the letter from my PCP today, letter from my therapist tomorrow, letter from cardiologist this week. I will present them to my employer along with the name of the Paramont manager who is handling the lapband stuff. Hopefully once my employer has the information that the procedure is medically necessary and that Paramont will pay if not excluded from company policy, the company will add the procedure to our policy. The other issue is the fact that my employer will be asking for quotes from other insurance companies as this is the time of year that they will change insurance companies if they can get a better deal. Another company may or may not allow the surgery. At this point self pay is not an option so on with the red tape! Thanks for listening Sandy3

The Toledo Blade reviewed a book in today's paper. I thought I would share. "What happens to me is this: I get fat. Then I get fatter and fatter, over a period of years, until I'm fatter than I've ever been. Then I get thin again. But when I get thin, I'm never as thin as I was the time before. And when I get fat, I'm always fatter than I was the time before." THE HUNGRY YEARS. By william Leith. Gotham $25. That's it in nutshell! Sandy

I just met with Dr. Schram at Barix in Ypsi. I was told he travels between both clinics. He said he has done about 80 bands and over a thousand By-Pass surgeries. He said he has never lost a patient on either surgery. He told me that self-pay would be $15,500 (I believe). Have you read the posts by Dr. Pleatman. I believe he charges $12,500 and that includes fills for 2 years. I am from OH and Ypsi is very close. Pleatman is in MI too but I do not know how exactly where. There are a lot of positive comments about him and he actually posts on this site. If I have to self-pay the $3000 would sure make a difference to me. Good Luck Sandy

Thanks for the support and feedback guys. How about a thread called "Experience Challenged" Jack? I like the sound of that one. You are too funny. Pam, I am going to check w/HR to see if I can borrow on my 403b. I had heard at one point that our employer does not allow that. I know people say that you shouldn't touch retirement money but, if I don't get the surgery, they're going to be using that money to bury me. SSoooo.... You know, I was watching a minister on TV last week. He was saying that if something is for you, God will give it to you in His time. He said that if you are somehow able to manipulate the situation and get it before you should have it, it will "turn to dust in your hand." I WANT THE SURGERY 10 YEARS AGO!! But what he said struck a nerve, especially since I want to be cremated when I die. If I insist on rushing things, not only will it turn into dust, but so will I. I always enjoy your posts Banded for Life. Your positive attitude about the results of being banded give me the encouragement I need to keep on keeping on.

Anybody interested in starting a 55 and older thread? I am 61 and agree w/Jack. If I don't get this surgery, I am sure I will not be around much longer. I just found out that I am only 5' tall, down from 5' 3". I weigh 280. (Just diagnosed with osteoprosis and taking meds). Was tested for sleep apnea years ago and diagnosed w/being on the borderline. Have gained about 50#'s since then. Surgeon wants me to get sleep study. I am resisting. He said if I was having Gastric Bypass he would insist. I want to be banded. I have to admit that lately I have been wakiing up 2-3 times a night gasping for breath. I cannot sleep on my back ever. I know I snore. As I read postings on this site, I am thinking more that I need to follow through w/the sleep study. It was not painful after all, just unpleasant. Better safe than sorry. I also have some heart problems and high blood pressure along w/panic attacks. He mentioned a stress test. Right now I can't walk even short distances w/o feeling like a fish out of water. Stress test scares me to death. Also have asthma. He wants pulmonary function test and asthma under perfect control before surgery. Also the usuual lose 10-15#' before to decrease fat on liver. So now I know what I need to do. I need to grow up, face the facts, get sleep study, stress test and asthma under control while losing up to 20#'s. As you all know I have plenty of time since the referral is just now being submitted to the insurance co. I have 2 adopted teen-age daughters and a 5 yr. old grandson. If I want to be around for them I need to get busy. Following through will mke me healthier after the surgery. You guys help me to keep my feet on the ground. I love the support and information on this site. Funny, I take all these meds for various medical conditions, yet was basically in denial that these conditions are serious and need to be addressed. God has laid out the path and with His help and yours I will keep my feet going in the right direction. Thanks for listening and most of all for sharing. Sandy

I had an orientation at Barix in Ypsi MI yesterday. I am from Toledo area. So far so good. Dr. Schram met w/me one on one. He instructed me to lose 10-15#'s for fatty liver. He wants a Pulmonary function test and documentation from my Cardiologist that I can tolerate the surgery. He said he wants my asthma under complete contol before he would consider surgery. Barix insurance dept is going to submit referral to Paramount insurance co. He has a good reputation. There is a site for Barix on Obesityhelp.com . They have facilities in MI and OH. There are testimonies from patients who have had the surgery. They just started doing the Lapband. Dr. Schram has done about 80 since May. He works at both MI Barix clinics. Tthe facility looked good. He stated he has done thousands of surgeries (ByPass) and has never lost a patient yet. If I get approved I will feel comfortable going to Barix. Good Luck w/your surgery Sandy

Baron: You've got a fight on your hands alright! But it sounds like you're just the person who can do it!! Maybe you could find info on this site on Doctors in your area who are supportive of the surgery. That way you won't have to re-invent the wheel. Chances are if a surgeon knows that your insurance will cover the band, they will help you qualify. I've read on this site that some surgeon's offices do most of the work. I am going for a consultation at Barix Clinic in MI. today. They say they help you fight appeals. We'll see. I have letters from 3 physicians and a therapist recommending I have lap-band. My list of meds were so long I had to write two or three in the lines meant for only one. I am on 3 meds alone for heart and blood pressure, and have been for years. I have been getting ready to submit to the insurance for over a year: 6 months supervised diet, aquatic exercise program, psych eval AND counseling, referral to Nutritionist (as the 6 months of supervised dieting has had MIXED results..surprise...surprise). I hope I have most of my ducks in a row. Even with that I expect a denial. Surgery " for weight loss" is not covered under my policy...but it does not say they won't cover if "medically necessary". I am hoping that requesting the surgery to alleviate my medical conditions, not just to "lose weight" might work. Who knows? I am in for the fight too. I plan to appeal, appeal, appeal. One lady on one of the sites even wrote to the White House. Anybody got the President's address handy? Looks like Baron and I might be needing it. I wish you well Baron. Sandy

I talked to a rep from Barix clinic. She stated they have a contract w/my insurance Co Paramount of Toledo. The insurance Co has told me that they do not pay for WLS surgery. Barix just started doing lapband surgery. Dr. Schramm reportedly has done 80 lapbands in 6 mos. I have set up a consultation....no fee. She said they would send a referral to insurance co. Any feedback from members on this clinic and physician (good, bad and indifferent) will be greatly appreciated. Also is ther anyplace on this site or another that I can get info on how patients have rated this facility or physician? Thanks sandy

Thanks "with the band." I will try to answer in the fewest words possible. I wanted to go to Dr. Duckett. For over a year the office manager "Nancy" kept telling me to "hang on" they were signing a contract w/Paramount. So I did all the stuff to prepare..psych, therapy, supervised diet etc etc. Then " Nancy" tells me that she knew all along that the contract they were going to sign was for self insured companies only (25% of Paramount contracts) She told me on a number of occasions that it would do no good to appeal "They won't pay for it: they won't pay for it. And if you have an appointment for a consultation, you had better cancel it unless you plan to self pay!!" She also said "Why would you do all those things when you were not covered? You just wasted your time". I even went to the last seminar to help me determine my next step. Same old story from my friend "Nancy". No support what-so-ever. She was very negative. So while I agree they probably are the best and it would be much more convieient, I saw first hand that the "office manager Nancy" is not going to be supportive of my need to appeal in case of a denial. So that's the only reason why Barix. There is no fee for consulation, unlike Dr. Duckett which is $150 which Nancy made quite clear would be lost once I was denied. The lady next to me in the seminar was worried because she's not sure if her insurance would cover. I gave her info on this site so she could at least investigate her options after "Nancy" got hold of her. Thanks for the reply though. Who knows, maybe it will work out in the end. I can't have my PCP send a referral to the insurance Co until after Jan. as my company may be changing insurance. Once I know who the insurance co is going to be I can start the process. Or maybe I'll get lucky and get banded before the first of the year through Barix. This whole thing has been like being in a maze. But with each set back I gain more knowledge and become just that more determined to see it through. My life depends on it. Sandy

:Bunny YES!! YES!! YES!! One more for us. I read in our insurance policy (on line) that, if they did provide the surgery, which they say they don't, you should see a nutrionist. Wondered what that was about. Maybe it is so you can get on the "diet for life". That will be one of my next steps. What an inspiration sarcar! Way to go!

Thanks for responding Jodie. I see that you are 17. That made my heart sing. I know you must have expierenced a lot of pain in your life already because of being overweight. But thank God you now have the best (not perfect) tool to date so that it may save you a lifetime of suffering. Did you get banded? I read somewhere that they are doing a study. They are banding people who are simply obese in the hope that this will save them from becoming morbidly obese. The article said that this may be the wave of the furture. Some people have been getting this surgery on an outpatient basis. Wouldn't it be great if the price came down so that more people could afford it. Good for you Jodie. You are an inspiration to me. Keep fighting. I have read that some people are trying to get insurance to reimburse them. Please tell me more about becoming an Obesity Epedemic Activitist. I am ready to fight! Sandy

Thanks Michael...things are better already.

