Hi Everyone,

I just wanted to share with you all that I've finally got a surgery date of July 24. After a year of waiting lists,testing and jumping through hoops, It's finally my turn. The only thing that makes me worry now is that my insurance company (BCBS of Ma) has new guidelines stating that if your BMI is under 40 with 2 co-morbid diseases, they do NOT have to cover you unless the diseases are to the very extreme, meaning you could die if you didn't lose weight right away. BUT my Dr. is pretty sure I'm okay. My BMI is 39.8 with 2 co-morbid diseases but, I do have many other medical issues that would benefit me if I lost weight, so the Dr. thinks this is what will get me through.

Now don't get me wrong.. I know that the insurance company doesn't have to cover anyone. I'm just stating that they've changed the severity of the co-morbid disease.

Anyway, wish me luck. I'm told that the ins. comp. will inform me either way. I'm not sure how long it will take, but i'll be waiting by the phone. How long did it take for any of you to hear from them?

Go ahead and get as much as you can get done out of the way. I know that most ins. have to have the psych evaluation. That alone added three weeks for me, the psychiatrist took forever to get the stuff to my Dr.

<meta content="text/html; charset=utf-8" http-equiv="CONTENT-TYPE"><title></title><meta content="OpenOffice.org 1.1.0 (Linux)" name="GENERATOR"><meta content="20060627;9191600" name="CREATED"><meta content="16010101;0" name="CHANGED"> <style> <!-- @page { size: 8.27in 11.69in; margin: 0.79in } P { margin-bottom: 0.08in } --> </style> It is difficult to make "honest" posts. I do not want to look like an attack dog, but it is too easy to agree with the person who is complaining, rather than to try to help them.

Maybe insurance companies are cheap and want to save money, but sometimes (maybe) they realize that when people go into these things (bariatric surgeries) without proving that they can put in the effort, that they are more likely to be failures.

According to the surgeon who put in my Lap-Band, "(as of 2002), the average Lap-Band patient lost 25% of the access weight between their starting weight and the weight that they should be for their height. It was close to 85% for gastric bypass patients ("roux-en-y" and "the Switch")."

I have lost 58% of my access weight. My doctor considers me a success. I still weigh 232 at 5'9". According to the charts, I should be about 165#. I would be happy at 180#. I have lost 65% of the weight to get to my goal.

BUT: My family looks at me wearing size 44 pants and X-large or 2XL shirts and sees a failure. Strangers who see me on the street snicker and call me fatso (behind my back). People who I do not know, make comments like "How can a big guy like you share a meal with your wife?"

Weight loss is not easy. TV shows highlight the success of big stars. The doctors tell you the statistics, but then paint a picture (with your help) of the wonders of weight loss surgery. They mention the possibilities of complications, but then move right on to the benefits that you are going to have. But they never forget to get you to sign the forms about the dangers.

Insurance companies are full of business people who know the stats. They know how much it is going to cost them paying for the treatment of the medical complications of obesity. They compare that cost with the cost of bariatric surgery and its complications. They are cold-hearted businessmen. But the stats that they use also protect you. More money out of the insurance company's pocket also means more heartache for you, the patient.

My BMI was about 48. I had tried many techniques to lose weight and always did, but then gained more weight back. I was 57 years old when I got my Lap-Band.

We had the pre-surgery candidates come into our post surgery emotional counselling sessions quite often. Once we had a 17 year old girl who was close to 300 pounds at about 5'6" come in. She was going to have either the "roux-en-y" or "the Switch". I suggested to her that she have a Lap-Band because neither the "roux-en-y" nor "the Switch" are reversible and at her young age, there may be better alternatives around the corner (with the research into ghrelin and other enzymes). No. She had to have the "roux-en-y" or "the Switch". It was her decision, but isn't 17 year old a little young to give up?

I wish everyone who has these invasive techniques, "the best". I wish we could get to the root cause of the problem for all this weight gain in the USA. But, until then, we need to try everything short of surgery first. Not half-hearted, to get it out of the way, in order to speed up the insurance company's approval, but to try to get it to work. As I said in another post, I know of people who purposely gained weight in order to meet their insurance company's criteria for bariatric surgery.

I think that is sick. But I am no psychologist, so I guess I have no right to talk.

If I do get approved, trust me I will do everything I can to keep the weight off. I am in this 100% for the rest of my life. I went to a seminar that you had to attend before seeing a surgeon and alot of these people were complaining about not being able to eat normal before and right after, and asking why do they have to see the doc every month for the first year for a fill, all the complaints, those are the people that want the quick fix. I am not that person. This surgery will probably affect my entire life which I am ready for. I want to be fit again and healthy. I was all my life, I was happy that way. I am very depressed being this big, it gets in my way of doing normal things in life. I am too embarassed to go in public sometimes, I won't go to class reunions or to see my husbands family because of my weight. I have a sister in law that tells me every year in July when they come for a visit that I am heavy and maybe I should surprise the family and lose weight. I am not as active now, I get out of breath easy, even walking up the stairs. Even if I only have a BMI of 35, I am still obese, I am over 200, 80 lbs over what I use and should weigh. I was never obsese as a child or in HS or after, it came on in my late 30's.

My docs all agree that losing weight will make me happy, I have cried to them many times about it. They understand completely and that is why they support me on this surgery, they know I will give 100%.

I have a sister in law that tells me every year in July when they come for a visit that I am heavy and maybe I should surprise the family and lose weight. .

Your sister in law is lucky she isn't my sister in law, I am far from a violent person, but if she said this to me... I would of reached out and smacked her. THIS IS THE REASON WHY I CHOSE NOT TELL ANYONE BUT MY HUSBAND. My in laws make weight related comments frequently.. UNTIL I told them to mind there business, I'm trying my best to do what I can. And until my Mother In Law is the correct weight for her height and maintains it.. keep her mouth zipped for now. Like I love being over weight/obese.

I also have many medical issues. I have had several back surgeries and I have a intrathecal pump implanted.. blah blah blah. It's up to me to do what I have to do to try to get this weight off. Like everyone else, I've tried it all.

TIRED OLD MAN, I agree 100% with your last post. Nice job

Also.. I forgot to copy the thread, but someone else who has BCBS of TN said the same thing, that the insur. company rewrote the WLS guidelines in April. I'll have to look for it. I really hope it doesn't have any effect on me or anyone else,who is close the 40 BMI with not so serious comorbid diseases..

Here is the thread, Go down a few until you see Mona's post. http://lapbandtalk.com/showthread.php?p=245960#post245960

Also.. I forgot to copy the thread, but someone else who has BCBS of TN said the same thing, that the insur. company rewrote the WLS guidelines in April. I'll have to look for it. I really hope it doesn't have any effect on me or anyone else,who is close the 40 BMI with not so serious comorbid diseases..

Here is the thread, Go down a few until you see Mona's post. http://lapbandtalk.com/showthread.php?p=245960#post245960

Mona, the women in the linked thread is in a totally different situation than the situation that I wrote about in my last post. With a BMI over 60, any insurance company denying bariatric surgery is either foolish, unethical, criminal, or uncaring (or any or all of the above) and deserves to be reported to the state regulators and maybe sued in court.

They are gambling that Mona will die before having to have medical treatments that would eclipse the cost of bariatric surgery. If the Tennessee state insurance regulators will not step in, it is time to write to the Tennessee state legislature and to the US congressmen. Each person in this country has one state Representative, one state Senator, one US Representative and two US Senators. Not knowing their e-mail addresses is foolishness on the part of any US citizen.

US House of Representatives

US Senate

State Legislatures

Mona, the women in the linked thread is in a totally different situation than the situation that I wrote about in my last post. /quote]

OH I didn't want you to think I was going off of your post on that. I was trying to break up the post by saying "ALSO". In this thread, early on, we were talking about BCBS of MA changing their rules and that was what I replying too. That BCBS might just be having the change every where else too. Sorry for the mix up.

Hi, I am considering Mexico too. I have talked with Carolyn at least twice since the doctors office told me I would have to gain 10 pounds for my insurance to cover me. Can you tell me more about the Mexico trip? We weigh very close to our start out weight. I am 232 and very healthy. I don't want to wait until I have heart disease or until I can not walk because of knees and hips. I am still extremely active and love life......except I hate being fat. It is beginning to depress me. Is that a co-morbidity????? Anyhow, I need to know more about the Mexico trip. I have all the forms. I just have not filled anything out or paid anything, because there is a little voice saying, "wait, wait, wait." But I wish I had done this 6 months ago. Share your experience with me.....please.

Wild

My BMI was only 38 and UHC decided my co-morbities weren't life threatening enough so they denied me. I was beyond frustrated so I did what was best for me and went to Mexico and couldn't be happier. It took 2 1/2 weeks for me to find out. Good luck to you!!

~Liz~

banded 03/10/06

Dr.Ortiz

241/196/150

Mona, the women in the linked thread is in a totally different situation than the situation that I wrote about in my last post.

OH I didn't want you to think I was going off of your post on that. I was trying to break up the post by saying "ALSO". In this thread, early on, we were talking about BCBS of MA changing their rules and that was what I replying too. That BCBS might just be having the change every where else too. Sorry for the mix up.

I didn't think that at all.

I was comparing two situations; One, where a responsible insurance company is looking after the best interest of the patient (thought not cutting their own financial throat) and the other situation, in which a medical insurance company is uncaring, irresponsible, foolish, unethical, and maybe criminal in it's actions.

I GOTCHA!!! I was confused for a minute there!!! I agree, there is a time when you just shake your head and say HUHHHHH? to the Insur. comp.

Hi, I read the co-morbidities that you listed above for the insurance to complete this LB procedure. I like to keep a sharp vocabulary, especially when it comes to medical terms. Here it goes:

<form action="/script/main/search.asp?" method="post"></form> <table border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr> <td align="center" background="/images/bkgd_search.gif" height="44" valign="top"> [/url]

</td> </tr><tr><td valign="top">

Definition of Pickwickian syndrome

Pickwickian syndrome: The combination of obesity, somnolence (sleepiness), hypoventilation (underbreathing), and plethoric (red) face.

The syndrome is so named because of the "fat and red-faced boy in a state of somnolency" that Charles Dickens described in his novel, The Pickwick Papers. (The same boy is thought by some experts possibly to have had the Prader-Willi syndrome).

</td></tr></tbody></table>

and the other one I looked up was this:

Signs and Symptoms

Pseudotumor cerebri (PTC) is encountered most frequently in young, overweight women between the ages of 20 and 45. Headache is the most common presenting complaint, occurring in more than 90 percent of cases. Dizziness, nausea, and vomiting may also be encountered, but typically there are no alterations of consciousness or higher cognitive function. Tinnitus, or a "rushing" sound in the ears, is another frequent complaint. Visual symptoms are present in up to 70 percent of all patients with PTC, and include transient visual obscurations, general blurriness, and intermittent horizontal diplopia. These symptoms tend to worsen in association with Valsalva maneuvers and changes in posture. Reports of ocular pain, particularly with extreme eye movements, have also been noted.

We need to know what those doctors are talking about when we go in to talk with them.

Wild

I found the link for the bcbs of ma site, this is the wls section http://www.bluecrossma.com/common/en_US/medical_policies/379_Medical_and_Surgical_Management_of_Obesity_including_Anorexiants_prn.pdf#page=1.

time to love me

Did you get approved yet?

Did you say you have BCBS of MA?

Where are you going for your surgery.

Thanks

I had to have all my paperwork submitted and approved before my doc. would even set my surgery date.

Same here. I was approved two days after the paperwork was submitted.

time to love me

Did you get approved yet? I'm still waiting, I talked to the insurance company on Monday and they said they'd get back to me within 2 weeks.

Did you say you have BCBS of MA? Yes

Where are you going for your surgery. Lahey Clinic in Burlington. What about you?