QTkidsmom

The band does work to control you appetite once you are at proper restriction. It can take a few fills to get there. The thing about it is that this is a permanent tool. Unlike other aides, this one stays with you and you are really in control. You have heard this from people in this thread at varying stages. Some new and others that have had the band for years. We all have different experiences but most will tell you that a week or two after surgery you don't feel like eating because of swelling. You lose weight. The swelling goes down and you get hungry (they don't fill you until about 6 weeks post op). You may return to being able to eat as you did before surgery, although it is not advised, and you may gain some weight back. When you get your first fill or even your second you may still not feel much restriction, but you will get to the proper fill level and your hunger subsides. You begin losing weight and it is steady. I would never want to go back to before I was banded now. I love my little band and all that it does to control my eating! God Bless!

I believe that they are misinformed about plans removing coverage from the policies, it is actually being approved by more and more as time goes on. Before too long, I expect it to be the new "gold standard" and knock RNY off the top. The stats are better at 2-5 years and the insurance carriers are noticing.

You may want to see if they will "grandfather" you since your care began when the provider was in-network. Often times, that makes a difference. Talk to your carrier, a manager there would be best.

It should be fine, unless you are diabetic or have other glucose intolerance. If so, check with your doctor. I tried them during my liquid phase but could not stand the taste. The brand I used was Special K. Good luck!

Have you called your carrier directly to ask why they have not paid the claim? I work in managed care, have for many years. Typically, when this sort of thing happens it is because the provider failed to send them requested records. Once the procedure is approved, they cannot legally delay paying the claim unless they have a good reason. As I said, this is usually that the provider either failed to supply requested information, or as was suggested in a previous post, billed incorrectly. Either way, the provider will need to rectify the situation. Only other thing that I can think of is that there was a some sort of contingency on your authorization. However, it would need to state that on your approval letter. Other than that, you acted on good faith and ultimately, they will have to pay up if the procedure done, was what was authorized. God Bless!

Sounds like a slip to me...I have eroded but I have slipped. The stomach relaxed after a 6 week unfill, but moved back up within 2 weeks of refilling. I have to have the band surgically repositioned now. See your doctor and ask for an endoscopy if you are concerned about erosion. God Bless!

I saw the doctor today and he took a culture...he said he isn't really sure what it could be but will let me know when the results come back.

Not a problem at all...I hope that things go smoothly for you and your husband! That is awesome that you are able to do this together. The important thing is to not lose hope, at this point it is all you have. Stick to your guns, do all that they ask, and you should be able to convince them that this is worth the investment. One thing to consider about the supervised diet is that a lot of carriers will accept past attempts, that have been documented. That means if you ever followed Weight Watchers, Jenny Craig or the type, you might want to check if they will accept those records. God bless!

That is all just double talk...they have really excluded all known "treatments" for morbid obesity in line 17. I still believe that the fact that they have stipulated that treatment for morbid obesity is covered when certain criterians are met, and the fact that if your doctor documents that the WLS is to treat the co-morbidities not the specifically the obesity itself, you have a good chance of coverge. That sounds confusing but basically, they do not want to pay for you to simply lose weight. They are likely to cover a surgery that will potentially reduce future cost the will be responsible for to treat the co-morbibities. Diabetes, heart conditions, sleep disorders and the such are all very costly to treat. That is the angle that you need to emphasize. The fact is that they know you losing weight is your best chance at improving or eliminating risk of needing treatment for these co-morbidities. If you can establish that you are unable to lose the weight without this tool, they will have a vested interest in paying for the surgery. That is why they are asking you for the documentation that they have. Don't forget, if they deny you, you will have appeal rights. You have an earlier version of you policy that indicates they would cover it. That may end up being the smoking gun in your pocket. Just give them what they are asking for, don't accept reimbursement for the expenses that you have already paid, unless you are denied and lose an appeal. The main reason I believe that they would deny is if you do not meet the criterian they stipulated. A good point to remember is that the plans CAN and often DO pay for services that they have listed as an exclusion, they CAN and WILL be sued for not covering what they say they will. If it comes to appeal, let me know, if you would like help writing it, I will do my best to help. God Bless!

I am a Manager for a Managed Care Plan, I get paid to read and understand this stuff and have for almost 20 years. I do not believe that they are reading this correctly. The first statement indicates that they will cover WLS when certain criterian are met. The exclusion is very typical of any insurance document. They will not cover the surgery solely for the purpose of losing weight (in other words, to improve appearance, even if it is doctor supervised). I think that you have a very good chance of coverage if you go through the process described from the agent at your insurance. At this point, this does not sound like an appeal because I did not read that you were denied yet. No denial, no appeal. You can fill a grievance with your health plan without a denial and sometimes that helps to clarify but they usually get things a little confused about who you are grieving against, that may disrupt your relationship with your surgeon's office since they will likely assume you are grieving about their practices or information they provided. You can maybe avoid confusion by clearly stating the concern in the grievance and alerting your surgeon's office of what you are doing and why. Hope this helps. God Bless you in your journey.

I can absolutely relate. I decided to only tell people that I thought I could trust to understand. I knew that did not include any of my in-laws. They are very hateful at times, and because I am more successful than the wife of the favored son, I am often a target of theirs. My husband agrees with this and supports my decision to say nothing to them. Funny enough, I have lost a lot of weight and I am now much thinner than my sister-in-law, who my mother in law likes to refer to as her "skinny daughter-in-law" who really isn't, and they recently accused me of having gastric bypass. I enjoyed so much being able to look her in the face and honestly reply "I have not had gastric bypass, where did you get that idea?" She has no idea the band even exists. I did however, tell my own sisters thinking that they would support me and maybe even follow in my steps as they are all heavy. One of the three has been very supportive while the other two take the opportunity to speak about me to the other and complain that I took the easy way out. That's okay, I always tell them that if they ever decide to get the band, they can let me know how easy it is after the have their first PB or have to sit around a house full of family eating their favorite foods and knowing that a single bite will send them to the toliet. I do not regret my decision at all and have learned to laugh it off.

Congrats on your banding....You are still healing so give yourself time. I would not push it at this point and not look to being full. You still should be in the liquid phase...yes? Just remember to sip and take your time. Once you move on to the food stage take it really easy, it will take time for you to get the hang of it and that's why it is really important to go slow. At the beginning, I never knew that I had taken my last bite until I had taken one too many. Too much, too often leads to vomiting and vomiting leads to problems. Take it easy and you will do fine. Best wishes!

That's awesome news....Congratulations!