Anyone out there have Premera thru Microsoft? I am just wondering if you had to do any supervised 6 month diet with a doctor or anything else to get approved.

Edited October 28, 200817 yr by WannaBSkinnyB

I had Microsoft Premera at the time I got my band in 2006. You have to have a 40 BMI or a 35 with two co-morbidities. I was the latter and they initially denied saying they co-morbidities I had didn't count (they were in the darn list on the benefits page so I don't know why the heck not). I sent a letter to the HR director and to Premera and they reversed the decision and my surgery was covered.

I would have preferred to use NWWLS near my house for surgery but they just told me MS would deny me and and weren't interested in helping. Implied that if I gained more weight I should call them. So I went with another doctor who was happy to fight for coverage. I called NWWLS later to make sure they new MS does cover 35 BMI so they'll stop turning people away.

Britt

I'm covered through my partner's Group Health coverage. They require a 12-month period of phone support -- 2 months pre-op and 10 post-. I'm currently targetted at <2000 calories, with the expectation of losing 5-10% excess before my surgery.

I've just started that this week, targetting myself at about 1700-1800 w/ 30 minute's walk each night (Mill Creek has been good for that this week). I've been dropping about 1-1.5 lb/d, which matches well with what my partner and I expect -- I apparently need 2700 to maintain my weight, and at 500 cal/lb, a deficit of 1000-1500 should keep me downward.

I *had* been in the 20/20 program through Premera previously, to no effect. I don't know if that was a requirement that I had independently satisfied or not.

My husband just got hired on @ Microsoft. he has not received his orientation date yet but I am chomping at the bit to get banded through his insurance.

Can anyone give me details on the requirements? I am at a 42 BMI with High BP and Sleep Apnea.

Can someone give me the rundown on the hoops I am going to have to jump through? Does Microsoft benefits pay for reconstructive surgery of excess skin after weight loss?

My husband just got hired on @ Microsoft. he has not received his orientation date yet but I am chomping at the bit to get banded through his insurance.

Can anyone give me details on the requirements? I am at a 42 BMI with High BP and sleep Apnea.

Can someone give me the rundown on the hoops I am going to have to jump through? Does Microsoft benefits pay for reconstructive surgery of excess skin after weight loss?

Congratulations to your husband! Microsoft is a large company, with many different groups and brilliant people therein. Finding the perfect fit can be a challenge, but once found is very rewarding.

I found orientation boring as hell.

I encourage him to get his Prime Card from the receptionist. The benefits attached to it are numerous and valuable. There are also a lot of other partnership benefits with other companies (Ford, etc) which you may be interested in. Definitely worth him checking out.

The following applies to Redmond (and probably Puget Sound, generally):

There are two weight loss programs available which I have undertaken. Both required BMI of 40+ or so, or 35+ with comorbidities (my memory may be lacking, but that sounds right). From the sounds of it, you undoubtedly qualify.

The first is a non-surgical, supervised nutrition and fitness program covered (at least when I took it) by Premera. There are various vendors contracted to provided the services, such as Pro Club's 20/20 program, Sound Health Solutions, and so forth. The OOP cost is on the order of $2k as I recall. It certainly works for some people. It didn't work well for me.

The second, via Group Health, is the bariatric surgery program. Total cost of lap-band placement for me was about $28k, of which I paid zero, and an additional OOP of about $1400, for a (mandatory) nutritional counselling program. This worked.

You *may* be required to enroll in the first program before you are admitted in the second. However, once admitted in the second, things move quicky. You will have about 10 weeks of pre-op weight loss, blood work, and so forth, then a quick surgery, and probably home by that evening (if your surgery was in the morning, as mine was). Nutritional counselling (which you paid form, remember) continues post-op for the better part of a year.

The surgery is performed at Overlake Hospital in Bellevue (next to Group Health's new offices, where you'll go for testing and, eventually, fills). They have a floor more or less dedicated to the weight loss program, with appropriately-sized beds and chairs. I don't have any bad memories of the staff.

I find Dr Bock & Co to be responsive but no-nonsense. They are more interested in making sure you get the fills you need than being either generous or stingy. The nutritional counsellors are appropriately enthusiastic and scolding (without being patronizing or insulting). As long as you're honest and dedicated, I expect you'll have a good experience. If you're not, I expect that'll be found out quickly (for your sake) as part of the psych eval or the pre-op nutritional counselling.

I lost about 40# before my surgery on 30 June, and since then another 60#. This is in excess of typical lap band loss rates they generally see (my nutritinist sometimes forgets I was banded, and talks as if I were RNY). My loss has been zero for the past month, but I'm still getting twice-monthly chats with the nutritionist, who's working with me to get things moving again to lose the remaining 40-50#.

