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.

My bellybutton (inny) has periodically cracked open and bled to the point where it has soaked through my clothes. The tissue in and around becomes red, inflamed and burns. I have been post-op for over a year and this began about 5 months ago. I did not have any incisions in my bellybutton so I don't think it is related to the surgery but I can't imagine what causes this. I have mentioned it to the doctor but of course it is never acting up when I am in the office and does not seem significant enough to make a special trip for. It is becoming more of an annoyance than anything really but I am concerned about getting an infection since it is not the easiest place on your body to treat. Anyone else have this problem?

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!

Wow...thanks! I thought I was just really weird. I have an appointment scheduled for next for the doctor to take a look at it. God Bless!

I was banded in Nov 06 and agree that it took a while for me not to notice the port. I can now feel it only if I try or if I am laying on my stomach. Did you say that your doctor didn't stitch the port in place? I thought this was done routinely...did he indicate why he didn't do this? It seems that would lead to a higher rate of flip or movement. Hmm...that it just an assumption on my part, I wonder what is the benefits on either side? Sorry...I think I have ADD sometimes...at any rate, I agree that you should call your doctor to be on the safe side but think you will happily find that you are normal. God Bless!

They believe that is too much vomiting...for me, they believed that I slipped after a slight adjustment that proved to be too much for me. I began refluxing at night and several times woke up in the morning with vomit all over my clothes without even realizing it had happened (gross, I know!).

Jessie... I found out last week that I also have a slip. It is likely that it slipped back in September and since then I have had multiple tests and tries at unfills and slight refills. I had some improvement during the times that I was unfilled but as soon as they put Fluid back in the reflux returned. All the upper GIs have revealed the slip but my doc is a watcher and only now decided that surgery is absolutely necessary. I hope that all is well with you and your surgery can be avoided. God Bless!

I had a single episode that sounds much like you are describing. It also came at the same time I began refluxing at night, what they call night coughing. Have you had reflux or have you been "coughing" at night?

TD, not sure if you noticed that in the link that you posted the poster mentioned Wasa in her story, to thank her for her support. It was pretty awesome how she said that Wasa supported her. I have read a lot of Wasa's post and can honestly say that I do not agree with many and sometimes feel that she thrives on debating but on the other hand many more of her posts have been helpful and I truly believe that she would do what she could to help any one of us out. I can see how you might be sensitive to the disagreement she posted but remember that she is entitled to her beliefs and opinions, just as you and I are. I also must say, I read her posting more than once I do not believe that her intention was to discredit or minimize your experience, just to point out that there are other views on the subject. I believe I have read from her other postings that she is a nurse and I believe her husband is a doctor. IMHO, this does add to her credit. To speak my opinion on my choice for band vs the other methods...I found out today that my band has slipped and I am going to need surgery for repositioning. Yet, I still feel that the band is the best choice of all the surgeries available. Why? Because it is reversible. This complication that I am having can be fixed easily, according to my surgeon. I like that my band is reversible not because I think I will ever want to have it voluntarily removed but because it can be if life threatening complications happen AND my anatomy has not been altered from God's original design. I imagine that most people that have had complications from the band were happy that it could be reversed after recovering from the disappointment of losing it. With the other surgeries, there is little chance that the procedure can be reversed and even if it is possible, it is very risky. God forbid that if I am ever faced with the news that my band must be removed, I love knowing that it can be and the fact that my anatomy has not been altered provides me with other options. I am sorry that you lost your band but I am happy that your procedure was reversible, for your health's sake.

I have worked in managed care for more than 20 years and must say that the EOC (evidence of coverage) usually lists more procedures under the exclusions than the plan will actually deny. You see, they CAN pay for more than they say they will if they have a policy to administer the coverage equally among their insured, or have good reason for making the exception. But, if they don't offically exclude it, they open themselves to having to pay for it. The coverage guidelines, intended for internal use and for the providers and delegated authorizing entities, would be helpful here. Good luck with that though, your best chance of getting it covered would be to have the doctor submit a request for the service with support of medical necessity. If it is denied, you should receive appeal rights (could vary by state). Usually, if it is denied and your appeal is upheld it will go to a 3rd party for a final decision (again could vary by state). Out of curiosity, did they cover your surgery or were you self pay? If they covered they surgery, that is a good indication that they may consider PS. Especially since, based on what you posted, your policy shouldn't cover WLS period. I have BC of CA (HMO) and they covered my surgery. They will also cover ab-plasty if certain requirements are met, after surgery. Plans vary greatly, even within the same insurance company. It really comes down to the individual policy you hold.

I had this and it was most likely gas. Gas-x didn't give me much relief either. Try walking a lot. It is good for you and was the only thing that helped me. God Bless.

This probably isn't what you want to hear but I have been having the same problems since September and after many tests and visits to the doctors for unfills and refills, I learned yesterday that I have a slip and need to go in for repositioning or replacement of the band. What you are describing sounds identical to my journey but there was one thing missing from your story, maybe this is the difference. Let me explain.... I had my surgery in Nov 06 and first fill in January 07. I did very well, lost a lot of weight and did not feel like I needed another fill until August because all of the sudden I could eat much more than normal. It was a little weird, I started having a little reflux at night about the same time I felt I needed the fill. I went in for the fill in September and they only adjusted me .25cc. I went home and within a copy days felt that it was way too tight but...if this makes any sense...I could still eat more than I was used to. I could even eat bread and Pasta which I could not eat since the day of my surgery. I was refluxing terribly at night, even to the point it appeared that I had vomitted in the middle of the night without noticing. I called the doctor and she suggested that I not eat after 5pm and see if the reflux improved. They also ordered prilosec. Neither of these remedies worked for me. I stopped eating after noon and was still refluxing liquid, not acid, throughout the night. The doctor brought me right in, I had an upper GI followed by a complete unfill. She said that she suspected a slip but felt that it we had irrated my stomach with the last fill. She had me wait a week and repeated the upper GI and all was normal. I even had an endoscopy that was totally normal so after 6 weeks of no Fluid, they refilled me. Within a week, reflux returned and so did the tests. Another upper GI revealed at too much of my stomach is resting above the band. It takes a skilled radiologist that is familiar with the band to discover this. To be certain, my doctor order the films and viewed them herself. I got the call yesterday that she confirmed the slip and I have to see her tomorrow to schedule the repositioning/replacement. I didn't realize that a slip meant that too much of the lower stomach is above the band, making the pouch larger. This meant for me that I could eat more but it took much longer for the food/liquids to move through the band and even not pass through at all, causing the reflux at night. This was a long story but if yours matches mine, get checked. For the most part, I am told that a slip is not a medical emergency but they can develope into one. I hope all is well with you and I wish you God's blessings throughout the New Year.

BC of California paid for my surgery. Reading the posts it appears that they have a good rep for doing so... Hope that helps!

Different state but I am insured by BC of California (California Care HMO) and my surgery, visits and fills have all been covered at just my copay. Don't lose hope, get the auth and you should be fine. I actually work in Managed Care, I am a manager for an HMO to be exact. If they try to deny after the rep said it was covered, appeal it and be sure to quote the day/time of the call and name of rep in your appeal.