Jebellah

Hi there! I would LOVE a copy. Thanks! Jessicalyndsey@hotmail.com

$15,595 in South Florida

I think it really depends on your plan. I was denied by Aetna (and denied 2 appeals) with a BMI of 47 and co-morbidities. They said it was specifically excluded from my plan (***) and not even my Primary Care or Surgeon's letters could sway them. Hopefully you will have FAR better luck but I would call someone and ask them to look specifically at your plan and tell you exactly what requirements they have. And make SURE you document the date/time/who you spoke to! Best of luck!

January 19, 2011 I called the Surgeon's office this morning to confirm my decision to go ahead with the sleeve. The PA was really excited and encouraging. She said they love when people decide to go with the sleeve or bypass over the band because they see such better results in follow-up. It was one more little encouragement making me feel better about this decision. Because I had been just about done prepping fo rthe band I have only a few more requirements to get ready for the sleeve, namely some pre-testing bloodwork and another consultation with the surgeon. I do have to wait for a school holiday to get the time off from work though. Its looking like Spring Break will be even more awesome than usual this year!! My new date is March 22, 2011 -- 61 days and counting!

December 1, 2010 Well, just 15 days from my scheduled band-date I had my appt with the Surgeon and after all my nervousness, it seemed anti-climactic when he didn't try that hard to change my mind. In fact he seemed...apathetic and rushed. He did mention the other surgeries and why he likes them but in the end he shrugged and said if the band was what I wanted then he would put it in, gave me a pat on the back and said he'd see my on the 16th at the Hospital. I left feeling upset. I wasn't looking forward to having to plead my case but I think I was spoiled by my primary care doctor's fantastic bedside manner and willingness to talk things through with me (without rushing from the room!!!) The office assistant gave me the final paperwork and, in passing, handed me the optional insurance packet because, as a self-pay, my health insurance would not cover ANY complications that were a result of a surgery that wasn't covered. This was something I had never considered and decided to go home and do some serious research before selecting the insurance packet for me. So here's where the sway starts, I started reading articles in medical health journals of extensive longitudinal studies performed on band recipients. I learned that the complication incidence rate at 1 year is close to 1:10, at 5 years it was closer to 1:7 and at 10 years after surgery, almost 1 in 3 people needed another surgery to correct slippage, port problems, erosion into the stomach, etc... It really got me thinking. At only 27, I may (hopefully) have this mechanism inside me for another 50-70 years, The findings made sense: things would break down with time and strenuous activity and I hope to have lots of both in the future. And being a self-pay am I going to be able to pay another 15 grand in a few years to go back in and fix something..? Did I want to take the chance? I was starting to have some serious doubts, but didn't feel comfortable with any alternative surgery. As evidence that karma is real and God DOES have a sense of humor, things started falling into place. A book I'd been on the waiting list came in from the library... Dr. Garth Davis' Expert Guide to Surgical Weight Loss. I had never seen Dr. Davis' show on TLC 'BIG MEDICINE', but I had heard the book was very good and been wanting to read it. I had been on the waitlist so long though, I forgot all about it until I saw it in the mailbox. Reading the book, I learned that Dr. Davis' favorite surgery is the sleeve. He explained it thoroughly and stated all the reasons why he preferred it to the others but found it was really only an option for self-pay patients because insurance won't cover it. http://books.google.com/books?id=ok 4iRskiDEC&printsec=frontcover&dq=garth+davis+big+medicine+gastric+sleeve &hl=en&ei=0q0gTae2DMH_lgeHwehP&sa=X&oi=book_result&ct=result&resnum=1 &ved=0CDEQ6AEwAA#v=onepage&q=sleeve&f=false Once I started talking about the sleeve and reading up on it, I seemed to become a sleeve magnet with people who'd had the surgery and wanted to tell me good things about it practically coming out of the woodwork!! I also started perusing this fabulous forum and hearing about other people's journeys and noted several members who switched to the sleeve after an unsuccessful foray with the band. I particularly liked this video I found on another member's blog: http://abcnews.go.com/Nightline/video/surgery-vertical-sleeve-gastrectomy-11968867 All told I wanted more time to think and read so I called the surgeon and canceled the surgery date after all. I told his office asst I would think and pray on it over the holiday and call back after Christmas. She seemedreally excited and told me they love the sleeve best and are always thrilled when someone chooses it over the band (although I maintain the surgeon himself is a bypass guy first and foremost!)

