GeezerSue

:::wondering how to start negotiating for the rights to bottle Donali:::

Ladies and Gentlemen, She's not just cute; she has a real brain, too!

Good luck at the war, Sue

Miss Thang...

Oh, my! My cousins Chuey, Flaca, Huero and Prieta have moved into your neighborhood. If they get out a piñata and a baseball bat, take cover.

Alexandra, you have just outlined what I see as the problem. (I put it in blue.) People who would never call a Mexican doctor's office because they wouldn't know what they are getting into, feel somehow protected by the presence of another American. EVEN THOUGH that person offers NO protection at all. For a hundred dollars or maybe two hundred, anyone can hire an interpreter to sit next to them on a telephone extension and translate every question and answer. The interpreter is on YOUR payroll and has nothing to gain by talking you into or out of anything. I still profess--while people here and there may have had good experiences that they think are worth $1500 give or take--the person who is on the doctor's payroll to talk you into ANY surgery (there are advisors at plastic surgeons' offices all over this country), is the one least likely to have your needs at the top of their list.

Or that there was glue in the sparkling fairy dust. Thanks for the visual. I spent few moments spitting sparkling Water out my nose. At my age, that kind of thing can pass for sexual activity, you know.

You have an ethical responsibility to yourself to seek the best possible care you can find. Period. NEVER, EVER, EVER go to a doctor who, in your opinion, is not the best you can find for your needs. Your responsibility to your doctors is to give them the info they need to understand what your medical needs are, to do as they say or tell them why you are NOT doing what they say (don't do one thing and pretend to do another), and to pay them or fill out the paperwork necessary so that they can get paid. And, a doctor who is not "sold" on the idea of the lap band is a doctor who is not ready to support the patients post-op, and IMHO a very bad choice. Since you asked...

Bravo...estamos de acuerdo. (Or something like that...but close enought to make the point.)

Especially, for newbies, lurkers, or other passers-by... IMHO there is no reason to use any of the referral services you find online. They act as liasons, for a hidden fee, and often slow down communication between you and your doctor. The established Mexican doctors have English-speaking personnel in the office and many of the doctors themselves speak English. I have heard patients compare prices, and it is my guess that a "representative" makes from $1000-2000 per patient, depending on services included. This is nonsense. And, yes, I speak enough Spanish to make a point in Spanish, but I'd feel the same if the country next door were speaking Danish. (And I know only one, really great cussword in Danish.) These paid promoters (most, but not all, are band patients) are unnecessary. Save your money and your sanity and call the doctors yourself. If they don't have a system in place which can serve your language needs, go elsewhere. The next guy will. Good Luck! Sue

Getting anything other than the Inamed (or POSSIBLY the Johnson & Johnson backed Swedish AGB because it should soon be approved by the FDA) would be a lot like driving cross-country, in the 1970's, in a Citroen or Saab. You might find a mechanic. Or not.

Dr. Kuri is an excellent surgeon and, because he has chosen NOT to proctor surgeons in other areas, he is almost always available in Tijuana. He practices out of two facilities in Tijuana. One is a VERY, VERY bare bones maternity sanitarium with about eight rooms. The other is his new, modern facility with much a much nicer view of the world and room for a friend/family member. Like the other Tijuana hospitals, they are more like two- or three-doctor clinics than like the fully staffed hospitals we have here. From your west coast location, Kuri is a good choice. I think he runs from $8-10K, depending on which facility you use. And Rumbaut from Monterrey used to have a follow-up deal going with Fox in Tacoma. I don't know if that still exists. And have you checked out Cirangle in San Francisco? He is closer to you. Rumbaut recommended him to me. The cost, which I think is around $12,000, includes some follow up. I'm still amazed that you (and others) have found doctors will to do follow-up on other surgeons' patients. That has been a rarity. At one point I found two independent doctors who SAID they would do follow up. But then one called back to say I'd have to have an endo$copy first and have the results sent ot his office and the other took my money and then wanted an endoscopy before doing a fill. In other words, they both needed me to spend a few thousand dollars to cover their asses before they would actually involve themselves in my care. And this was just for routine care. Anyway, yes. Kuri is one of the best. The only reason I mention the others is that getting to and from Tijuana--and getting fit into his schedule--can be very time-consuming starting in LA. So you will consume even more time. Good luck on your search. Sue

Sandy is an Ortiz patient and promotes his services in various arenas. In other words, it is yet another advertising campaign.

It IS a long way to Monterrey every time you need to see your surgeon.

Roberto Rumbaut Diaz of Monterrey, MX, was my surgeon as well. Dr. Rumbaut is from a Cuban family, attended junior high in Ohio (so hs English is better than mine) and then he completed his education in Mexico, as his family relocated there after his junior high school years. He is one of the very few doctors (I think there were five or six) who participated in the pre-FDA testing. That is, before the FDA allowed the trials to be conducted here, they had to look at results from elsewhere. They looked at Rumbaut's results. And, he is one of even fewer band surgeons who is also a band patient. He often does about five band placements per day, two days per week. when I got mine almost two years ago, he had placed over 1400. Now it's over 2000. (some doctors will say, "WE'VE PLACED X-bands...", and then they add up all the bands placed by all the doctors in the practice. Rumbaut counts the ones HE has done. The hospital is a teaching hospital; you'll have a private room with a bed or sofa for a family member and a private shower. There are about four or five patients per nurse, post-op. Patients stay at the Hampton Inn, next door to a McDonald's an Applebee's and a shopping center. Applebee's provides limited room service at the hotel. Patients are taken from appointment to appointment by the hospital's van or by taxi, included in the room rate. He get about a billion emails a day, so he is NOT the fastest at answering them. But he gives you HIS cell phone, not an assistant's. And he has even answered a call from me while he was on a stage in Chicago getting ready to give a lecture. (I asked if I should call back later, he said, "No, it's not my turn to talk yet.") If you call his office, he returns calls promptly. Feel free to ask more specific questions if you have them. BTW, he is a proctor for US doctors. That's what he was doing on the stage in Chicago and his band surgeon was Franco Favretti in Italy. Sue

Me, too. And it's easier than making up your own BS...

oops

BTW, the goal of the letter was to say, "Kindly find someone else to F*** with, because I don't plan to make this easy for you."

Just so you can see what we wrote. I don't think this was our FINAL appeal letter--there may be a later version--but it was the ONLY one. ~~~~~~~~~~ Name Address Los Angeles, CA 90036 Phone 14 April 2003 Chris Jagmin, M.D., Medical Director Patient Management Department Aetna Insurance Company 2777 Stemmons Freeway Suite 300 Dallas, TX 75207 Re: Your denial letter dated: xxxx Member Name: xxxx Date of Birth: xxxx Reference #: xxxx Employer Name: xxxx Employer Account Number: xxxx Dear Dr. Jagmin, I am in receipt of your denial letter dated xxxxxxxxx and submit the following information in support of this appeal for reconsideration: It is my understanding that I do meet Aetna’s criteria for coverage of breast reduction surgery because my surgery will be performed for reconstructive indications, I am over age 18, and I have met the following criteria, as documented by my physician and chiropractor: A. I have a diagnosis of Macromastia, and 1. I have persistent symptoms in the following five (5) anatomical body areas below, affecting daily activities for at least five years: * Pain in upper back * Pain in neck `* Pain in shoulders * Headaches * Pain / discomfort / ulceration from bra straps cutting into shoulders; AND 2. ALL of the following criteria have been met: a. Photographic documentation confirms severe breast hypertrophy; and b. My PCP has documented that chronic pain symptoms are caused by macromastia; and c. I have undergone an evaluation by my PCP who has determined that ALL of the following criteria are met: i. The pain cannot be solely explained by a musculoskeletal condition (e.g., arthritis, spondylitis, acromioclavicular strain); and ii. Reduction mammoplasty is likely to result in improvement of the chronic pain; and iii. Pain symptoms persist as documented by the PCP despite years of therapeutic measures such as: * Supportive devices (e.g., proper bra support, wide bra straps) * Analgesic / NSAIDs interventions * Physical therapy / exercises / posturing maneuvers Remaining, then, is the issue of the quantity, in grams, of breast tissue, not fatty tissue, which will be removed from each breast, based on my body surface area (BSA). Your chart indicates that the amount of tissue you require be removed is 1055.7 grams per breast, while the peer reviewed literature you cited (1. Miller, et al.) argues that the quantity of tissue removed did not correlate with outcome in the mammaplasties studied. Five board-certified plastic surgeons have now examined me and agree that a substantial amount of tissue needs to be removed from each breast for non-cosmetic reasons. The weight of the tissue those five surgeons have proposed removing ranges from a low of 450 grams to a high of 1050 grams, even though each surgeon proposed leaving the same amount of breast tissue. The surgeon who proposed the 450 gram reduction is the one whose preauthorization you have rejected. Since that request was submitted, I have elected to utilize the services of a different physician, a board-certified plastic surgeon within Aetna’s network of providers, who--like the other four surgeons and the current literature (2. Bruhlmann Y, et al.)--recommended a reconstructive removal of less than the 1055.7 grams on your chart. While the use of BSA as a general guide seems reasonable, complete reliance on that criteria would suggest that Aetna does not consider bone structure, muscle mass or other specifics regarding the individual. All of those factors--and others--were taken into consideration by the five board certified plastic surgeons who examined me, prior to their stating that such surgery is indeed medically necessary in my specific case. Attached please find statements from my PCP and Chiropractor. I look forward to a positive response to this appeal. Meanwhile, xxxxxxxx, M. D. will be submitting a request for coverage verification and authorization for this surgery. Sincerely, xxxxxxxxxxxx Enclosures: 2 xxxxxxx, M.D. xxxxxxx, D.C. References: 1. Miller AP, Zacher JB, Berggren RB, et al. Breast reduction for symptomatic macromastia. Can objective predictors for operative success be identified? Plastic Reconstruct Surg. 1995;95(1):77-83 2. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Ann Plast Surg 1998 Sep; 41(3):240-5 ~~~~~~~~~~ Pretty good if I say so myself!

First step...call Don Mills at Inamed and ask if he has had any success with fighting the BC "experimental" thing. Sometimes, they have had the surgeons explain whay the patient is NOT a good candidate for the bypass and they get through that way. Anybody got Don's number close by? Other first step...find out if your employer is a self-pay for insurance. If so, they are actually the ones making the decisions and BC is just administering the plan. If not, they are covered by the CA state insurance commissioner (they have a web site.) They have a three times and then to outside review thing. One thing I found handy when I was on the phone pretending I was my daughter (her job at the time did not allow for personal business calls) fighting for her breast reduction with Aetna...dumb-sounding-questions-with-a-plan seem to get their attention. As in, "Okay, so does this count as the first time you've turned me down? So then, does this go to outside appeal after the second time and the third time is the outside appeal or do you have to actually turn me down three times before we go there...I'm sorry, but this is new to me and I want to make sure I understand it all." And ask everyone how to spell their name, and explain that's it's nothing personal but you know it's probably going to end up going for outside review and you at least want to spell the names correctly. Be loving and kind and their new best friend. Also, I did end up using Aetna's journal citations for our kid's appeal. If I could find a contrary opinion in the abstract, I quoted it, just like they did. if I could find a later publication by the same researcher which contradicted the first citation, I quoted it. They never DID turn her down the second time, because they knew that she was ready to go the whole way and that they would lose. Go for it. Sue

My kid got this from a friend in your parts...I thought you'd enjoy: 3 Brits die each year testing if a 9v battery works on their tongue. 58 Brits are injured each year by using sharp knives instead of screwdrivers. 31 Brits have died since 1996 by watering their Christmas tree whilst the fairy lights were plugged in. British Hospitals reported 4 broken arms last year after cracker pulling accidents. 8 Brits had serious burns in 2000 trying on a new jumper with a lit cigarette in their mouth. 5 Brits were injured last year in accidents involving out of control Scalextric cars. AND FINALLY.... In 2000, eight Brits cracked their skulls whilst throwing up into the toilet. RULE BRITANNIA !! Sue

According to the Blue Cross CA website, they consider the band experimental. Which is bunk. And they use antique literature to back up that claim. (Additionally, some policies may not allow for ANY weight loss surgery.) You should contact Don Mills at Inamed and ask him if he has had any successful reversals of that policy. http://medpolicy.bluecrossca.com/policies/surgery/morbid_obesity.html

My friend just named her last animal "Hamburger" and that kind of kept it in perspective for her.

Newlapper, How much you can drink and how much you can eat of things that melt at body temperature (almost) cannot be impacted by tightening the band. For many of us, there is almost no limit to how much we can drink and how much of stuff that melts we can eat. The band only works on solid food; the rest (much to our dismay) is all about headwork. Many of us cannot eat even a tiny bit of potato, but we can eat a bag of potato chips. Can't eat an egg, but can eat the entire box of meringue Cookies. Can't eat two pieces of boiled noodle, but can eat a bag of fried noodles. Can't eat an orange segment, but can drink orange juice or a box of frozen orange fruit bars. I speak from experience here....this is NOT about restriction, this is the head part. What getting overtightened does is teach you how to eat all the wrong stuff, since the tighter you are, the less good stuff you can eat. So if you can eat a half a chicken, you probably need a tighter fill. But if you can drink a six pack of soda, I think we all can. If you can eat a banana, you MIGHT need a fill. But if you can eat the entire banana split EXCEPT for the banana, join the club. And if you can eat a handful of rasins you MAY need a fill, but if you can eat a RitterSport chocolate bar except for the raisins, so can most of us. Now, here's where it gets sticky...if you have the right fill but just need to do some headwork and get a tighter fill instead, then you will ONLY be able to drink the soda and eat the banana split except for the banana, and THAT'S when you start to gain weight. For headwork, talk to Donali. She's the smart one. Sue

oops