5DogMa

THANK YOU, THANK YOU, THANK YOU for posting this!

We are going thru alma and my daughter will have surgery with Dr. Garcia on January 23rd. Alma has been great, she's a real sweetheart. Since I am having this surgery in CA next week she even answers my questions. Although I know my doctor does things different here in CA some questions will have the same answer I'm sure regardless.

This is exactly what we needed to hear AGAIN. You are the second person in the last couple weeks who is equally happy with Dr. Garcia and his staff.

YAY! Glad to hear you're doing so well. Congrats to you and how far you've come!

How are you doing today?

How are you two doing since your surgery? Do you have a blog?

I wasn't so concerned about the drain tube itself as I was the NOT being able to take a shower!

Also, I don't understand why some, even a lot, of doctors don't even use them. If they are really necessary why doesn't everone use them? If they are not necessary, then why do the use them. I'd rather not have it if it's not really necessary.

Thanks for all the responses.

I'm going to shower and cover it up with plastic wrap to try and keep it dry while keeping my back to the shower stream.

I have a pre-op with some person in the doctors office who will go over all the pre/post-op questions and most likely talk about eating after surgery.

Just 15 days away, I'm so scared.

So my son just called me said there is some stuff going on in TJ and it's not safe for us to travel down there. I told him a lot of people have been going down there for surgery and I haven't heard of any troubles in TJ. So can you please tell me your experiences there and if you ever felt un-safe? I think he's overreacting to things he may have heard from others.

Heather,

Thanks for posting this! My daughter is scheduled for Jan 23rd with Dr. Garcia. We are going thru Alma at Ready4Achange.

Keep us posted on how you are doing and good luck on your journey.

I was told NOT to shower. That probably bothers me more than anything. Sponge bath just doesn't get it for me. I like my daily shower, it feels good and wakes me up. I wonder why so many don't have a drain tube? I really don't want to have to deal with it if it's not absolutely necessary. If you guys could shower why can't I?

I saw my Dr yesterday and I am scheduled for surgery Dec 7th. Got all the approvals etc and I'm good to go. I am scared and excited, but mostly scared. Oh, do I really want to do this??? 48 hour clear liquid diet before surgery and that's all.

One thing that's really bothering me is he said I will have a drain tube in for almost a week! He says it will lay beside the sleeve to make sure there is not leak? He's never had a leak. I guess whatever drainage comes out you can tell if you have a leak??? What? Anyone ever heard of having a drain tube in for so long? I can't take a shower and he said he will take it out at my post-op appt that is 6 days after surgery. Can you imagine bending over the kitchen sink to wash your hair with this drain tube in the way? This is gross. I have heard some docs don't even put in a drain tube. They take x-rays to check for leaks. Is this old school or what?

Your experience and comments welcome PLEASE.

Getting ready to send her a depost for my daughters surgery using Dr. Fernando Garcia in TJ in January. Looks legit and they have a BBB rating I checked out. She is super nice and seems very experienced in doing this. They are part of Obesity Solutions Int'l. Anyone have first hand knowledge of this group? Thanks!

^{Oh, don't most insurance companies change things starting in January of the new year? I've never experienced one changing things in December.}

Cortknee98 & AndreaP - I'm having similar issues with BCBS. Customer service told me several times by different people NO 6 month wait period and they told the doctors office there was when they called in to verify coverage. They told them 6 consecutive montly office visits. After my doctors office told me this, I called customer service again and again they told me NO waiting period just need to meet the BMI requirement. Well, we submitted last week for approval and I am penciled in Dec 7th for surgery. I started seeing my doctor in May but missed 1 appt in July because I was moving. My doctors office said we are taking a gamble they won't notice the 1 missed appt. I have a co-worker who had RNY 2 years ago and she didn't have to wait 6 months. URGH!

That's just unbelievable! Who does she think she is?? Is this the loan officer, bank president, what? Either way it doesn't matter. If it's a personal loan, that's just what it is "personal" they have no right to ask you what you will be doing with the money. You just need to qualify for the loan. Tell her the only thing you're going to promise is to spend the money wisely investing in your healthy future. No, really it's none of her business! This makes me so mad people who bully others and that's just what she is - a bully.

It's none of her business where you spend the money. SHE said you have to promise ME, the BANK didn't say you have to promise any such thing. Huh, promise??? A personal loan, is a personal loan. What you do with it is YOUR business.

