JasonSWrench

So, here's what's been going on in Lap-Band world for me. Last Thursday I went in for my upper endoscopy. Overall, not a bad experience. They were very nice and the whole thing went very quickly. The last thing I remember was the anesthesiologist saying "This may sting a little" - and I was out. When I woke up 20 minutes later, the nurse assisting my GI was packing up the equipment. He showed me the pictures and my GI came in and told me what she found. Basically, unbeknownst to me, I actually have some serious Gastric Reflux issues. Apparently, she found ulceration and scaring in my lower esophagus. I know I had a little Gastric Reflux occasionally, but usually I would pop a couple of tums and be perfectly fine. She decided to put me on a drug for the Gastric Reflux and I get to go see her again in two months for another upper endoscopy (lucky me!!!). Of course, by the next day I had lots of questions. I called her office and got ahold of one of her office staff who was able to go over the report with me. Thankfully, my GI doesn't think that her findings will prevent me from having the surgery and ultimately when the surgery occurs is something that will be left up to the surgeon. Speaking of the surgeon, I go into finally meet the surgeon tomorrow. I'm just hoping that the GI report gets to him by tomorrow. Other than the GI report, I have flown through every hoop they have sent my way. I should know tomorrow when I'm going to be scheduled for surgery. Of course, getting scheduled for surgery and then getting approved by my insurance company are two unrelated issues. I just find this process a little backwards. I have to go through all the hoops, and then hope that the insurance company goes along with the idea. My surgeon's office has a really good history of getting patients accepted by their insurance companies, but I'm not going to be completely happy until I'm laying in a recovery room.

So, here's what's been going on in Lap-Band world for me. Last Thursday I went in for my upper endoscopy. Overall, not a bad experience. They were very nice and the whole thing went very quickly. The last thing I remember was the anesthesiologist saying "This may sting a little" - and I was out. When I woke up 20 minutes later, the nurse assisting my GI was packing up the equipment. He showed me the pictures and my GI came in and told me what she found. Basically, unbeknownst to me, I actually have some serious Gastric Reflux issues. Apparently, she found ulceration and scaring in my lower esophagus. I know I had a little Gastric Reflux occasionally, but usually I would pop a couple of tums and be perfectly fine. She decided to put me on a drug for the Gastric Reflux and I get to go see her again in two months for another upper endoscopy (lucky me!!!). Of course, by the next day I had lots of questions. I called her office and got ahold of one of her office staff who was able to go over the report with me. Thankfully, my GI doesn't think that her findings will prevent me from having the surgery and ultimately when the surgery occurs is something that will be left up to the surgeon. Speaking of the surgeon, I go into finally meet the surgeon tomorrow. I'm just hoping that the GI report gets to him by tomorrow. Other than the GI report, I have flown through every hoop they have sent my way. I should know tomorrow when I'm going to be scheduled for surgery. Of course, getting scheduled for surgery and then getting approved by my insurance company are two unrelated issues. I just find this process a little backwards. I have to go through all the hoops, and then hope that the insurance company goes along with the idea. My surgeon's office has a really good history of getting patients accepted by their insurance companies, but I'm not going to be completely happy until I'm laying in a recovery room.

Hello to everyone who is actually reading my blog - the whole 3 of you!!!! Thanks for reading!!! OK, I've had a few fun things going on in blog land. On Monday, I finally got to meet with the GI specialist and I'm scheduled to have my endoscopy next Thursday. While I hear the endoscopy isn't bad, I haven't been under anesthesia of any kind since I was like 15 when I had my tonsils taken out. This is the last hoop I have to finish before we can begin the real trek towards getting the lap-band. Today, I went to my surgeon's office and I found out I'm down 11 pounds, so I only have to lose 4 more pounds to put me in the spot my surgeon wants me in before the surgery. Furthermore, since I have finished all of the fun hoops (see previous post), I am finally going to get to meet the surgeon. On August 15th, I will finally get in to see the surgeon who will be performing the operation. Apparently, I'll also get a tentative surgery date that day as well. While this sounds all great, it's far from over. Once I see the surgeon, he will then write the letter to my insurance company explaining that I am a fat bastard (according to one of my students) and need the surgery to make me a skinny bastard. I just feel like I'm going through all of these hoops hoping that I'll get the surgery when at this point who knows what the insurance company will say. Furthermore, my grandmother is hoping to fly to New York for the surgery. I would hate for her to make plans and then have them all dashed against the rocks because the insurance company throws us a major hurdle. Oh well, it's all a game!!!:redface:

Hello to everyone who is actually reading my blog - the whole 3 of you!!!! Thanks for reading!!! OK, I've had a few fun things going on in blog land. On Monday, I finally got to meet with the GI specialist and I'm scheduled to have my endoscopy next Thursday. While I hear the endoscopy isn't bad, I haven't been under anesthesia of any kind since I was like 15 when I had my tonsils taken out. This is the last hoop I have to finish before we can begin the real trek towards getting the lap-band. Today, I went to my surgeon's office and I found out I'm down 11 pounds, so I only have to lose 4 more pounds to put me in the spot my surgeon wants me in before the surgery. Furthermore, since I have finished all of the fun hoops (see previous post), I am finally going to get to meet the surgeon. On August 15th, I will finally get in to see the surgeon who will be performing the operation. Apparently, I'll also get a tentative surgery date that day as well. While this sounds all great, it's far from over. Once I see the surgeon, he will then write the letter to my insurance company explaining that I am a fat bastard (according to one of my students) and need the surgery to make me a skinny bastard. I just feel like I'm going through all of these hoops hoping that I'll get the surgery when at this point who knows what the insurance company will say. Furthermore, my grandmother is hoping to fly to New York for the surgery. I would hate for her to make plans and then have them all dashed against the rocks because the insurance company throws us a major hurdle. Oh well, it's all a game!!!

Some of my friends have suggested that I start writing a blog about my process to get a lap-band, so here goes. My process started in June. One of my friends is going to have a gastric bypass in December, and I promised here that I would go be with her when her surgery happens. In response, she told me that I should look into getting surgery too and she could come be with me. Well, I saw my primary care physician and asked him at what point I should seriously start considering surgery, and he was like - now. I called my insurance and found out what they wanted. I then found all of the bariatric surgeons in my part of New York. Sadly, there were not many at all. In fact, the closest one to me is an hour away. The surgeon who I ultimately went with does not perform gastric bypasses, but is a lap-band guy. I wasn't completely sure what the lap-band was, so I did some investigative work and realized that I really preferred it to the gastric bypass. I called the surgeon's office and scheduled to go to a day-long meeting in early July. I might add, that I hate waiting. On the day of his seminar, we met his team. The morning consisted of the basic educational overview and the afternoon consisted of meeting with the insurance specialist, talking with the dietitian, meeting with a nurse practitioner, and then meeting with the program director. The program director said I would have problems with my insurance company because my BMI was too low, but she said she'd double check and call me the next day. Sure enough, my dream of weight loss surgery was quickly dashed against the rocks. I ultimately ended up spending the entire 4th of July weekend annoyed. On Monday morning, I saw my general practitioner and decided to have them measure. Now, I'm a big boy. I've always said I was 6'4". However, my primary care physician measured me at 6'1" (and no, I did not slouch). I quickly called the insurance specialist and the surgeon's office and told them I was 3 inches shorter than I had told them. By losing those three inches, magically my BMI was above 40. It was the first time in a long time that I was actually excited at being bigger than I thoguht I was. Now, I have a BMI over 40 and one co-morbidity - high blood pressure. I'm pretty happy and keep crossing my fingers that my insurance company will pay for it all. After finding how that I could qualify, I started setting up all of my appointments. Now, my insurance company only requrires that I send in a letter from the surgeon explaining the necessity of the surgery. However, the surgeon has a long list of things he wants to see before he will even see me. I admitedly find this process very strange. Here is my laundry list of things I must complete before I can even meet the surgeon: 1) Have Bloodwork 2) Have upper GI x-ray 3) Get clearance from cardiologist 4) Get letter from primary care physician 5) Get a behavioral evaluation 6) Attend two group meetings 7) Have an endoscopy done 8) Meet with the dietician monthly 9) Loose 5% of my body weight(though I think this is only a requirement by the day I actually do pre-op) 10) Watch an online course about the lap-band surgery. I completely understand why all of this is needed before the surgery, but I'm not completely sure why all of this is necessary before I meet the surgeon. But, like a good little doobie, I've gone through and done everything asked of me. The only thing I'm now waiting on is the endoscopy. I have to go in on Monday to meet the GI guy who will then schedule me for the procedure. I'm hoping to get the endoscopy in the next couple of weeks and then schedule the meeting with the surgeon. I'm a teacher, so I'm trying to get all of the doctor's appointments out of the way before the beginning of the school year. Once I see the surgeon, he will then write the big letter that goes to my insurance company, and then I will have to wait. From what his office has told me, they have a pretty good track record with my insurance company. But, I'll believe it the day I finally get my clearance. I'm admittedly a pessimist, so I'm trying not to get overly excited because I don't want to really set myself up to heartache if I get denied. PS The barium drink for the upper GI was not bad. It's like drinking a flavored water that's a little chalky. I went in thinking it was going to be just horrible tasting, but was realistically plesantly surprised. The Radiologist even turned the monitor towards me so I could watch the liquid going down my esophogus. :frown:

Some of my friends have suggested that I start writing a blog about my process to get a lap-band, so here goes. My process started in June. One of my friends is going to have a gastric bypass in December, and I promised here that I would go be with her when her surgery happens. In response, she told me that I should look into getting surgery too and she could come be with me. Well, I saw my primary care physician and asked him at what point I should seriously start considering surgery, and he was like - now. I called my insurance and found out what they wanted. I then found all of the bariatric surgeons in my part of New York. Sadly, there were not many at all. In fact, the closest one to me is an hour away. The surgeon who I ultimately went with does not perform gastric bypasses, but is a lap-band guy. I wasn't completely sure what the lap-band was, so I did some investigative work and realized that I really preferred it to the gastric bypass. I called the surgeon's office and scheduled to go to a day-long meeting in early July. I might add, that I hate waiting. On the day of his seminar, we met his team. The morning consisted of the basic educational overview and the afternoon consisted of meeting with the insurance specialist, talking with the dietitian, meeting with a nurse practitioner, and then meeting with the program director. The program director said I would have problems with my insurance company because my BMI was too low, but she said she'd double check and call me the next day. Sure enough, my dream of weight loss surgery was quickly dashed against the rocks. I ultimately ended up spending the entire 4th of July weekend annoyed. On Monday morning, I saw my general practitioner and decided to have them measure. Now, I'm a big boy. I've always said I was 6'4". However, my primary care physician measured me at 6'1" (and no, I did not slouch). I quickly called the insurance specialist and the surgeon's office and told them I was 3 inches shorter than I had told them. By losing those three inches, magically my BMI was above 40. It was the first time in a long time that I was actually excited at being bigger than I thoguht I was. Now, I have a BMI over 40 and one co-morbidity - high blood pressure. I'm pretty happy and keep crossing my fingers that my insurance company will pay for it all. After finding how that I could qualify, I started setting up all of my appointments. Now, my insurance company only requrires that I send in a letter from the surgeon explaining the necessity of the surgery. However, the surgeon has a long list of things he wants to see before he will even see me. I admitedly find this process very strange. Here is my laundry list of things I must complete before I can even meet the surgeon: 1) Have Bloodwork 2) Have upper GI x-ray 3) Get clearance from cardiologist 4) Get letter from primary care physician 5) Get a behavioral evaluation 6) Attend two group meetings 7) Have an endoscopy done 8) Meet with the dietician monthly 9) Loose 5% of my body weight(though I think this is only a requirement by the day I actually do pre-op) 10) Watch an online course about the lap-band surgery. I completely understand why all of this is needed before the surgery, but I'm not completely sure why all of this is necessary before I meet the surgeon. But, like a good little doobie, I've gone through and done everything asked of me. The only thing I'm now waiting on is the endoscopy. I have to go in on Monday to meet the GI guy who will then schedule me for the procedure. I'm hoping to get the endoscopy in the next couple of weeks and then schedule the meeting with the surgeon. I'm a teacher, so I'm trying to get all of the doctor's appointments out of the way before the beginning of the school year. Once I see the surgeon, he will then write the big letter that goes to my insurance company, and then I will have to wait. From what his office has told me, they have a pretty good track record with my insurance company. But, I'll believe it the day I finally get my clearance. I'm admittedly a pessimist, so I'm trying not to get overly excited because I don't want to really set myself up to heartache if I get denied. PS The barium drink for the upper GI was not bad. It's like drinking a flavored water that's a little chalky. I went in thinking it was going to be just horrible tasting, but was realistically plesantly surprised. The Radiologist even turned the monitor towards me so I could watch the liquid going down my esophogus.

I forgot to answer the basic question. NO, not all insurance companies expect you to be on a diet for 6 months.

Actually, each company is quite different. My insurance company really only looks for a BMI over 40 and one co-morbidity or a BMI 35-39 with two co-morbidities. Your individual surgeon will probably have someone in her or his office that can help you navigate the insurance obsticles. Obvisouly, it's in the surgeon's best financial interest to help you get the surgery.

Hello Everyone!!! I'm hoping to get banded if everything goes as planned some time this fall. Unfortunately, my surgeon thinks my insurance company may throw a few road blocks in my way before I can get approval. Here's the basic deal. I have a BMI of 38.2, but I have high blood pressure. My surgeon doesn't think the single co-morbidity will be enough to get the surgery. I know I don't have diabetes, so my best hope is that I undergo a sleep study and find out that I have sleep apnea. I can honestly say that this is the first time in my life that I'm hoping to have something wrong with my body. Sadly, with my luck, I won't have the sleep apnea and my insurance company won't cover me at that point. Hopefully, everything will work itself out fairly quickly. Jason

Hello Bandsters: I'm a 32 year old gay guy in New York. I'm hoping to get banded this fall, but not sure it will happen. I found at yesterday that my BMI is only 38.2, so I actually would need to gain 15 lbs for my insurance to cover me with a co-morbidity of high blood pressure. However, I may get lucky and have sleep apnea, which would definitely help me get banded. I'm just a little frustrated about this whole process. The idea that 15lbs could actually prevent me from being able to follow through with this is just nuts!!!! How about all of you, did you have trouble with your insurance companies? Jason :thumbup: