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Cha-CHING!

RavenClaw779

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Well, I'd was holding out hope that maybe just maybe sticking to soft(but nutritionally sound) foods would result in a miracle and I'd be able to start working in some normal foods and not need surgery. Alas...attended a party yesterday where I managed a couple of tablespoons of guacmole, a teaspoon of corn salad and two mini empanadas - or so I thought.A half hour after my last bite I was in the bathroom - SIX times before leaving for home.

It continued after I got home and removed my "second band" - my bra. Later that night I barely got down a cup of hot tea.

 

Amusingly enough a friend who is also banded was at the party. She's had several fills, and had no trouble eat small amounts of all the different foods served - and there I am with no fill barfing to beat the band.

 

Pretty much decided that when the band comes out, the surgeon would do a vertical sleeve - after all that's what we'd talked about. Called my insurance carrier and they were okay with this - no additional hoops to jump through. Imagine my surprise when the case coordinator called to tell me that before a removal/revision, I'd have to have another psych consult, testing, nutritional counseling, attend a class about WLS and two support groups. It took some back and forth for me to finally get her to tell me that while my insurance carrier does not require this, their practice does!? Really - did you tell your surgeon this 'cause he was planning to do the full monty in a couple of weeks. Now my choice is to try to run around and get all these additional "requirements" done in a couple of weeks before a 6/15 surgery date, or have the band out and then go through the whole set of hoops again for another surgery in a couple of months OR wait to have the removal/revision after I fulfill these requirements again. Seriously?



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Do you mean a different practice? Yes, it's possible as there are several others in the area. However, I'm not their patient thus I'd most definitely have to go through their pre-surgical requirements.

If you mean another surgeon within this practice, I suppose I could, but my surgeon already agreed to do this as one procedure, so it maybe that he's not aware that the business side of the practice has these requirements. That's not uncommon as doctors focus on the "practice" side of a medical office and the business side is handle by admin types.

I can't even say for sure that this requirement is a mandate for all of this practice's patients. It may be based on the type of insurance you have or a particular carrier dictating the "need". Example - BCBS(my plan) doesn't require anything for a bonafide revision but based on my plan(PPO) they'll pay for almost any doctor's visit I need. The case coordinator knows this(as she knows all of the various carriers plans and policies) hence the practice is "requiring" all these additional steps because they'll get paid.

Another insurance carrier may also not require any additional steps prior to revision and won't pay for another psych eval, nutritional counseling etc. The practice wants to make money. They'll make more doing a removal/revision than just removing the band. If the patient is not going to be covered for all their "required" additional steps, it's not likely the patient is going to foot the bill for additional tests, visits etc. So since the practice will get paid to take out the band and do a revision in one procedure it makes more $$ sense to do this, than to hold the line on requiring re-certification which might result in the patient just having the band removed and never returning to go through the whole process again before yet another surgery.

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