Especially compared to what I hear from other programs on this site, I'm impressed with the bariatric program at Group Health. If you're going to have weight loss surgery, I definitely count GHC as one of the better places. (As a side note, I understand from Dr Bock that their *typical* patient has a BMI > 50, so I was somewhat lighter than typical, and you would be moreso, but still qualifying.)

Microsoft also offers area gym memberships. I can certainly recommend Pro Club in Redmond. It's a vast complex just off-campus with a variety of facilities: pools, weight rooms, cardio theaters, etc. They also have a restaurant and spa, as well as hot tubs and saunas, and even car detailing while-you-sweat. Your husband will get access for free, and adding you should be a comparatively little cost. This can be useful (recommended) as part of the Group Health program. I happen to be enrolled with a trainer there, who's torturing me with heavy weights. He's a good kid, who's worked with weight loss surgery patients before. It seems to be working out well enough.

Thank you for the informative response keithf. I am SO excited about getting banded I can think of little else. I know it is going to be tough work but I am sick and tired of being in massive pain all the time. I know about the pros and cons and even the horror stories but nothing can be worse than the handful of pain pills i have to take every night.

The only worry I have at this point is the psych eval. I stopped taking my bipolar meds and decided on a more holistic way of controlling my disorder. I do not want to be forced back on meds because some shrink thinks it is the only way to deal with mental illness.

The only worry I have at this point is the psych eval. I stopped taking my bipolar meds and decided on a more holistic way of controlling my disorder. I do not want to be forced back on meds because some shrink thinks it is the only way to deal with mental illness.

In my experience, the psych eval is looking for underlying emotional issues that would impede success of weight loss. You have a few months after surgery to really make it count, because that's when you'll be losing weight the fastest. The psych will at worst delay the process, but that delay will be toward ensuring a greater chance of a good outcome.

Heck, with all the bloodwork, they may discover an underlying condition that explains things, so you never require surgery at all. Same idea here.

So just be honest, and cultivate the support structures you need among friends, family, and yourself, particularly as ragards realistic expectations about how much success, why/how prior attempts to lose weight didn't succeed, and so forth. If for some reason the psych raises a concern, you certainly wouldn't be the first, and it would be for your greatest benefit to not worry about it. If it happens, it's all part of the treatment, of which surgery really is the last (and common) resort.

IMHO, you really shouldn't *want* the surgery. You should instead simply be open to the idea that surgery may be the best option in the long term, for whatever reasons apply to your case (in the case of lap band, portion control -- if you have other issues, you probably should consider a different surgical treatment).

Bloodwork, psych, etc are simply standard ways to convince both you and the bariatric program that yes, indeed, there are no known medical conditions that would render the surgery ineffectual (some endocrine diseases cause obesity), no significant mental blocks that would prevent you from following the program (you're mentally ready to change your lifestyle radically), and you've created relationships that are supportive of a post-op lifestyle (your husband's not going to insist you go out and eat pizza with him, your mother will understand if you don't eat her apply pie, you've learned to ignore your uncle's recriminations about your current body shape, etc).

Again, good luck.. just remember that every successful patient out there went through pretty much the exact same thing.

Oh I want this more than words can even begin to explain. I have been doing my research for over two years. I have tried other ways and due to my health have failed. I know my reg doctor will back me 100%. She has been amazing through all of my struggle, tough when she needs to keep me on my toes and understanding when I need support.

Thank you (again) for your reply. You really put my mind at ease about the eval. I am sure it will be a piece of cake. In my years of struggling and trying to heal I have come face to face with my demons and cast them aside. I was just wary of a shrink. I have had so many "lets just throw medication at it and it will be all better" doctors and 'mental' professionals and I am tired of it. I know what I want, I know what will make me better and I am not going to let ANYTHING (even my weaker side) get in the way!

Hubby has orientation tomorrow.... I am SOOO excited (and proud)!!!! :blushing::w00t::thumbup::w00t::thumbup::w00t:

Edited January 4, 201016 yr by whiterabbit

Oh I want this more than words can even begin to explain. I have been doing my research for over two years. I have tried other ways and due to my health have failed. I know my reg doctor will back me 100%. She has been amazing through all of my struggle, tough when she needs to keep me on my toes and understanding when I need support.

Thank you (again) for your reply. You really put my mind at ease about the eval. I am sure it will be a piece of cake. In my years of struggling and trying to heal I have come face to face with my demons and cast them aside. I was just wary of a shrink. I have had so many "lets just throw medication at it and it will be all better" doctors and 'mental' professionals and I am tired of it. I know what I want, I know what will make me better and I am not going to let ANYTHING (even my weaker side) get in the way!

