Hi,

This is a long post, but I need to vent! Does anyone have PacifiCare insurance? I can't believe what they are doing now! I had been so excited to find I could get coverage for LapBanding, as I have an HMO. (I was surprised to find out that PacifiCare PPO doesn't cover the procedure! ) Anyway, I spent my last 2 days happily setting up the appointments and getting my schedule cleared for all the long trips down to the city I would be going to for the surgery, when I got a phone call from the surgeon's office telling me that PacifiCare just implemented a new policy: Every potential Lap Band patient MUST go to a diet center set up by PacifiCare and be monitored FOR SIX MONTHS before they can start the process for banding!! :angry I couldn't believe and tried to fight it because of the seriousness of my health issues, but there are NO exceptions. Has anyone else run into this? I have about 100 pounds to lose, so what if I lose some weight on this diet program....can they deny me the surgery because I no longer have the required amount of pounds to lose? If I don't lose weight, can they deny me because I will look like I am not motivated? I am so sad, I cried at work when I found out. I have SO many health issues, as well as knee/foot issues that keep me from walking. I was so looking forward to a "new" life; I want that so much! Now, if I do this, it will be almost a year before I can start. My DH and I just got ourselves out of debt.... should I put us back in and just pay for this ourselves? Help!! I am so depressed and upset....:cry and I am so glad you all are there.

Karen

I wish you the best of luck!!!!

One last question, Funny.... what is "HTH"???

I can't speak for others but for me I could diet till the cows come home and the result is always the same. I lose 10 to 20 lbs fairly easy and than my appetite hits so hard I would be willing to eat the covers off of matches to fill my gut. If I don't get the tools I need it will be impossible for me to lose the weight I need to have better health.

I am married to a Registered Dietitian and she says I need something besides a diet to lose the weight.

Don't be discouraged by a No it just is an opportunity to try another door. I think that if I am turned down by Insurance I will try to get it done at VA and failing that Hola Mexico!

I think Funny Duddies is right, I think the insurance companies do that because they have to pay for less surguries this way. A lot of people aren't willing to wait and go through all of that first. Like you said too, what happens if you do lose some weight, then they probably wouldn't let you have it done anyway and you might gain it back after you go off of their supervised diets. I didn't ask about the complications. I only thought of that deeply, after I had the surgury which wasn't exactly smart of me. Unlkie your situation, my process happened very quickly..... I am sure this is because I paid for it myself. I didn't have to see a psychologist, nutritionist, etc. That is something that the insurance companies require but not the surgeon. In fact I got financing one week and was banded the next. I have been very worried lately about complications though. I planned to ask my surgeon on my post op visit on Wednesday. Everything seems to be fine, but I had posted the other day wondering if my band does slip, would I know it??? I have been extra worried about that and having a leaky port etc., because I paid for it myself. I can't afford for them to go back in again. I will let you know what I find out.

Not helping people lose weight is very short sighted. I know that the VA did a study on 1000 Veterans who got Gastric Bypass Surgery and found that after the initial surgery that for most Veterans their costs dropped dramatically. Keep in mind that the VA actually bears almost 100% of costs for Meds and Treatment.

Jack, you have PacifiCare PPO, right? Because the HMO does cover it, but only after you jump through enough hoops. Kristina, how long has it been since your banding? Probably your chance of complications will be small, if your surgery went well. I am more worried about surgical complications, since I have heart and anesthesia issues and feel like my insurance company will not cover anything related to that if I pay out-of-pocket. Pete, do you have a surgery date yet? I look forward to the day we are all senior members of this group and can put at least THIS problem behind us!

L8BloomR- My surgury was 8/23/06. I am still doing well, but still worrying. I can't wait till we are senior memebers too and skinny senior members at that!!!

Kristina, how are you feeling?? It is so soon after your surgery and you sound like all is well!! :clap2: I am so glad for you! Any problems yet, or surprises? I am jealous.... I want my surgery NOW!!!!

Karen :ohwell:

I don't have Pacificare..I have NJ Carpenters Health Fund..all I had to do for my doc is write down the diets I have tried in the past how much weight I lost and how much i gained back...and give dates..I had to have 10...omg I had 14!!!!! I do have to see a licensed Nutritionist..who shares his office. I saw her once, I will see her again before surgery....but I have to see her 12 times total!!! Its actually a good thing...I love her and even thought that if I were turned down, I'd just go to her --she has other weight loss programs. 6 months will go by quickly and the knowledge you gain will be priceless more importantly it will make you a better bander. Don't fret, it will go fast! Take care.

Bettina,

How soon till you have your surgery? How lucky for you that you love your doctor!! It sounds like you have a good insurance plan; I wish mine allowed documentation on my weight loss history... I'd have had the band in already! Thanks for your encouragement!! I am counting on the 6 months going fast! I will be looking for an update on your progress, so let me know how it goes!!

Karen

Bettina,

How soon till you have your surgery? How lucky for you that you love your doctor!! It sounds like you have a good insurance plan; I wish mine allowed documentation on my weight loss history... I'd have had the band in already! Thanks for your encouragement!! I am counting on the 6 months going fast! I will be looking for an update on your progress, so let me know how it goes!!

Karen

Hi Karen...24 days and counting...in less than an hour it will be 23 days...lol. I am not going anywhere..so I will keep you updated! Seriously 6 months will be here before you know it! Look at it this way...most people love the holidays and the goodies it brings, you get your last chance at the holiday goodies and can start fresh in the spring...still in time for next summer...so its all good!!! If you are really worried about it, can't you appeal it with your insurance?? Explain to them that you started this process before they changed their policy...you should be grandfathered into the old policy. Try it, you have nothing to lose!! Let me know what you do! Take care.

Hi Bettina,

I DID try to get around the 6-months-diet rule, but my insurance company won't budge!! I appreciate the encouragement about waiting... unfortunately, I already DID think about the holidays....part of me is happy to be able to eat, the other is scared of how much more weight I will gain!! The most depressing thing for me is that for the first time in my life, I was really ready to give that all up and now I can't. I mean, I used to plan my diets around the holidays, birthdays, family trips, so that I could eat during those times. I have finally reached a point where I care more about my health than my stomach and don't want to eat, and now I have to wait. I think I am scared that I will lose my motivation. :girl_hug: I need this group to keep me going. I will be anxious to hear how you and the other newbies do and I so appreciate your encouragement!

Thanks for your supportive post and keep in touch....I will be counting down the days with you!

Karen

How brave you were, Jack....Thanksgiving AND Christmas!! Good for you!! You are an inspiration!! I wish my insurance would let me follow your example.... Now that you are banded, are you worried at all about the holidays this year?

Karen

That is wonderful to hear, Jack!! That must be such an empowering feeling.... Congrats!! And thanks for sharing that, it gives me something to hope for!

Karen

Don't you find it just amazing that some insurance companies are helpful in getting this surgery for you and others are not, especially since losing weight is supposed to be the cure-all for so many ailments? The really amazing thing I found out about PacifiCare is that their PPO plan will not cover it, only their HMO plan.... now why would that be?? Makes NO sense! !

ins

It all about CARVE OUTS. An insurance company may offer it to a company and the company chooses a cheaper plan based on what is "carved out". just because an insurance company covers it in some doesnt mean they do for all. Its all up to what the employer is paying for and saving money on. Everyone curses the insurance company- its not their problem. Its what the company chooses to cover or not!

Think of it as a turkey. The turkey cost is $20 per person if you carve off the breasts(WLS, PS, other $$$ procedures) then the cost comes down to $8 perperson that is more affordable for the company and the majority of the employees. THAT is how insurance for companies and employees is dealth with.

Hope that helps- its not personal its business. The people are not factored in except for how many in numbers need health insurance. sooo if you want it covered you have to go to the personel/human resources and that will be a fight of fights as you will find. If they make an exception for you they have to do it for everyone. Silence is never kept and they end up losing $$$$.

Good Luck!