Tired_Old_Man

Recently I walked up to a store that had two glass doors; side by side. The right door had a sign with an arrow pointing to the left door and the words "Use Other Door". I used the left door and then told the proprietor that the sign was incorrect. He asked "Why is it incorrect? It says to use the left door." I told him that the sign said to use the right door. If the sign points to a door and then says to use the other door, it is saying to use the "other" door (instead of) the door that it is pointing to. To prove it, I made the inquiry: "if the sign on the right door had said 'Use that door' and the arrow pointed to the left, which door would be the correct one to use?" The proprietor answered, "the left door". So I asked, "If the words 'Use other door' and 'Use that door' both mean 'use left door', then aren't you claiming that the word 'other' means the same thing as the word 'that'." If "Use other door" equals "Use that door", since "use" equals "use" and "door" equals "door", then "other" must equal "that". Think about it.

I only have one insurance, no secondary.

When I explained the "request for authorization procedure" to her, she was totally lost. And she still did it wrong, because all I needed was an authorization to change the follow-up care provider, not a procedure by procedure authorization. My insurance company like many others, routinely denies coverage and holds back payment for mouths. When you are dealing with $300,000,000 in payments per year, a month or two or more of interest here and a month or two or more of interest there can really add up.

My insurance does not require prior authorization for an endoscopy. It only requires one prior authorization to take over my Lap-Band after-care and only because the insurance company no longer allows any weight control (bariatric) surgery. Asking for the authorization for the bariatric follow-up care and then the endoscopy just puts the idea in the insurance company's head that the endoscopy is related to the Lap-Band. As soon as the Fluid was removed from the Lap-Band, my swallowing problem was gone as seen by the flouroscope. As I said earlier, a friend of my wife had a reflux problem and as soon as they found H.Pylori and she was treated for it, the reflux stopped. Exactly. So by asking for authorization to do a test that only requires authorization if it IS Lap-Band related, the clerk in effect is saying that the test is Lap-Band related when it may not be. Even it was Lap-Band related, I doubt that the insurance company could prove it or that the doctor could know 100% that it was band related, except if the band had herniated the stomach wall.

There is an old say: "If you want it done right; DO IT YOURSELF". But sometimes, you are forced to rely on other people. The insurance company insisted that I was not allowed to make the request, so I printed up a step by step list of directions. 1. Call: 800-xxx-yyyy 2. Select option #2 3. Tell them the name of your institution 4. Tell them my name, ID#, DOB 5. Tell them that you want authorization to do my Lap-Band follow-up care 6. Tell them the follow-up care authorization was previously under xxxxxxxx by zzzzzzzz Of course, I put the x's, z's and y's in place of the actual words and/or numbers that was supposed to be used. All the information required was on my list. There was no thinking required. Could it be that when a patient is covered by medical insurance and a visit costs $200, the insurance says the contracted amount is $125 and then they pay 80% ($100) and I pay 20% ($25), but if the insurance company says the treatment is not covered, the facility gets the full $200 from me, so that if the treatment is covered they only get $125 from the insurance company and me combined? On treatments like surgery, the numbers can even be worse than that. I had orthoscopic surgery one time and the surgery bill was $1500. The company said the contracted amount was $575, so they paid $460 and I paid $115. They received only $575 instead of $1500, but more importantly, I paid only $115 instead of $1500. The facility' billing clerk has no incentive to work for the patient and the insurance company has no incentive to help the patient.

First a little background. While an employee, I had medical coverage. After almost 35 years, I was laid off because of 911 in 2001. I went on COBRA. I decided on Lap-Band surgery and was approved by the employee medical plan in 2002. I received follow-up care through the medical plan. In 2003, I relocated about 1400 miles and retired. I am now covered under the retirement version of the same medical plan. The benefits are the same (per the medical plan representatives). The plan dropped coverage of Morbid Obesity Surgery and all complications from such surgeries last year. Last year, I had my band tightened a few times and an endoscopy. The endoscopy and band adjustment were done by the only hospital that I could find within 150 miles that took my insurance. They are 101 miles away and insisted on the endoscopy prior to any other treatment. I was having LB's. The insurance paid for the endoscopy, but balked on paying the band adjustment that time and the following ones over the next few months. I spoke to the insurance company last week because I have been neglecting treatment because of the financial burden. Finally I got someone who would listen and she told me that even though they were no longer covering bariatric surgery or it's follow-up treatment for new surgeries, they were obligated to my follow-up care because the surgery was approved and covered prior to the change in benefits. She told me how to get the new hospital to get authorization to do my post-op follow-up coverage which must be done prior to any more Lap-Band related treatment. Before I had a chance to call the hospital to tell them what to do, I started having terrible PB and reflux problems. This past Monday morning, I called the hospital and told the bariatric nurse that I was choking on my own fluids even while sleeping sitting up. They made an emergency appointment for me to come in that afternoon just before closing. They emptied my band. By the time the procedure was finished, the clerical help had gone home for the day. I wasn't sure if I would be covered because they hadn't gotten prior authorization prior to be my post-op provider. Yesterday I had an endoscopy. I told the clerk who handles billing how to get the authorization to be my post-op provider before going for the endoscopy. I told her that I hoped the insurance company would cover Monday's band adjustment retroactively. She said that she would also get authorization for the endoscopy. I told her not to get authorization for the endoscopy because #1, the insurance rep might be wrong and follow-up care might not be coming to me and #2, there is no medical proof that the endoscopy is related to the Lap-Band. It might be any one of many reasons why I have reflux problems. She agreed About 4-5 hours later, after the endoscopy and after coming back from the induced sleep, I found out that the clerk had given the job of calling my insurance to another clerk, who is more involved with the bariatric department. I spoke to the second clerk. She said that she got authorization for the band adjustment and had also asked and received authorization for the endoscopy. I told her of my concerns. She said that she had gotten it, so we were ok. Suppose that the insurance company had said no. The doctor did a biopsy for H. Pylori. If it is H. Pylori, then the clerk put me at risk of being turned down for nothing. She had no right to make a medical conclusion that the endoscopy was Lap-Band related. Even the insurance company had not made that conclusion last year when they paid for the endoscopy, but rejected the band adjustments.

I will be taking it easy. My throat is so sore from the Endoscopy, that I can barely write this. I can't type without saying (what I am writing) out-load. It means that I either have to write very fast or talk very slow.:cool: I have to drive home today from my friend's house. It is about a 90 mile drive.:help: Thanx2all of you4your encouragement. 4the rest of you who boubt my ability2take over Jack's harem, "Why do you think that I am so tired?":clap2: Practice Practice Practice

I had my endoscopy today

Hollywood people are the beautiful people, but all their money, fame and power can not make them happy, nor cut their divorce rate. When we get thin, we may still need to save ourselves. When I was in a bariatric support group in NY, there were a few bypass patients who had lost all the weight that they had wanted to, but they were still having divorces, still have problems with their parents, children and/or siblings. Coming down from 320 to 120 and coming down from 640 to 175 does not make happy anymore than hitting the lottery. It just changes the focus of one's unhappiness. I was very often the one man with 10-13 women in the meeting. Even the shrink was a woman. While talking, I mentioned that I didn't care what I looked like, nor how other people felt about how I looked and a few of the women asked "then why did you have your surgery?" "For my health" I replied. If you had your surgery for the opinion of others or the approval (overt or covert) of others, you will be disappointed when you hit your target weight. Like an alcoholic who has stopped drinking, but is still miserable, achieving your goal does not change the person inside. In fact achieving your goal may remove your only reason for living. Love yourself, no matter who else loves you. Love yourself whether fat, thin or in between. Note: Though I quoted pplqueen to start this post, I am not referring to anyone in particular. It is a general statement. An alcoholic learns at AA not to drink that first drink. But he also learns that if he does fall off the wagon, to get right back on without feeling sorry for himself or beating himself up. We are constantly beaten up because we stand out in a crowd, though the US public is doing their best to make us normal (by comparison to the GROWING of the public). I hope that no one was offended by my thread opening post. It was just a combination of food for thought and confession.

Does Carrie know??

For now, maybe, but just like my eating problem, I want it all.

Hi everyone: I had my endoscopy. The doctor said everything was normal, except for a little gastritis. He took a biopsy of my upper stomach wall to be check for "H. pylori". If it is positive, that might explain the gastric reflux attacks that I have been having and it can be treated with a regiment of antibiotics. I hope others with reflux problems can benefit from that knowledge. My wife had told me about a month ago that her friend had told her of horrible gastric reflux attacks and after she was checked for "H. pylori" and treated with antibiotics, she finally had relief. My wife's friend suggested to my wife that I be tested for "H. pylori", but I never got around to it. My reflux problem was really exacerbated recently when I was taking an antibiotic (clindamycin) for a infected finger-nail. maybe the clindamycin caused a reaction with an infection. My face swelled up, I felt lethargic and I had a rash on my stomach, so I called to get a different antibiotic. When I stopped the clindamycin and switched to the different antibiotic, the reflux improved, but was still very bad. My wife and I are staying at our friend's home, 15 miles from the hospital. I was in no condition to drive the 101 miles to our home tonight.

Especially with me.:help:

Next month will be our 39th Anniversary. I think I'll have to keep her, at least until I get my anniversary gift.

My wife is about ready to toss me out of the house for spending so much time on my PC.

I think my hunger is more emotional than physical. Eating the right Snacks is better than eating the wrong food, but being able to say "NO" is more important. Thanks for your suggestions. I will look into them. I already do things like mix part-skim Ricotta with Jello or no-fat american cheese with Jello. But as soon as I finish eating it, I count the minutes to the next commercial.

I can eat "no-sugar added" icecream, nuts and good snacks until I am blue in the face. The more I eat, the hungrier I get.

The embarrassment of being overweight is only overshadowed by the embarrassment of needed bariatric surgery to stop being overweight. I have to admit something to the members here. I post at many other forums (not weight related) and I always use the same name. But here, I chose a different name. I am heavy into political debates and I would not want anyone blackmailing me by referring to my postings here. This may sound small of me, but it is being pragmatic. How can I call for a politician to step up and do the right thing when I can't control my hand from putting food in my mouth? I know we have a sickness, but the majority of people look down on us for being fat. No matter what vices they have, we are weak (in their minds). That is why that very few of my acquaintances know of my surgery.

#1. I hope my post does not discourage anyone from getting a Lap-Band. I would do it again if I could turn back the clock. Has anyone tryed Hoodia? This Lap-Band would be so much more successful with an appetite supressor. I get so hungry sometimes. #2. I drank some barium after they unfilled by Lap-Band. It looked good on the flourescope. #3. Thanks for all the good wishes. I will report back and let everyone know how things turned out. #4. I always wanted to be surrounded by women. I finally got my wish at this forum.

I had a BMI of 48.28 when I started. Can I join the club?

What part of Florida do you live in? The Cleveland Clinic Bariatric Department is where I am go now. I had my surgery in Brooklyn 4 years ago, but moved to Florida 3 years ago. The Cleveland group in Weston, FL is good. I like them better than the group that was involved with my Lap-Band installation surgery.

It was suggested to me that I post here regarding my complications with my Lap-Band. I haven't checked to see which LBT member has had a Lap-Band the longest amount of time, but I am sure that I am up there. September, 2002: Weight = 327 Today: weight = 232 But that is the good part. The bad part is: #1. I lost from 327 to about 260 by the end of the year. I then fluctuated between 265 and 245 until April of this year. #2. I started having very bad gastric reflux problems and in a attempt to self-cure myself, I am now down to 232, but having problems which could be life threatening. Let me explain (I will do it in chronological order rather than in order of importance): Everything was going fine until the second band adjustment in November 2002. Then I had my first PB attacks. I was told that it happens sometimes. The frustrating thing about the PB attacks is that I have no way of gauging when they will happen. I can eat x amount of food y one day and get the PB's. Another day, I can eat 4x of y with no problem. PB's can so debilitating, that I spend my concentration on avoiding them rather than losing weight or eating healthy at times. I was told to drink a cup of Water about 30 minutes prior to eating and then no liquids until a minimum of 2 hours after the meal. Whether I drank the water before the meals or not, I found that PB's happened too often. I also found that warm liquid sometimes shortened the PB attack. Eventually, all my meals were soupy type stews. I know I was defeating the Lap-Band's effect by washing food from the upper pouch to the lower stomach, but if it kept the PB's away, I was happy. I would listen to the doctor's advice on PB's, but usually after a month of failure, I would go back to my own methods. Positional changes, liquids, etc were tried. I did what I had to do. I will try the method suggested in the Possible Solution for PB's and restriction pain thread when I get a chance. Hopefully, I'll never need to have to check it out. I had the surgery in Brooklyn, NY. I moved from Brooklyn to Florida about 14 months later. The closest doctor that takes my insurance is 101.64 miles away. I say takes my insurance, but there is a problem there. When I had the surgery performed, I was on COBRA, now I am retired. The insurance paid for the surgery, but the retirement plan claims that I am not covered for Bariatric surgery or complications. It is the same plan, I say, but they disagree. That means for a band adjustment, the insurance will not pay, but they will pay for the endoscopy. I went from February 2003 until January 2005 without seeing a doctor because of the insurance and distance problems. My fill-port is difficult to find, so they do it in radiology which jacks up the price. Since going to the doctor in Florida for the first time in January 2005, I had had two band adjustments and an endoscopy Until this April. Whenever I had a bad PB attack ("bad" defined as over 2 hours before I stop regurgitating), I found that PB attacks were more prevalent in the next few days, so I would use the same eating regiment as if I had a band tightening and then after about 2 weeks, I would start eating normally. Normally for me though is over-eating for a Lap-Band patient, though not eating like I did before getting the Lap-Band. My wife and I usually share one meal in a restaurant (plus we don't eat the bread or desert). Prior to the Lap-Band, I would eat one meal and then finish what would have been my wife's "doggie-bag" from her meal including bread. My big problem weight-wise is that I get the munchies at night. If I am doing things on my PC, I can go for hours (or days) without eating, but once I sit down to watch the TV, I wear a path between my recliner and the kitchen. I started having gastric reflux attacks about 18 months ago. I am now taking two Nexiums per day. But recently the attacks became more prevalent and stronger. It got to the point that last Saturday, I spent the night sitting in my recliner and I was still waking up with my mouth full and sometimes there was Fluid coming out of my nose. Tums and Pepto Bismal were used alternately and continually. I went 4 days without eating. I would drink 8 oz. of soymilk in the morning, 8 oz. of V8 juice around noon and a cup or two of water during the day. And I still had the reflux problem. I called the Bariatric clinic that is 100 miles from my home and they said come in today (Monday, June 5, 2006). They removed all the fluid from my band and I finally had 2 nights without reflux. Tomorrow, they will do an endoscopy on me.

I will start a thread in the Lap-Band Complications Section as you suggested and I will link it to this post. Thanks for the warm welcome.

I made my first post in the wrong section. I am 61, was banded almost 4 years ago at 327 up in NY and now weight 233, but live in FL. I have been having problems with PB's since my second band adjustment and due to the lack of doctors doing Bariactric surgery in my area, I have to travel over 100 miles for all lap-band related problems. I had my band emptied yesterday because I was drowning in my own saliva while sleeping. An under the pillow wedge stopped being effective and even sleeping in a recliner didn't solve the problem. I am having an endoscopy two days from now.

I've got a big mouth, so I'll be slinging as much info as I know. If I knew the answer to that, I would be charging people for the advice, not paying the doctor to do an endoscopy on me two days from now.:cry Thank You for the welcome and I will give the "Old-Timer's" section a look.