November 13, 2010 Went to the lab Friday to get the chest x-ray and blood work done. Despite the fact that I had to disrobe (again!) it was quick and painless. My PCP said she should have the results in a few days and if everything is in order she will send over my medical clearance for surgery. I called my surgeon's office to confirm the next items on the checklist and got a bit of surprising news. With just 34 days to go, the nurse informed me that they have canceled my surgery date because the Surgeon wants to wait till my pre-op consultation (12/1/10) to talk with me about gastric bypass surgery. I shared concern that I am not willing to consider the bypass after seeing what a HORIFFIC experience it was for my Mother a few years back. I also mentioned that I had to request the time off work months ago and if I lose the date I don't know when I would be able to reschedule. The nurse was adamant about canceling the surgical suite. I felt truly frustrated. I had no intention of switching to another surgery. I have researched the lap-band, learned all about the lap-band, spoken to other lap-band patients and prepared myself for the lap-band. I scheduled this surgery back in August so Im not sure why it came up at the end of the process! I've shared in previous posts that I could tell from the informational seminar that the surgeon was not a big fan of the lap-band. He spent far more time discussing the bypass and sleeve. That being said he stated he thinks the lap-band is more appropriate for people with a BMI no higher than 45 (mine is 47) but that he's performed the surgery on people with a BMI up to 52 and will do it if its all a patient is willing to consider. I'm hoping that if I go in and show him that I'm seriously not going to be swayed, he will acquiesce and we can get back on track for December 16th. I would be crushed to have come so far only to be shot down now. I feel if a surgeon is not willing to do a lap-band procedure than he needs to be upfront and not make a patient spend months jumping through hoops only to say no at the end. Here's hoping I can work this out... :bored:

October 25th, 2010 Had a pre-op appointment with my Primary Care today. The visit was basically just an EKG, check-up, file review, and an order for the neccessary labs. In the next two weeks I'll need to get more bloodwork done as well as a chest x-ray. Then she'll send the surgeon a medical clearance document and I'm one step closer to the lap-band®! The only incident of note was finding that I have high blood pressure. My primary care doc is great though, she is ALREADY planning how we'll make the prescription work after the surgery (for however long I'll need it). Things are going well. Surgery is 50 days from tomorrow. I'm excited but really nervous. I'm starting to get burnt out on the uncomfortable/embarrassing tests too. I'm trying to stay positive and know it will all be worth it in the end. Although Im hearing the x-ray is another one I'll have to go topless for. Yippee. :thumbup:

September 18, 2010 http://www.youtube.c...h?v=r5ICI9q7nxU I found this great (awful) video on youtube and have watched it several times now. It's quick and dirty but I think I have a better understanding of how the actual surgery is going to work. Not gonna lie, I had to turn it off twice the first time I watched it so I could run to the bathroom, gagging. I simply am NOT brave about hospital stays/surgical procedures. All told though, I'm glad I found it. I've been looking for something like it for a while, and as always my imagination cooked up images MUCH scarier than the reality of it. Just wanted to share. 88 days and counting! :thumbup:

September 5th, 2010 I had my consultation at the Hospital Diabetes Education Center. The appt was with a Registered Dietician and was probably the most helpful step of the process thus far. The dietician sent me a packet to fill out a week before my appointment that asked for my medical/psychological history as well as a 3 day food journal. I brought the completed packet with me, and we spent the first 15 minutes going over my responses. The only physical portion of the consultation was stepping on the scale. Always my favorite part... After that it was just sitting at a desk going over paperwork. She asked me some more medical questions, my family history of obesity related weight concerns mostly... then proceeded into the information about the surgery. She explained the process where everyone else left off... at the point of waking up from the surgery. What to expect pain wise, what to eat, the first day, week, month, year of recovery. And most importantly what the rest of my life would be like. She took out a 2 ounce measuring cup and put it in my hand to help me understand what it looked like, (and to drive home the point that a piece of pizza would NOT fit in it). She went over a lot of possible complications and the requirements for getting the most out of band. She was incredibly patient and encouraging, answering all my questions and honestly laying out the difficult road that only STARTS at getting the surgery. She gave me a behavior modification schedule that the reccommended starting NOW to be an expert at it by the time the band is put in. As I left I knew this was something I was going to do. I took the little cup home with me and set it on my foyer table where I would pass it often. The next day I called the Doctor's office and scheduled the surgery. I'm still nervous, but really the hesitation and doubt have lifted. I'm so confident with my decision to have weight-loss surgery. I'm really excited about this first step in changing my life. :thumbup:

