When you pay, things can happen.
This should not have been any huge epiphany for me; I mean, although it's not one of the Ten Commandments, it's well known enough to have qualified for an eleventh.
I finally got tired of being slapped around by doctors, their assistants and the insurance company, and wrote a simple query to the offices of a well-respected Lap Band surgeon, Dr. Pedro Kuri, in Mexico, twelve miles from my home in San Diego.
Five minutes later, dozens of my questions were answered in a very concise email, along with prices, funding options and transportation arrangements. Three days later, I had a date set up for surgery, around three weeks later. My new DOB (Date of Banding) would be May 10th, 2008.
They set me up with a facilitator, who was there via email or phone and my beck and call, just about 24/7. If she didn't know the answer to a question, she found out promptly and got it to me pronto.
I was so amazed at the way this was coming together, I almost cried when she called me with the date. I had been trying to get this done for five months in the States, but the only result was feeling like a cat toy being batted around by a monster tiger.
It was difficult to imagine: They were actually behaving like I was the customer and they were the service provider. Could it possibly be so easy?
"Mexico? Are you out of your mind?" was the reaction of most people I told. There seems to be a built-in paranoia of anything serious coming from somewhere other than the United States. What they either don't understand or don't want to believe, is that the medical system here is seriously broken and doesn't work nearly as well as elsewhere.
Instead, they'll bitch and complain about the lack of care they got at Kaiser or Sharp-Reese Stealy, but continue to go because that's where they have their insurance. They are denied multiple times for surgeries like the Lap Band, even though it would save the system untold dollars in medical care. The patients dutifully follow the instructions to go back and get a membership at Jenny Craig. They lose the same twenty pounds they've lost and regained their entire lives and then are told they don't need surgery because the diet plan worked.
Denied again.
Screw that; I went to Mexico and had the surgery. Immediately afterwards, my blood sugar went down and stayed at a level where I could 86 two of my three Diabetes medications. My blood pressure is great, and I'll bet the test results this month will show my cholesterol down, too, even though I have not taken the meds for that since I got my Lap Band.
The hospital in Tijuana was incredibly deluxe, more like a four star hotel. It was very clean and the staff was friendly. Doctors in Mexico hug you, and are most attentive and respectful. It was a stark and welcome contrast to any medical experience I've ever had here.
I have lost that twenty pounds again, but this time it's for good, and I'm not stopping there.
"If you have surgery in Mexico, our doctor will not give you any follow-up care," warned a medical assistant here after abruptly informing me that I'd been denied a final time by my insurance company. She knows many people are turning to other options.
I feel like making a video of myself laughing and thumbing my nose and sending the link to the insurance company and the medical personnel here who charged so much for absolutely no real service at all.
I doubt if they could get their heads out of their asses long enough to see it.
What a refreshing change from
Friday, July 4, 2008
Monday, May 12, 2008
We're Here to Help
From the moment I began my Lap-Band journey, it felt like someone was trying to kick my ass so that I couldn't possibly get down that road. Like a carrot dangling over my head, I was promised good health, a thinner me. Yet, at my every turn, there was someone ready to bludgeon me for trying.
After I went to the surgeon's seminar, and lined up the insurance, I was set up with appointments all in one day for my meetings with a shrink, an internist and the surgeon. Things seemed like they were going along swimmingly. I mean, the insurance specialist had assured me that my type of insurance was a snap for approval, as long as I jumped through all the hoops of appointments etc.
Easy enough. Hell, it only took my brother, Bruce, a few weeks from start to finish with the same people and he had the same insurance company as me.
"I see you've been on a lot of different diet plans," said the shrink, as she shuffled though my paperwork. "We've got Weight Watchers, South Beach and Hollywood diets, even the Shick Center. "What was the most successful one?"
"The divorce diet," I said flatly. "That was worth a good 30 pounds. All I did was ride my bike and cry all day."
She gave me a look and then proceeded through the gamut of questions. I told her what I thought she wanted to hear. She finally pronounced me fit to have the surgery. It was time to see the internist.
I was scared about this part. I'd been eating everything in sight in order to weigh in at the necessary BMI, but was a little shaky because I'd weighed a little shy of the requirement before leaving the house.
"Put rolls of quarters in your pockets," advised someone from the online user group. "Lots of people do that to get around the weigh-in." I decided to wear the heaviest shoes I could find, instead, hoping they'd be one of those places that lets you wear them on the scale.
"Those are cute shoes. Take them off." said the assistant to the doctor. Dammit, here goes nothing, I thought, and stepped on, completely quarterless. Apparently,I was weighty enough.
"I don't like your blood pressure," said the internist.
"Flatterer," I thought.
I was told that I'd hear from them once all the tests were in. I waited. I called, and was sternly told to be patient. Ha. Very funny.
I found out only by accident a few weeks later that I had been approved for surgery by this doctor, but that my insurance had denied me. They wanted me to prove that I had attended a Weight Watchers or other costly program for a continuous six month period during the last two years.
By the time you reach my age, you've long since given up on this kind of thing, and I had no proof. My insurance ran out at about the same time. I signed up for COBRA benefits, an extension given in California where you can pay an arm and a leg for up to eighteen months, but maintain the same coverage.
I was beginning to wonder exactly what coverage when I received a bill for $400 from the internist.
"Write an affidavit to the insurance company," wrote a good friend. "Swear that you've already tried all this stuff and it doesn't work. Cite the study that they did in Australia. They can't dispute it. They'll have to cover the surgery." She was writing this from prison, after having failed her own appeals.
And, just like her courtroom drama, I could almost hear the insurance company say, "Nyah, Nyaaahh!" as they completely ignored my affidavit and denied me a second time. Then, I got a letter from a representative of the insurance company, telling me that they were there to help, and to just call with any questions.
Oh, I had questions, alright. But the representative assigned to my account told me she was just available to help me with medical issues, not denials or billing problems.
I feel so much better now.
After I went to the surgeon's seminar, and lined up the insurance, I was set up with appointments all in one day for my meetings with a shrink, an internist and the surgeon. Things seemed like they were going along swimmingly. I mean, the insurance specialist had assured me that my type of insurance was a snap for approval, as long as I jumped through all the hoops of appointments etc.
Easy enough. Hell, it only took my brother, Bruce, a few weeks from start to finish with the same people and he had the same insurance company as me.
"I see you've been on a lot of different diet plans," said the shrink, as she shuffled though my paperwork. "We've got Weight Watchers, South Beach and Hollywood diets, even the Shick Center. "What was the most successful one?"
"The divorce diet," I said flatly. "That was worth a good 30 pounds. All I did was ride my bike and cry all day."
She gave me a look and then proceeded through the gamut of questions. I told her what I thought she wanted to hear. She finally pronounced me fit to have the surgery. It was time to see the internist.
I was scared about this part. I'd been eating everything in sight in order to weigh in at the necessary BMI, but was a little shaky because I'd weighed a little shy of the requirement before leaving the house.
"Put rolls of quarters in your pockets," advised someone from the online user group. "Lots of people do that to get around the weigh-in." I decided to wear the heaviest shoes I could find, instead, hoping they'd be one of those places that lets you wear them on the scale.
"Those are cute shoes. Take them off." said the assistant to the doctor. Dammit, here goes nothing, I thought, and stepped on, completely quarterless. Apparently,I was weighty enough.
"I don't like your blood pressure," said the internist.
"Flatterer," I thought.
I was told that I'd hear from them once all the tests were in. I waited. I called, and was sternly told to be patient. Ha. Very funny.
I found out only by accident a few weeks later that I had been approved for surgery by this doctor, but that my insurance had denied me. They wanted me to prove that I had attended a Weight Watchers or other costly program for a continuous six month period during the last two years.
By the time you reach my age, you've long since given up on this kind of thing, and I had no proof. My insurance ran out at about the same time. I signed up for COBRA benefits, an extension given in California where you can pay an arm and a leg for up to eighteen months, but maintain the same coverage.
I was beginning to wonder exactly what coverage when I received a bill for $400 from the internist.
"Write an affidavit to the insurance company," wrote a good friend. "Swear that you've already tried all this stuff and it doesn't work. Cite the study that they did in Australia. They can't dispute it. They'll have to cover the surgery." She was writing this from prison, after having failed her own appeals.
And, just like her courtroom drama, I could almost hear the insurance company say, "Nyah, Nyaaahh!" as they completely ignored my affidavit and denied me a second time. Then, I got a letter from a representative of the insurance company, telling me that they were there to help, and to just call with any questions.
Oh, I had questions, alright. But the representative assigned to my account told me she was just available to help me with medical issues, not denials or billing problems.
I feel so much better now.
The Last Supper
Permission is a wonderful thing; it really sets you free -- sometimes, to hurt yourself. When I realized that my Body Mass Index (BMI) wasn't high enough to warrant the Lap-Band surgery I so dearly wanted, I set out to qualify.
Anything that starts out with the two words: Hot Fudge is a good beginning, I figured. I bought gallons of ice cream and jars of hot fudge, and doled it out every night with determination. It didn't take much effort; it's ingrained in my very being: hot fudge, should be a major food group in my opinion.
Now, although I love chocolate, and will do just about anything to get to it, I never allow myself to go overboard, usually, as I am a diabetic and have to watch it. In fact, I'm a very healthy eater. I love fresh fruits and vegetables and grilled, simple things like chicken and fish, and that's usually the way I eat. Whole grains, like wild rice, diet sodas or iced teas -- never a fully-sugared drink, unless it's a rare margarita. I've always talked a good talk, but have usually made the healthy choices when it came down to it, unless I was doing it with purpose, like going out with friends to splurge. I like to splurge.
My friends were startled at my decision to get the surgery, because I wasn't exactly of gargantuan proportion. When I told them of my goal to good health, they were all more than willing to help me get there. It not only helped me on my journey; it gave them a reason to pig out, too.
"Where do you wanna eat? We've got to get it all in before your surgery," they'd say. I was at the ready, fork in hand in an instant. Let's load up; I've got a lot of work to do here!
It began gradually, almost timidly, during the holidays when my dad was dying and all kinds of handwriting was on the wall. I needed something to help me not end up in the same sinking boat as he. The diabetes, the cancer, the dementia. "Get me out of here," my body seemed to cry to me on a daily basis. I needed the escape of the surgery; sure, I'll have the cheeseburger platter.
On a Thanksgiving trip to Las Vegas, I began eating like a person without weight problems. There was a really good buffet at the hotel where we stayed, and they had a flour-free fudge torte that was to die for. I had it at every single meal.
I told Robert about the surgery before we left. He was reservedly in favor of it, once he heard my reasoning. He wants me to be healthier, too, and he respects that it's my body and my decision. He also knows how much I love chocolate. He doesn't really understand why I would want to have some if I wasn't even hungry -- he doesn't understand that chocolate isn't about hunger; it's about satisfaction. It's difficult, I suppose to understand the psyche of an overeater if you're not one. But he never sees the weight; he only sees me. That's one of the reasons I love him so much, even if he never gets it.
The buffets became the Big Deal. You can't get the most out of a buffet if you can only eat 6 - 8 bites of food, which is what my future meals would be after surgery. I wanted to hit a buffet every time we went out to dinner. Usually, whenever we went to one, one of us would load up a plate full of seafood and bring it back to the table for both of us. One time at a buffet in Oregon, two little boys around 8 years old, were watching me, completely wide-eyed, as I left the buffet and headed to our table with a great big pile of peel-and-eat shrimp.
