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Topic: RE: Turned down
Yes that is a word. There is no set of standard questions outlined in the DMS IV to ask a patient considering weight loss surgery. The questions and the process as a whole are probably as numerous as there are doctors. They look for a lot of things that may be aggravated by or cause new problems after weight loss surgery. For example someone who is depressed should look at that first. You are embarking on a challenge and it is never good to start with a handicap. There are others as well. Like do you use food to cope? If you eat when stressed or depressed or what ever then it wouldn't be a good thing to remove that coping mechanism without first replacing it with something else. Just answer any questions honestly. Whole thing really isn't that complicated typically. Worst case scenario from my point of view would be not right now rather than never.
Topic: New show on The Learning Channel
Let the words of my mouth and meditations of my heart be acceptable in thy sight, oh Lord my strength and my redeemer.
For all of you that have cable tv and get The Learning Channel, Starting on Monday of next week they will begin broadcasting a new show called Big Medicine. I'm looking forward to this and I'm hoping to glean more information and help out of it also. It will be on Monday evening sometime. I look forward to watching it and seeing what goes on.
Let the words of my mouth and meditations of my heart be acceptable in thy sight, oh Lord my strength and my redeemer.
Topic: RE: hitting a rough spot
That is what I tried to tell her. She said she has seen new research and been to a conference and they will not do them execept every 4 weeks. Sonja used to do them every 2 weeks and I was losing consistently. She just will not do it. Do you know if there is a dr in the wichita area that will do just the fills. My year is almost up as a cash patient and so are the year of fills. Just really disappointed because I have seen it work and now no matter how hard I try it is not working like it was.
Topic: RE: hitting a rough spot
It really sounds to me like you need a fill. If you feel hungry all the time and you're not losing weight, then your band is not doing its job. I don't care what the nurse thinks or how many cc's you have in your band - everyone is different, and every sweet spot is different. You should be allowed to have a fill if you think you need one to get going again!! If your doc office won't do it, find another one. You should not have to struggle like that.....
Let us know what you find out!!
~Tiffany
~Tiffany 266 preop/160 current
"A musician must make music, an artist must paint, a poet must write, if he is to be ultimately at peace with himself. What one can be, one must be." ~Abraham Maslow
Topic: hitting a rough spot
I have never posted to this board. My name is Hope and I was banded Oct 20, 2006 in KC. I have lost 60 of the orginal 334 ilbs that I started with. My question is, has any one else out plateu and how did you get started again. I have not lost anything in about 2 months. I exercise for 30 minutes to 1 hour 6 days per week. I have 7.5 cc in a 10 cc band. I am not feeling the restriction that I once did. I had been at 7.0 CC a couple months ago and they had to remove some of the fill because I was too tight. Since that removal I have not been able to lose any more weight and I feel like I am as hungry as I was pre surgery. I have talked to the nurse at the clinic and she said that I just have to hang in there. I am really fustrated with it all. Any one else there have had this problem and what did you do to get the weight loss started again.
Thanks,
Hope
Topic: RE: hitting a rough spot
Morning! So sorry to hear of your struggles. I was just wanting to suggest you also check out the lapband forum, if you've never been. Lots of lap banders post there and may have some suggestions for you. http://www.obesityhelp.com/forums/lapband/a,messageboard/boa rd_id,5359/
Best of success to you!
~Tooter
(deactivated member)
on 5/22/07 1:27 am - Waldorf, MD
on 5/22/07 1:27 am - Waldorf, MD
Topic: hitting a rough spot
I have never posted to this board. My name is Hope and I was banded Oct 20, 2006 in KC. I have lost 60 of the orginal 334 ilbs that I started with. My question is, has any one else out plateu and how did you get started again. I have not lost anything in about 2 months. I exercise for 30 minutes to 1 hour 6 days per week. I have 7.5 cc in a 10 cc band. I am not feeling the restriction that I once did. I had been at 7.0 CC a couple months ago and they had to remove some of the fill because I was too tight. Since that removal I have not been able to lose any more weight and I feel like I am as hungry as I was pre surgery. I have talked to the nurse at the clinic and she said that I just have to hang in there. I am really fustrated with it all. Any one else there have had this problem and what did you do to get the weight loss started again.
Thanks,
Hope
Topic: RE: ins approval..anyone have PPK?
It does sound like the wording is the same. Like I said, at first it was that they wanted me to be seen by my PCP for 6 consecutive months, but I had a weight gain and that along with my Dr. letter I think sent up red flags. I was on the phone with them constantly. I really do think I drove them crazy. I am not sure PPK has the same rules when it comes to "if it's not specifically excluded, it's covered". It seems to me that they keep changing their criteria on me. I think it's more about the mood they are in an any given day. I have a good friend who works for a local Doc and that is her opinion.
Topic: RE: ins approval..anyone have PPK?
I sell health insurance and have filed several claims to get things covered before. It looks like from what you have found out, that it is covered. Now all you have to do is find out what hoops you have to jump through to get them to pay for it. I agree that you have to keep track of everyone you talk to. Get names and numbers and include the time and dates in your records. Do not give up and do not get discouraged. It can be done. Don't be afraid to ask for help. Good luck and best wishes.
Topic: RE: ins approval..anyone have PPK?
i did get them to send me a copy of the certificate and it says
"if you have complied with more conservative treatments, you can have your dr initiate the prior authorization process to determine if you meet the criteria for coverage"
#4. Surgical treatment and all services related to such treatment of obesity and weight reduction, unless the Member has complied with more conservative treatments.
so this is basically what you are dealing with?
I work in the insurance claims industry and our rules are "if it doesn't specifically exclude it, then it's covered"...lol
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