August 31, 2010 The Psych Consult. For a therapist, I was surprisingly nervous. The subject matter rattled me. As I've mentioned in other posts, I don't make a habit of frank discussion of my weight and dieting habits. The surgeon reccommended 3 therapists he had worked with before but only 1 was on my list of approved providers so my choice was made. The office was small but comfortable. The therapist was older and not threatening at all. After about 10 minutes I was able to relax and breathe normally. We started by discussing a brief history of my life. Family, friends, school , jobs, relationships. How did my weight affect me in all these arenas? Did I have any mental health disorders or eating disorders? What did I expect the surgery to do for my life? Then we moved into the surgery itself. What was my understanding of the procedure and the possible risks? How was I prepared to change my life afterwards? The whole session was done in a very casual conversational manner. The only uncomfortable bit was when he was asking about my sex life and said "you know some guys really like big women. they look for that in particular..." Said with an ever-so-slightly-lecherous tone. Made me wonder why he chose this as a specialty. Lol. Other than that it was fine. He said he'd send the report directly to the Surgeon and my work there was done. As I left I called the office girl to let her know the report was coming and informed her, while I wasn't sure about the money or the timeline for being able to proceed as a self-pay client. I was interested in continuing and would be moving on with the list of requirements. The next of which was the Nutrition Consult. :thumbup:

August 19, 2010 I mailed back the paperwork I got at the seminar a few days later. The response was almost immediate. The surgeon's receptionist called and told me that AETNA had denied my appeal. I tried to get approval on my own at first but had held out hope that the medical staff had some secret language or handshake that would unfreeze the cold-dead hearts of my insurance benfits reps. Apparently not. She told me I could consider doing it as a self-pay patient. The hospital has a financing plan that approves everyone (with 30% down) and gives you five years repayment time with prime plus 6% or no interest if paid in 1 year. She encouraged me to consider it and told me the next step would be a psych consult if I decided to proceed. I told her it was a lot to process and I'd let her know. I thought it over for a week or so and vaccillated like a mad woman. My mother and friends convinced me to see the therapist, talk about it some more and not make my mind up just yet. Since my insurance covered the psych visit, I figured what the hell... :thumbup:

I created this blog months ago on the lapband talk forum. Somewhere along the journey, for reasons that become clear in later posts, I changed my plans and thus my blog site. I will start with my old postings... August 11, 2010 I finally attended the Weight Loss Surgery seminar at the Hospital. I had registered for it twice before in the last year but then cancelled at the last minute. I kept telling myself I wasn't there yet. That I didn't really need this. There were about 35 people there to hear the lecture, and 2 post-op volunteers who came to share thier stories. The surgeon discussed the gastric bypass, vertical sleeve, and LAP-BAND®. He flat out announced that he's not a fan of the LAP-BAND® but I was pretty sure I wanted this surgery before I got there. It took a lot to get me to this point. I was really scared of rerouting my intestines OR removing part of my stomach. The band appeared to be the safest weight loss surgery. The Dr. shared he akmost ALWAYS prefers the bypass for any candidate. At first, being at the seminar was terribly uncomfortable. I was embarrassed to sit in a room where everyone knew I had come because I want to lose weight. I've made a lifetime habit of blending in, wearing dark clothes, and sitting in the back. I don't draw attention to my body or discuss my weight. The fact that the Surgeon was so down on my preferred method didn't help either. Despite it all, I liked him a lot. He is very frank and straightforward. I felt he was glib (almost to the point of rudeness) with some of the question askers but I appreciated his open discussion of some possible complications and even the possibility of death from the surgery. I've never had an operation and was really scared about the prospect of being cut open and talking about it upfront made it seem less sinister and more manageable, I guess. One thing he said that really struck home was that... "if you go on living obese, there is a high likelihood you will need surgery in the future, hip replacement, hiatal hernia, open heart, etc. The mortality rates for these surgeries are 5-10x higher than the mortality rate for WLS." He almost convinced me right then and there. As it was I took home all the paperwork he gave me to look over and filled out the health forms the next day on my lunch break. I still wasn't conviced this was in my future but I figured it couldn't hurt to fill out the paperwork. :thumbup: