JoannMarie

Phyl, you really do look great. I can really see the difference - even with baggy clothes, your face shows two things: losing weight BIG TIME, and HAPPY! You look beautiful! I'm so glad to hear you are doing so well. I've taken the first steps - decision, application, scheduled for the psych evaluation next week, all other paperwork in - hope to be banded early this summer. You are my inspirational thought for the day! Joann

I'm a bit concerned about the need for a TT. Here again, does Medicare pay?? kinda doubt it. Joann

Thanks Mommy2 for that information. I also have severe arthritis and am not looking forward to pre-surgery time off Celebrex. I've had to do that before and it was terrible. I am hopeful getting weight off will help, but I know it won't make it all go away... I am hoping to be banded in June or July and hope I'll be able to take Celebrex after the surgery. I have never had a stomach issue with it in about 12 years. Joann

From my research I know medicare only pays a fraction (small fraction) of what the docs charge. I can't blame them for taking a limited number of medicare patients/month in order to maintain their facilities, staffing, equipment, etc. It's all expensive! The one location I found with the long waiting list had been taking names while awaiting their approval as a Center of Excellence. It took a long time and now they have a very long waiting list. Medicare has been covering this surgery for just a little over a year, and lots of facilities have applied to become the Center of Excellence medicare requires them to be. It's a long process and things will probably loosen up in time. I am happy to find the facility I have found - even though I have to drive about 180 miles round-trip. Even with the cost of travel I will come out ahead because I can hopefully get it done early this summer. My application is in, my psych evaluation is set up for early May, and I have met the other requirements of medicare. I'm told my number should come up early June and I'll have my consultation and set a date for surgery which should be a few weeks following that consultation. So far, so good. I have done a lot of research and know this is the tool I can work with. Just wish I could have it done yesterday! Thanks for your input. Joann

I don't have an official answer to your question about medicare coverage for fills - also have read several posts re medicare coverage and it was my impression from those posts that they do. You might check with your doc's office. If he/she accepts medicare they would know about the fill question. Some docs do not accept medicare at all. I am surprised to see that you have not had a fill since your surgery last summer. Have you been losing weight? I am waiting for paperwork to clear for my banding. Also a medicare patient and I have had some trouble finding a doc who accepts medicare assignment, patients over 65, AND is not backlogged for 2 years. Let's face it - when you are a medicare patient, the whole idea is to alleviate and prevent those serious health problems in the next 2 years! Kinda defeats the purpose if you have to wait... I finally found the place for me, and I'm very happy with it. They tell me it will be June or July. My application is date-stamped and on their desk! Let us know how you are doing... Joann

Congratulations, Karen. Hang in there! Joann

FANTASTIC! You gals make my day! Joann

Good luck to you, Grammy! I'll be thinking of you next Monday. Let us know how you are doing... Joann

All of you are so inspiring. I have done the research and now trying to find the right facility - will go to the 3rd and last seminar this weekend, then make my choice. I am ready! I won't feel guilty or ashamed. I HAVE tried, many times, as have all of you. I have reached the point where only the most drastic of diets will help me lose weight, and the subsequent "maintenance" plan leads to weight gain almost immediately. At some point I just give up. Keep trying, but without real hope. Those of you in your 30s and 40s are in the perfect position. I am 65 - no lifethreatening co-morbidities (thank God), but very severe arthritis that limits me physically. As my doctor said - can't exercise without losing weight, can't lose weight without exercising... I have a very active, very supportive husband, but I feel like I am holding him back and keeping him from enjoying those things he loves to do. No more. I count my blessings that he is healthy, and I don't yet have the really bad stuff that comes with being overweight. We have a chance. Please don't feel guilty about saving your life - and don't allow ANYONE to make you feel that way. Many of you have kids to play with and raise. Kids take a lot of energy and strength. You are taking the steps to make sure you have what it takes to make life good for you and your kids. As for me - I'm making plans with my wonderful grandchildren! I wish all of you great success.

Hey - that fork thing - now that's a good idea! The face pain will make you forget all about the second poptart (have to finish the first, though).:Dancing_wub:

Loved that video, Karen. Reminded me of music from "Menopause the Musical". If anyone gets a chance to see that play buy your ticket and GO - preferably with a friend or 3! It's a very funny play. There were not many husbands in the audience (understandable), but those who were there laughed harder than anyone. After all, they have to live with us, don't they...

There are several resale shops in our area that would be able to sell them and at the same time you can check for transition duds that will get you to the next level (going down!!). Most of the clothes at issue with me will be casual, as I've been retired for 3+ years and the more professional pieces are now in other hands. One of my friends at my former job shopped resale 2 or 3 times a month, basically exchanged what she had been wearing for something new (to her). Not a weight issue with her - just loved having something new to wear. I worked with her for 8 years and don't remember seeing the same outfit on her twice! and she always looked GREAT! Much as we would like to BURN the old - this sounds like much more fun in the long run, especially as shopping for clothes becomes a fun activity and not just another heart breaking experience. Look for a resale shop that specializes in plus sizes - they are out there. Have fun trying on a smaller size!

Hi Karen! I am a grandma (of 4 - oldest is 23, youngest grandson just turned 1 year old yesterday) and a great-grandma of a 15 month old girl. We all have the same incentive - being active and able to enjoy these wonderful children! I also love to quilt and enjoy cooking. I think so many of us on the 60+ forum have a lot in common, and good shared experiences. I, too, began the serious weight gain because of severe arthritis and knee surgeries which restricted my ability to exercise. I'm back in that situation with the other knee now. Doc recommended injections in that knee to help stave off replacement. The injections seem to be working and I have begun to exercise. The lapband and subsequent weight loss will make all the difference. I am determined to make this work. I am still in the researching stage, just trying to find the right facility that accepts medicare assignment for hospital charges AND the doctor's charges - AND does not have a 2 year waiting list for medicare patients (as one of the nearby facilities has). I am attending a seminar on April 12th that I believe will open that door for me. I am READY! I love your parents already! What a wonderful gift for you - please accept their gift with love and appreciation, and begin to plan how you can pass their love on through you to your children and grandchildren. I believe that's what we are all here for... Good luck to you Joann

Can I join this list? JoannMarie, 65, Independence, MO In the Quest for banding

Karen, I'll be thinking of you tomorrow! Please keep us posted on your situation. I agree we are all at risk. Our ins agent keeps telling us that docs will have to continue to accept Medicare assignment because of the aging population. I don't agree. I've heard too many stories of docs opting out or not accepting new MC patients. It's a worry, but I guess all we can do is keep on keepin' on. Joann

Hi Karen, I think my first call would be to the doc's office to find out specifically how this is going to affect you. You have already been banded - they need to tell you exactly what you can do from here. Can you send their bills to Medicare and supplement? Is it possible you can pay for f/u and fills up front and be reimbursed? Do you need to find another Medicare connected facility where you can have the necessary followup care and fills? My guess is this is not an overnight decision on the doc's part, and it is not a very good business practice to leave patients in that situation without some assistance. We're caught in the middle here - Medicare keeps pulling back on what they will pay for our care, while expenses go up for the doctors. I wonder if this is the coming crisis if the country goes for a totally government sponsored health care plan. Your next call should be to Medicare to find out what your rights are and what your next step should be. Start asking lots of questions... Joann

Hi All, I am really glad to be on this search, because I have certainly learned alot about supplemental insurances. The plan I have states it pays excess physician charges - come to find out they have their own method, and I have been told by the company rep and the agent they figure things a bit differently. I just spoke with a different company got a different story - they DO pay 100% of excess physician charges. I'm beginning to feel I am not getting a straight answer from anyone. I'm waiting for a call back from the COE rep to ask her what their experience is. I'll switch plans - which I am now inclined to do anyway, considering the run-around I'm getting from the current company. It's good to hear the rest of you have had good luck with your Medicare and supplement coverage. I know I'll get there too. I'm just glad to be researching this now before I waste more money on a plan that does not pay what I have been told they pay. Good luck on your journeys! Joann

Thanks, Sharon and Sallie for your responses. Sharon, your weight loss already is amazing! When I read posts like yours I am so encouraged... I should clarify the COE I am talking with was very upfront about their surgeons not being contracted with Medicare, therefore charging their usual charge for this surgery. I know if they are contracted with Medicare they cannot charge you more than Medicare will pay. The center also said (and it is in their written communication) they will accept what Medicare AND MediGAP supplement will pay. I will check that out further and talk to my ins agent about the right kind of supplement. The other COE I am visiting indicated they have 3 surgeons who are contracted with Medicare, so there would be no further charges for the doc. I have been told the Medicare requirements and approvals are easier to obtain than many insurances. The trick is finding a COE with Medicare docs convenient to your home. This will be SO WORTH IT! Stay positive, Joann

I've been interested in this thread because I am also a Medicare patient - kinda mid-point in my research. There are several facilities in my area (Kansas City) that are receiving their certification as Centers of Excellence, but Medicare seems to be pretty slow to get all their paperwork done and billing codes established, etc. Unfortunately, I am not always very patient with crossing the t's and dotting the i's... At any rate, I am considering going to Topeka for my surgery - about 160 miles round trip. My question for Sharon - do you have to go on your 400 mile trip for all your followup, fills, support group, etc, or can you get that done (and covered) locally? I am attending all the local COE seminars in hopes of doing all this locally with a center I am comfortable with. Headed for Topeka this weekend to discuss their program at their seminar. Another thing I am finding -- the docs at some of the COE's do not accept the Medicare assignment. In other words, if Medicare pays $900 and the doc's charge $5000, I would owe the doc $4100. Is this what others are finding? That's out of my league, and would be for many Medicare folks I know. My supplemental ins would help, but I don't know if it would pay enough to make the doc happy. The hospital facilities are accepting the Medicare assignment so that does not seem to be the problem. Ever hopeful, Joann:huh2:

Thanks so much for your replies. I'm happy to hear that good news - maybe I'll be able to hang on! I had heard about the Center of Excellence requirement and am scheduled for an informational seminar at the one closest to me next week. I looked up info on the Medicare/CMS website and it was pretty straightforward as far as whether or not it is covered - written in gov-speak of course, so there was still that concern... I appreciate your information and encouragement. Joann

I have a 5 yearold artificial left knee and am looking at replacement on the right soon - all due to severe osteoarthritis. Orthopods tell me I should use the elliptical and/or the recumbant bike to avoid the impact you have with the treadmill. I think either is a good way to exercise, but everyone needs to be aware of high impact on the joints - esp those of us who are overweight. I have not yet had my banding - still researching - but I am looking forward to feeling like exercising again...

I am at the beginning stage of researching this surgery - and impressed with how successful and happy most band patients seem to be. I understand Medicare pays for the surgery. How 'bout the fills, follow-ups, etc.? How long does it take for the okie-dokie from the Medicare folks? I am attending the informational seminar at the nearest "Center of Excellence" next week - BUT just can't wait for some answers! Once I decide I'm ready I want to move forward. Sounds like I will have to learn patience again... :smile2:

I am at the researching point in this journey, and anxious to hear ideas and information about the process of lapbanding and the life that follows. In looking at some of the forum topics, it seems there will be a lot of information on this site! Any comments are welcome. Joann:smile: