Jodi73

My insurance coordinator and I read and re-read the bulletin on Aetna's website. We finally determined that as long as my PCP noted excercise on each visit, along with behavior modification, etc...that that would suffice. I do not have approval yet, they just submitted today I believe. As for the nutritioninst, I went to one official appointment with her, then also had 3 classes that she was present at/taught at as well. We sent a letter documenting all of the "visits" with her. Some people go to 3 visits with all three entites (nutr, excercise ther, and pcp). My coordinator just did not read the bulletin that way, and neither did I . We will see if we are correct I suppose. Let me know how yours goes! Good luck! Jodi

CONGRATS I just finished the 3 month multi program. We are submitting this week ! Hope mine is as easy as yours! Jodi

Mind you, I am not banded yet, but I know from reading on here and what my doc and nutritionist have told me, you can definately eat around the band. Things like chips, cookies, candy, etc will slip right thru. If you are a big sweets eater, or a big junk food eater, maybe its not right for you. If, like me, you tend to eat too much at one sitting, a huge piece of meat, plus all the sides, then want more in just a little while, then the band may be just what you need to help get your eating under control. I am of the mindset that the band will only help those that help themselves! Like I said before, I am not even banded yet, so take my thoughts with a grain of salt! I have researched both GB and LB to the nth degree though, and I think the band is the better of the two for me. It all comes down to you and your particular struggles!Good luck with your decision! Jodi

I had my final weigh in today, and am down another 2 lbs. over a 4 week period. I am just glad I was down some, I have not done as good as I could of in the last week or so! Its TOM, it makes it hard on me, I know TMI! I go for my final psych eval tomorrow, then they will submit to Aetna. ! I am so nervous, but I really think I have all my ducks in a row! I have two more classes to attend, one next week, then one more after I am scheduled for surgery. We get a 3 month membership to a local gym, and three visits with a personal trainer with our prgram fee, so I am pumped up about using that. We can start as soon as the surgery is scheduled. Hopefully, that will help get a few more lbs off before surgery. I can't wait for a new me! I'm think I'm on my way!Jodi

Find out exactly where she is sending it! Ask your ins. for the fax number to them directly, then give it to your docs office. Sounds like the lines are crossed somwhere! Good luck! Jodi

Well, everything will be submitted to insurance on July 22nd. I am nervous already! I go for a pre-op class on the 22nd, and then another on Aug. 12th. They will schedule surgery after insurance approval comes in, I just have to have those classes under my belt before the actual surgery happens. I have Aetna, and have heard good things, we will see I suppose! In reality, I might be a September bandster. I can hope though!

I cant wait to be in your shoes ! Congrats!

Congrats !!!

Look on Aetna.com at the Clinical Policy Bulletins. That will give you details about their policy. Some companies DO exclude weight loss surgery, so check that with your workplace HR office. I cant quite tell, but it sounds like your policy will cover as long as a doc deems it necessary. But, you cant really tell since it does mention the "death" part. Yikes, thats sounds bad! Talk to your PCP, check out the website, and by all means pursue this if you really want to! Aetna is really good to approve, so keep your head up! Good luck! Jodi

YESSSS!!!! I have aetna too, I can only dream of that quick of an answer! Good Luck!

I am looking at mid month , if all goes well :-) Lets keep each other up to date!

You made me laugh out loud! Keep'm coming!

We are on the same track! I did my first visit with my PCP on April 22, my next will be June 1, then one more I have not scheduled yet. I also have to see a nutritionist and excersise ther. Do you? Let me know how things go for you! Jodi

Congrats! Let the games begin!!!!

I have been journaling on sparkpeople.com, it gives you %'s of exactly what you eat, when you eat, calorie count, etc. It has really opened my eyes to to my habits, my weak points, and my real problem areas! I to have a habit of doing really well thru the work day, then crash and burn at night. Weekends are really hard too. It seems the structure of the day is blown, so there goes my ability to make healthy choices and not go overboard with portions. One thing I am trying to do, like a previous poster said, is to change my routine when I get home. Replace my snacking as soon as I get home with playing with my daughter, or doing a little housework. Anything to delay that urge to eat. I have found that if I wait 30 mins. or so, that extreme urge to eat has really dissipated. It really is head hunger. :lol:My dad used to tell me to "live off the lay of the land" He was right! Weekends, well lets just say I am still a work in progress!

I would make absolutly positive you do not have any co- morbidities. Have a sleep study, make sure your BP isn't slightly high, or see if it has been in the past two years, check your cholesterol levels. Have your PCP check any and everything, maybe you are less healthy than you think! Congrats, right?! Its terrible to think we would welcome one of those conditoins! If you do have any of those conditions, get your PCP to document, and add a letter of necessity, then resubmit. Also, Aetna is a stickler for documentation, be sure your PCP is VERY thourough in the notes!

I called Aetna yesterday, and I still couldn't get a straight answer. The person did a live chat with someone else and everything. I was trying to figure out if I needed to go to the nutritionist once every month for the three months, just once for the whole thing or what....she said I needed to go weekly, to the nutritionist, excercise therapist, etc..., I said I really did not read that in what I have read on the website. Thats when she did the chat, then came back and said my PCP just needs to coordinate with the nutritionist, and document the excercise, etc. So basically, I am still not sure what coordinate with the nutritionist means. Monthly, weekly or what! Geeze, the 6 month diet is souding easier right now, whats another three months for the rest of my life right! No doc around here offers the Multi-Discp. program, so I am kinda on my own with this, any help would be greatly appreciated! Thank you, and congratulations! Jodi

Can you tell me exactly what you did for the three month diet? I have Aetna POS II and I keep getting conflicting info on the nutritionist requirement. The CPB on their website is just not clear to me! As in, do I need to see them (nutritionist) once, or for all three months? Any help would be greatly apprecaited! Jodi

By the way, I have Aetna POS II. I have heard they are good about approving!

Maybe its just me with some wishful thinking, but the way I read the Clinical Policy Buletin it says: Excercise Regimen.....supervised by excercise therapist or other qualified professional. Behavior Modification supervised by qualfied professional Should your PCP not be a "qualified professional"? Mine documents my eating, excercise, behavior, everything...at my monthly visits. (I have had two so far) I have to bring in my food and excercise journals for her to look over, very detailed! Only the reduced calorie diet program need to be supervised by an actual nutritonist or dietician. And...it doesn't say that you need to have three consecutive months documented with the nutrionist, just that you should be "supervised" by them and have a consultation. To me, it seems like the one visit my doctor requires with their nutrionist will suffice. Plus of course the monthly visits to your PCP. Well, at the end of my three months, we will see I suppose! I will kick myself if I should be doing something now, and am not. I just can't afford a lot of this extra stuff! We have a max out of pocket of $2300, my hubby is already at his "limit" with that, if you know what I mean! I am sure to try and go see an "excercise professional" would cost a fortune! Yikes... If anyone reads something differently in the CPB, or has other experience with this, let us know! Good luck to all! Jodi

Like the poster before me, I have a 32 oz bottle at work. I drink 3 of those a day. To help me, I add those little Crystal Lite packets to each bottle. They are only meant for 16 ozs, but I find that its just enough flavor to make me drink, and only 10 calories! Also, try putting a glass by your bed at night, if its accessable, you will drink it! Good Luck! Jodi

I will pray for peace for you! Good luck, we will be thinking of you on the 22nd!

I had my first of two required psych visits yesterday. It wasn't bad at all! He went over how when we are not eating (with the help of WLS, hopefully) out of boredom, stress, happiness, sadness, etc. you will need to start examining your true "inner self" and your motivations for your previous destructive behaviors. He said it was a real eye opener for a lot of his paitients, and that most people only really start "getting it" after they really start keeping track of what and when they eat, then how they feel after it. Also, keep track of how you feel during the day, ups and downs, what causes them and how you cope. He did recommend food journaling, but REALLY stressed journaling about your moods, and your energy levels. Makes sense to me, you can see what foods make you feel good, what foods make you feel crappy. Then...this is what we all need to do, modify your behavior to keep on the "good" end of things. Personally, this is where I hope the band can help me! Good luck to you, let us know how it goes! Jodi

Thank you to all the those with advice! I am doing a lot of soul searching, and talking with those who know me best. I am starting an excercise class at a local church next week. It's cheap and close by. A friend and I have commited to going 2-3 times a week. She needs to loose quiet a bit too, hopefully a cohort will help me stay motivated. I have always been good at getting one thing going good. As in I exercise really well, but eat bad, or eat right, but am not active enough etc. If I can get into a habit of exercising, then get my food right too....I think thats where the band will help me. If all the puzzle pieces would fall into place, I truly think the weight would come off pretty easily. It has before, then I fall off the wagon, and gain it back. plus some! Again, thank you, good luck to you all too! Jodi

This is the first time I approached her about WLS, so I was a little nervous. SHe basically said to really think about what I wanted to do. That she has had some patients that have had the surgery loose a lot of weight, some have not. If I am an emotional eater (who isn't, I say) to think long and hard about having the surgery too. Emotional eaters can still eat all day, just small amounts, and not loose very well. I can't say that I eat every time I am hapy, sad , etc., but I do eat for pleasure and reward. I recognize that, thats the first step right? :sad: She suggested really checking out the doc, making sure they have good aftercare, etc. All good advice. So overall, she did not push me one way or the other. I feel better having brought the subject up. I do not have to have a referral or anything, but I did want to get thouroughly checked out before going on with this. The good news is, I am healthy as a horse! Cholesteral a little high (208) nothing diet and exercise won't fix. The bad news is, I am still on the fence about the surgery, I have spent $270 on program fees already, and another $400 or so in coinsurance and deductables for my pre-op testing. I do not want the fact that I have spent a lot already sway me. I just really want this to work for me. I am scared to death that I will be one of those people who loose nothing! I know its up to me to succeed, but if I have never succeeded before, what makes me think I can succeed now? The fear is all consuming, but so is my weight, I am miserable with myself ! It seems it is all I think about some days. Is anyone else going thru this? The self doubt and fears of failure yet once again? Thanks for listening to me ramble, sometimes it helps to just write it all down! Jodi