Hubby has orientation tomorrow.... I am SOOO excited (and proud)!!!! :blushing::w00t::thumbup::w00t::thumbup::w00t:

Everyone worries about the psych, yet nearly everyone needlessly so.

So you should be covered effective tomorrow, and your husband should regain consciousness sometime around lunch Tuesday, when NEO ends and he gets his badge. He'll be just around the corner and down the block from where I'm stationed half the week.

I think if you get your GHC physician and your prior physician chatting, it'll help on the application, but I suspect you'll be needing to get the referral primarily through your GHC physician. Mine was reluctant, but his reluctance was simply wanting to make sure I knew this wasn't some miracle surgery, and that I could (albeit with more difficulty than before) just regain everything. But after our discussion he got things going on his end. He doesn't get to see me very often, but did see me shortly after surgery, and was pleased with my progress.

Incidentally, you'll need documentation for any sleep studies for apnea, etc, that were performed elsewhere, which GHC won't have record of. They won't simply accept your word that you have it or any other condition -- they'll want to see evidence that an actual diagnostic study was performed. This was the cause of my initial rejection. A simple phone call to the records office at my old medical provider, and I had my entire record shipped to GHC. My appeal was approved very shortly thereafter (just in time, too.. I really delayed just making that stupid phone call).

I'm very pleased with GHC -- I'm pretty sure you will be as well. Sign up for MyGroupHealth, and you'll get online access to your appointments, email with your docs and specialists -- including the ones on the bariatric team -- test results as soon as they're approved by the physician, etc. Very worthwhile.

I will be lucky if my hubby regain consciousness anytime this week. The knuckle head stayed up all night playing WoW.

Anyway back to the subject at hand... I am really going to miss my PacMed doctor. I wish i could keep her since she is the first doc in over 10 years that actually listened to me. I got sick and tired of so many docs telling me "is because you are over weight. Fix the fat and you will be fine."

Hello! Earth to doc... did you some how miss the stack of medical records on your desk that i have been keeping since I was 135 pounds and in good health?! My back issues are not from being overweight (yes being fat does not help but...) it comes from wrapping my silly young and seemingly indestructible butt around a tree while snowboarding when I was 16. The pain in me right knee... a tree branch going through it the next winter while stupidly participating in the same sport! I did a lot of damage to my body as a young woman and it has impacted my life from skinny to overweight.

Doc Ed is wonderful, she went over all my records with me and set up a work out that I could do and not damage my joints until I lost the weight. I don’t want to give her up but my current insurance won’t even look over my case no matter how many times we have submitted it L.

Edited January 4, 201016 yr by whiterabbit

My back issues are not from being overweight (yes being fat does not help but...) it comes from wrapping my silly young and seemingly indestructible butt around a tree while snowboarding when I was 16. The pain in me right knee... a tree branch going through it the next winter while stupidly participating in the same sport!

I ski as well as Sonny Bono did on his last day. The only way I know how to stop is to aim myself at a tree. I don't ski much, obviously. :rolleyes2:

Have you investigated alternative footware, like MBT-brand shoes (available at The Walking Company)? It may help alleviate some types of pain that happen to be due to weight/posture -- obviously pain from joint damage would still remain. If you have plantar fasciitis or runner's knee, I can state that it cleared mine in about 3 days, which helped a lot in getting my walking in. Anything to help you get that much extra activity in will be valuable, particularly at the early stages. I actually can't walk long in flats anymore, and use my old shoes only for weight training sessions (where a rounded shoe becomes very unstable).

As far as "you gotta lose weight" .. okay, yes, that is still true, even though they may be a bit short with how they state it. I think part of the problem they see is that, without weight reduction, effective treatment of other issues becomes difficult. It's akin to why we as WLS patients give up half our blood supply to the endocrinology lab, so they can screen for underlying disorders that need to be dealt with in order to make the surgery worthwhile.

They could still be a little more helpful about it, though.

My MD at GHC is Gelgisser. Nice guy (almost too nice -- I can see him being a pushover), and has no problem sending someone off to a specialist, or to the diagnostic lab. I've not had any problems with him. Sure, sometimes he's forced by policy to go through the stuff we all know won't work, but he doesn't stand in the way of progress.

Hi, I have the Premera Blue Cross and it did require I do 6 months of weight management. I did 4 months a couple of years ago with Natural Weight Loss Clinics in Tacoma and 2 more months at my doctors office.

My Dr. is Dr. McMahon and he runs the Weight Loss Clinic at Swedish Hospital in down town Seattle. So far the experience has been great. The know what they are doing as far as our insurance goes and they are willing to help.

I would suggest you also check him out !

Good luck!