I recieved what I felt was a very sarcastic and unsupportive response from a member on this site. I feel I fight enough of that with the insurance company and Dr. offices...I sure don't need it from a "support" site. I really do not care to deal with comments from that individual again. Hope there is something I can do. Thanks

Thanks for the feedback and support everyone. sandy

Sarcar: You are absolutely right. My employer is fully funded not self covered. Therefore it is the insurance co who dictates if the service is a paid procedure. The insurance rep explained to me that the contract they signed was w/self insured companies. The insurance company will provide services as if the procedure is covered, but when the bill comes, the employer will pay for it. I am hearing through the grapevine that the insurance company has paid for Gastric Bypass. In fact, I contacted the insurance company and said that I needed a denial for WLS. The lady said "Our company does not approve for WLS". I said " I know, that's why I need a denial letter." She said to have my PCP send in a referral for WLS. She then said "I believe Dr. Patrick White does that surgery". I said "Yep". (that's the guy I have heard they have allowed other Paramount members go to for the surgery. ) Problem is that he has an age cutoff of 50 something (I am 61) and that he only does By-Pass (I want Lap-Band). So now I know to ask my PCP to send a referral to the insurance co so I can get a denial. Then I will contact Obesitylaw.com and procede through the process. I am gleaning lots of information from all of the WLS sites and am gearing up for a battle. I may end up a self pay but I will continue the fight, up to and including contacting the people with the power to change legislation in Ohio. I may even see if there are others in the same boat who would like to see this discrimination against us stop. My therapist's office said that after Paramount signed the contract w/the Dr.'s who do lap-band, that his phone rang off the hook. Individuals were scheduling the required psych test. A few days later, a number of individuals called back to cancel the psych indicating that the procedure was an exclusion on their company policy. The surgeon's office said the same thing. When I asked the insurance rep at the Surgeon's office what happened to those people when they found out they were not covered she said "I don't know. They never called back" (I think she was making a hidden slur regarding my character lol) Little does she know that I am hopeful that I will someday get banded by that doctor and the bill will be paid by Paramount! Anyway, that's my story and I'm gonna stick with it!! Thanks Sandy

I posted Angry and frustrated in Toledo. I am new to this site. I have Paramont insurance in Ohio. They recently signed a contract w/Dr. Duckett to pay for lap band surgery. Currently it is excluded from my company insurance policy. (It seems mainly because Paramont was not includiing it is any policies). Can people please share any experience they have had in getting their company to add the surgery to their policy once the insurance has made it an approved procedure. Any advice on what to do? I have access to letters from PCP and cardilogist plus therapist indicating that the procedure is medically necessary. I plan to present these to my employer. Anything else I need to do or know to speed up the process? I have been working on this for a year, waiting for Paramont to sign a contract w/the Dr. only to learn that now I have to convince my employer to include it in our benefits (before they possibly change to a different insurance company by the 1st of the year). Thanks Sandy3

Thank you all so much. Kathy, you have a good point. I was thinking about the fact that when we type something the other person cannot read our body language. I read this person's profile and saw that she has a lot of pain. Because of the content of her profile I do plan on visiting the post-op site, which I have not done for awhile (I have been lurking on these sites for over a year). Additionally, I know I was rambling because I was feeling so confused and overwhelmed. People on this site are feeling the pain at the core of their being. We don't just wake up one sunny morning and say," well I think I'll have WLS." It was the hardest decision of my life to realize that, for whatever reason, I was in a horrible cycle with my weight. I would get all excited, start a new diet, lose weight, feel good, know I would never/ever be that fat again only to regain that weight and another 10-20#'s. This has been my cycle since I first stepped on the "diet doctor's" scale in the '50's when I was 8 years old. Did you ever see the commercial of a woman riding a roller coaster and at first having a lot of fun and thrills. Then when it was time for the ride to stop, she had a look of relief on her face because she was glad she was going to get off the ride. But instead of stopping, the ride started again and she could not get off. She had a look of pure terror on her face. It was a commercial about addictions. About the horrible roller coaster ride we all are on. The thrill of victory and the pure terror of defeat. I finally realized that surgery will be the only tool that can help me get off the roller coaster (and that may or may not work either as we all know many have had very serious complications with the surgery). Only in order to get the surgery, we have to stay on the ride until someone else says we can get off. I thank God every day for my therapist. He is helping me through this. And this support site is the only place I can ramble and feel like someone understands. I am feeling very vulnerable right now and when that person came across as being sarcastic, it felt like the roller coaster ride had slowed down long enough for her to give me a slap in the face. Actually, I probably needed that. I am likely in my "victim-stance" right now and overly sensitive. I need to remember that others are dealing with their own deep pain and fear. It isn't only about me. It feels so good to have a place to vent and share. I might explode with all these feeliings if it were not for all the support and information on this site. Thank you all again. I am off to church right now. They have a speaker who has all the answers to all the difficult questions people have about why God allows bad things to happen. I hope to be much more enlightened by the end of that session! Don't worry, I won't leave the site. You guys will probably be gettiing an ear full (or eye full) for quite a while. Thanks again Sandy

Thank you both so much. I will try taking this person off my buddy list. Sandy

Jodi: I have been reviewing older posts as I am planning on pursueiing appeals up to and including usiiing obesitylaw.com. Your post was very helpful. Where are you in the process. Thanks Sandy