Help

HI everyone, I am having a hard, hard time with myself and I feel absolutely desperate. Aetna will not cover my Lap Band. I am now changing to Pacificare as of July 1, though I don't know if that will be any better. I am so depressed and I am just unable to pick myself up and walk through life. This weight thing is killing me;physically and spiritually. For the first time in my 49 years of life I can feel how the weight it pulling me down. How carrying around this eight hurts my back, my knees, my ehart and is bringing me closer to the diabetes that runs in my family. I am tempted to write to Oprah or someone with the resources to help me. I jsut can't do it anymore. I have two children and when I look at them I feel so ashamed. I am a good, loving mother but I can no longer jump on a horse and spend time riding with my daughter. I can't take long walks with her and the dogs. I just want to lie down all the time. I am a hard worked; I am an eighth grade English teacher and I love my children. I keep on holding my breath and waiting for the day that one of them makes reference to my weight. It's got to happen. My kids are very respectful of me ; they think I 'm cool; I'm from NYC and they like my accent and attitude. And they are a hair intimidated by me, but all it will take is that once that they call me "fat" or make some unkind reference to my weight and I will just die. I do stand up comedy; I have been very successful at that in my town. But I don't have the funds for the Lap Band surgery. And those of you who had surgery in Mexico please forgive me for saying this but I can't do that. It just scares me too much. I have heard too many horror stories about surgeons in the US much less Mexico and I just can't do it. I really wanted to go to Dr. Simpson; he would wonderful; Christine was so very supportive but the insurance won't cover it. I am hoping, though it may be very unrealistic, that somehow, somewhere Pacificare will cover it or I will find some generous benefactor who believes in education and will help me just so that I can continue to teach. I don't know what to do. I want to wake up and go riding. I want to take long walks with my dogs. I want to stop hiding and get out there and live. But I can't. My stomach is so big that I feel so ashamed to go out to dinner or be seen. I am off for the summer so that is good and bad. It enables me to hibernate, but it also enables me to thing. I am starting a class tonight on body image,; I am trying to stay positive but I am sinking inside. Thank you for listening to me, Aimee

Did you even consider RNY? In my opinion, any weight loss surgery, is better than living the way you describe... if your insurance will cover RNY then do it....

Aimee - I agree with Darlene. I am 56, had laproscopic RnY 5/24/05 - best decision I ever made - after marrying my Dearest Old Bear. Elder sis (almost 70) had the lap band one week later. She and I have kept pace with one another re weight loss. I've lost 110, she's lost about 100, but she's 2 inches shorter than I am. I don't know if Aetna covers RnY, but if they cover any WLS, they cover that. A lot of insurers still think the lap band is "experimental", or not proven. I had Dr. Villares in Phoenix as my surgeon - I cannot say enough good things about him. I have had zero problems. Only 3 times in the past year has my tummy really rebelled and each time it was because I took too large a bite of chicken. Check the two insurers, and make sure you know which procedure they will cover. Do your research. Keep your chin up. Most of us went through the same thing you're experiencing now and we understand how you are feeling. If I can be of any help, feel free to e-mail me. I will do my best to answer as quickly as I can. Mom Bear

Aetna won't cover LapBand? I'm not sure about your specific coverage, but the info I have from Aetna on their Clinical information bulletin says that they will cover RNY or LapBand. Have you actually contacted Aetna? Because everybody I talked to there is very helpful in giving me all of the infomation. The physical requirements are a BMI over 40 or a BMI over 35 with co-morbidities. Or are they not covering it due to an exclusion? Because if it is due to an exclusion, there is not really much you can do. And chances are it won't change with a change to an insurance company, because this is determined by the company. I also agree with Darlene, have you considered RNY rather than the Lap Band if that is the issue? I mean, if the weight is causing that many problems, then I think anything is better than nothing. Good luck. Jen

My friend just got back Puerto Vallarta, Mexico last night she had surgery with Dr Joya bec she was self pay. I was the last person my employeer paid for to have WLS...now full exclusion. Dr Joya is very good...many sugeries...he is a pro. I found Dr. Joya for my friend through the message board on OH called South of the Border. She is working today driving the school bus and is 12 days out. I amazed. She is 28 lbs down in 12 days...double amazed. Dr. Joya has a real nice web site and a yahoo message board. drjoya.com. Self pay is better than living like you are. Sandy in Tucson 187 lbs down Dr. Fang 11/04/04

Aimee, Whatever you do, don't give up. I was in the same position you are over two years ago. I was hibernating in my house, had stopped spending time with friends and relatives, missed important events like weddings and funerals and had all but shut down. I was certain that I wasn't going to make it another five years. My insurance denied coverage so I hired an attorney. It was the best 800.00 I ever spent. We went through three appeals and took it all the way to the state insurance commission, but we finally won. Look at all your options and do what you have to do for yourself, even if you have to find a way to self pay. If your insurance won't cover the band, then maybe RNY. If they won't cover one surgeon, then maybe they will cover another surgeon. Check with your HR people and make sure that wls is covered in your benefits. The state of Arizona specifically excluded it for their employees with some of the insurance carriers. If it's not excluded, maybe your employer can go to bat for you. Do you work for TUSD? I'm a firm believer that there is always a path to where you want to go, sometimes it's not easy to find, but you can get there. Keep fighting and don't give up. Hugs, Connie

Aimee, I replied to your post here via OH email as it was a long reply huggsssssssssss Shalom Mike Berkwit

Hi Aimee.. I can sure understand your frustration. I have Aetna. They do not cover the lap band but my plan does cover the RNY. Do you have a strong preferance to the Band? Would you consider the RNY? Reasearch both and you might find the RNY is a little more complicated but far more effective long term.(that was my opinion after research) Whatever your decision please dont give up. You sould like a WONDERFUL person! This surgery will happen for you...just dont give up.. Take care. Sally

If you don't have your heart set on Lap Band Why not Lap RNY? Pacificare does cover the RNY and they are very easy to work with. They have been wonderful and approved me very quickly.