"Big appetite!" giggled one of the boys, hand over his mouth. The other nodded his head in obvious admiration of my capacity. I told Robert when we got back to the table and it became a standard joke between us whenever we went to buffets.
But, it wasn't so far off the mark. I did have a Big Appetite, and buffets were going to be one of the things I thought I'd miss the most. Like an old friend I'd probably just see in passing, but not to really hang around with anymore.
"I'm sorry, but I'm going to have to stop seeing you."
"But, why? We're great together!"
"No, no. You're a bad influence."
"But you love me!"
"Okay, maybe just one more slice of chocolate torte. But after that, we're through. You know how people talk."
This wasn't going to be easy.
Anything that starts out with the two words: Hot Fudge is a good beginning, I figured. I bought gallons of ice cream and jars of hot fudge, and doled it out every night with determination. It didn't take much effort; it's ingrained in my very being: hot fudge, should be a major food group in my opinion.
Now, although I love chocolate, and will do just about anything to get to it, I never allow myself to go overboard, usually, as I am a diabetic and have to watch it. In fact, I'm a very healthy eater. I love fresh fruits and vegetables and grilled, simple things like chicken and fish, and that's usually the way I eat. Whole grains, like wild rice, diet sodas or iced teas -- never a fully-sugared drink, unless it's a rare margarita. I've always talked a good talk, but have usually made the healthy choices when it came down to it, unless I was doing it with purpose, like going out with friends to splurge. I like to splurge.
My friends were startled at my decision to get the surgery, because I wasn't exactly of gargantuan proportion. When I told them of my goal to good health, they were all more than willing to help me get there. It not only helped me on my journey; it gave them a reason to pig out, too.
"Where do you wanna eat? We've got to get it all in before your surgery," they'd say. I was at the ready, fork in hand in an instant. Let's load up; I've got a lot of work to do here!
It began gradually, almost timidly, during the holidays when my dad was dying and all kinds of handwriting was on the wall. I needed something to help me not end up in the same sinking boat as he. The diabetes, the cancer, the dementia. "Get me out of here," my body seemed to cry to me on a daily basis. I needed the escape of the surgery; sure, I'll have the cheeseburger platter.
On a Thanksgiving trip to Las Vegas, I began eating like a person without weight problems. There was a really good buffet at the hotel where we stayed, and they had a flour-free fudge torte that was to die for. I had it at every single meal.
I told Robert about the surgery before we left. He was reservedly in favor of it, once he heard my reasoning. He wants me to be healthier, too, and he respects that it's my body and my decision. He also knows how much I love chocolate. He doesn't really understand why I would want to have some if I wasn't even hungry -- he doesn't understand that chocolate isn't about hunger; it's about satisfaction. It's difficult, I suppose to understand the psyche of an overeater if you're not one. But he never sees the weight; he only sees me. That's one of the reasons I love him so much, even if he never gets it.
The buffets became the Big Deal. You can't get the most out of a buffet if you can only eat 6 - 8 bites of food, which is what my future meals would be after surgery. I wanted to hit a buffet every time we went out to dinner. Usually, whenever we went to one, one of us would load up a plate full of seafood and bring it back to the table for both of us. One time at a buffet in Oregon, two little boys around 8 years old, were watching me, completely wide-eyed, as I left the buffet and headed to our table with a great big pile of peel-and-eat shrimp.
"Big appetite!" giggled one of the boys, hand over his mouth. The other nodded his head in obvious admiration of my capacity. I told Robert when we got back to the table and it became a standard joke between us whenever we went to buffets.
But, it wasn't so far off the mark. I did have a Big Appetite, and buffets were going to be one of the things I thought I'd miss the most. Like an old friend I'd probably just see in passing, but not to really hang around with anymore.
"I'm sorry, but I'm going to have to stop seeing you."
"But, why? We're great together!"
"No, no. You're a bad influence."
"But you love me!"
"Okay, maybe just one more slice of chocolate torte. But after that, we're through. You know how people talk."
This wasn't going to be easy.
Monday, May 5, 2008
Road to Hell
The road to Hell could be paved with fat.
The whole process of Lap Band(R) surgery is generally called a "journey" by those who go through with it. Sounds so nice, that word. Like a vacation to a beautiful place -- where people greet you with a welcoming smile and refreshments.
I began this whole thing last November when a friend of mine was just beginning her journey. I made her promise to tell me every single detail. I was also considering it, since I finally had insurance that would cover it. She lived in Australia, where this kind of surgery is old hat, and has a long track record of success. She was about a week away from her surgery, just like I am as I write this.
I want to be thinner, of course. But, more importantly, as I saw my dad disintegrating before my eyes due to ill health, I became more determined. I don't care how long I live, but while I'm here, I want to be in as good shape as possible. I'm convinced that his dementia was augmented by his diabetes, and a recent study seems to support that conclusion.
Of course, if you want to make a case for just about anything, you can find a study to point to, and say, "See? 'Told you so!" I once found one that said you could eradicate the bad effects of smoking a cigarette by drinking two glasses of red wine. I would have been pretty hammered back when I was smoking upwards of two packs a day, but if I wanted to make a case for either drinking or smoking, I'd choose that study.
Anyway, there was an article last January in JAMA about a study done in Australia. It reported that 73 percent of the participants who had bariatric surgery for weight loss experienced full remission from diabetes. Incredible. Who cares if it only involved 60 people? I like that study.
I thought it'd be a good idea to go to a meeting being held by local "bandsters". Ironically, it was being held at a restaurant. As instructed, I asked the maitre 'D for Phyliss, the code to get to the table. The waiter arched his eyebrows and nodded in the direction of a long table where lots of fat women were seated. Upon further investigation, however, I realized that most of these women had been twice this size, pre-surgery.
I sat next to one of the trimmer ones, one who didn't give me that, "What are you doing here?" attitude. Okay, so I'm not 300 pounds. I don't want to have to get there before I start this process. A bouncy blonde asked me if I wanted to "feel her port". This is not an offer I get every day, so I jumped at the opportunity. I watched people eat just about anything, I asked a thousand questions. By the end of the meeting, I was convinced that this surgery was for me. There was only one problem: I was about 10 pounds short of the BMI (Body Mass Index) I'd need to be in order to qualify for the surgery.
"Two or three pizzas," I wrote to my friend via email. "Mau', I can gain four pounds overnight. I do that a couple of times and voila! I'm right there in BMI land." She thought it was funny; I thought eating a few more carbs would be a small sacrifice in the name of remission. That's what was required along with the co-morbidity factors I have, such as high blood pressure, high-cholesterol and diabetes. It's either that, or be more than 100 pounds overweight to get the surgery.
I wanted to find out about my brother's surgeon, the guy who had done his very successful gastric bypass, a much more radical procedure than the gastric banding.
"Pffttt. You won't qualify," Bruce scoffed.
"Two pizzas, Man. Three, tops, and I'm there."
Ahh, if only. Mau's surgery seemed to have taken her a lifetime to arrange down under. It took her a month or two with all the doctor's visits and paperwork to get it going. Still, she was losing already, and was very happy she'd gone through with it all. She encouraged me to join her, and I was ready.
I went to the surgeon's required seminar. It was the same one I'd attended with Bruce when he had to go. I had all my questions at the ready and I fired them at him. He didn't flinch. He was cocky as nobody's business, but in a way that didn't bother me for a surgeon. I wanted his talent, not his personality. Out front at the seminar, a very skinny woman was already gathering paperwork from the dozens of people who were dying to be thin. Business was good. My insurance was changing at the first of the year, but to a company that would be a breeze for approval, they assured me, as they handed me a folder of materials to read.
So, it was the beginning of December, and since I didn't have the right insurance yet, all I could really do at that point, was to do a lot of research and get on down that road.
This journey couldn't begin soon enough, I thought, as I woofed down a combo slice with extra mushrooms.
The whole process of Lap Band(R) surgery is generally called a "journey" by those who go through with it. Sounds so nice, that word. Like a vacation to a beautiful place -- where people greet you with a welcoming smile and refreshments.
I began this whole thing last November when a friend of mine was just beginning her journey. I made her promise to tell me every single detail. I was also considering it, since I finally had insurance that would cover it. She lived in Australia, where this kind of surgery is old hat, and has a long track record of success. She was about a week away from her surgery, just like I am as I write this.
I want to be thinner, of course. But, more importantly, as I saw my dad disintegrating before my eyes due to ill health, I became more determined. I don't care how long I live, but while I'm here, I want to be in as good shape as possible. I'm convinced that his dementia was augmented by his diabetes, and a recent study seems to support that conclusion.
Of course, if you want to make a case for just about anything, you can find a study to point to, and say, "See? 'Told you so!" I once found one that said you could eradicate the bad effects of smoking a cigarette by drinking two glasses of red wine. I would have been pretty hammered back when I was smoking upwards of two packs a day, but if I wanted to make a case for either drinking or smoking, I'd choose that study.
Anyway, there was an article last January in JAMA about a study done in Australia. It reported that 73 percent of the participants who had bariatric surgery for weight loss experienced full remission from diabetes. Incredible. Who cares if it only involved 60 people? I like that study.
I thought it'd be a good idea to go to a meeting being held by local "bandsters". Ironically, it was being held at a restaurant. As instructed, I asked the maitre 'D for Phyliss, the code to get to the table. The waiter arched his eyebrows and nodded in the direction of a long table where lots of fat women were seated. Upon further investigation, however, I realized that most of these women had been twice this size, pre-surgery.
I sat next to one of the trimmer ones, one who didn't give me that, "What are you doing here?" attitude. Okay, so I'm not 300 pounds. I don't want to have to get there before I start this process. A bouncy blonde asked me if I wanted to "feel her port". This is not an offer I get every day, so I jumped at the opportunity. I watched people eat just about anything, I asked a thousand questions. By the end of the meeting, I was convinced that this surgery was for me. There was only one problem: I was about 10 pounds short of the BMI (Body Mass Index) I'd need to be in order to qualify for the surgery.
"Two or three pizzas," I wrote to my friend via email. "Mau', I can gain four pounds overnight. I do that a couple of times and voila! I'm right there in BMI land." She thought it was funny; I thought eating a few more carbs would be a small sacrifice in the name of remission. That's what was required along with the co-morbidity factors I have, such as high blood pressure, high-cholesterol and diabetes. It's either that, or be more than 100 pounds overweight to get the surgery.
I wanted to find out about my brother's surgeon, the guy who had done his very successful gastric bypass, a much more radical procedure than the gastric banding.
"Pffttt. You won't qualify," Bruce scoffed.
"Two pizzas, Man. Three, tops, and I'm there."
Ahh, if only. Mau's surgery seemed to have taken her a lifetime to arrange down under. It took her a month or two with all the doctor's visits and paperwork to get it going. Still, she was losing already, and was very happy she'd gone through with it all. She encouraged me to join her, and I was ready.
I went to the surgeon's required seminar. It was the same one I'd attended with Bruce when he had to go. I had all my questions at the ready and I fired them at him. He didn't flinch. He was cocky as nobody's business, but in a way that didn't bother me for a surgeon. I wanted his talent, not his personality. Out front at the seminar, a very skinny woman was already gathering paperwork from the dozens of people who were dying to be thin. Business was good. My insurance was changing at the first of the year, but to a company that would be a breeze for approval, they assured me, as they handed me a folder of materials to read.
So, it was the beginning of December, and since I didn't have the right insurance yet, all I could really do at that point, was to do a lot of research and get on down that road.
This journey couldn't begin soon enough, I thought, as I woofed down a combo slice with extra mushrooms.
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