There is a nasal spray called Astepro that is a antihistamine that works really well. It's kinda expensive, my co-pay is $25. I have really bad allergies and I spray it and Flonaise every day and I get allergy shots to boot.

Has anyone else with BCBS-LA had experience with this? My company is self insured and BCBS is the administrator. I guess my company actually pays all the medical bills.

Anyway, what they tell me when I call customer service and what they tell the doctors office are two different things. The main one - 6 MONTHS CONSECUTIVE OFFICE VISITS! I was told 3-4 times by customer service there was no waiting period and only needed to meet the BMI requirements. Then after my doctors office told me about this I called them again and got the same answer - NO waiting period. So I told them what my doctors said and she even put me on hold and talked with her supervisor and came back and said NO waiting period. My co-worker did not have to wait 6 months, but that was 2 years ago. When I told her this, she said that was crazy.

I've been at this since February, picked my doctor in May, have gone through so much testing it's crazy. Now this? I didn't go to one appt in July because I was moving so my doctors office said I have to start counting 6 months from August! I had a fit since I was told there wasn't a waiting period directly from my insurance company so said they would submit, but I will probably have to appeal if I want to have surgery before the end of the year. Then I still might get denied!

I've already paid my max out of pocket this year because of all the testing. If it gets pushed into next year then I have to pay $4,000 more out of pocket. I could have this surgery in Mexico for $5,000 without all this grief.

My experience with BCBS has been that what customer service says when you as the customer call in to ask about coverage, and what the department that the doctors office calls and then submits for approval could say two different things. I have been told several times from customer service there is no 6 month waiting period and the doctors office was told I had to have 6 months consecutive visits to get approval. Meeting the physical criteria, BMI,and history o obesity, etc isn't enough. My co-worker who had RNY didn't have to wai,t but that was 2 years ago. I'm setting myself up thinking I might have to appeal. We'll see, the submitted for approval last Friday. Good luck, I hope it goes through fast for you.

Working for a hospital that is also a premier bariatrice center of excellence, I see this all the time. BCBS is a main offender. As the patient, I will reccomend that you stay on top of them because they quite frequently say they will reprocess something and it will go into the Anthem black hole and when you follow up you will learn they really have done nothing with the claim. Also, I would suggest finding out WHY they denied the claim. It is also important to note, the pre-approval is not a guarantee of payment. The insurance company determines payment eligibility upon receipt of claim, and surgery notes, etc. They are under no obligation to pay for your medical services because you received a preapproval letter. Frequently we will receive precertification for inpatient hospital stays, only to have them denied once we submit the claim. We end up going through appeals processes to overturn their original denials. Insurance companies are very ambiguous in their wording so that if they do decide to deny something, they can site the technicality in the letters to you that will allow them to not do so. Also, what someone else said is true too - your benefits are ultimately determined by your group (employer). Companies buy insurance packages that are one size fits all, and they in turn distrubute them to their employees. The company you work for determines what they would like included in the benefits package and sometimes costly procedures are nixed for budget purposes.

YIKES! So does that mean your employer knows that you are having WLS? I thought this stuff was confidential.

I was told they base it on your weight when you start with the bariatric surgeon since most doctors will require you to lose some weight before surgery. Then I've also heard the same as above. Wear ankle weights to keep your weight up. Why can't we get straight answers out of our medical insurance companies!!!! When I started I was 42 BMI now I'm at 38, but then after all this testing found out I had 2 co/morbs so I'd still qualify. Since I don't trust my insurance company to tell me the truth, I'll be sure not to fall below 35 BMI to qualify.

I have BCBS of LA. I have found out that what it says on line when you check, and what they tell the customer when they call in to check on their benefits, MAY NOT be what they tell the doctors office when they submit for approval or call in to verify coverage. I had verified on line and even printed out the content from the web site. Then over the phone verified at least 3 times with 3 different people there was NO 6 month waiting period to have VSG if you met the criteria of 40+ BMI. I was 42 BMI. Then they told my WLS I have to have 6 consecutive monthly office visits! I am so mad because if they stick to the 6 consecutive month weigh ins and doctor visits it pushs my surgery out until January which means I'll have to pay the max out of pocket AGAIN! This year my max out of pocket was $3,000 which I have already paid because of all the testing, but next year it goes up to $4,000 out of pocket! That means my share of cost would be $7,000!!! I am told by my doctors office this happens a lot. So be careful. I am going to appeal if they deny coverage for this year. My WLS submitted yesterday for approval so we'lll see. Until then my bloodpressure will be elevated. Oh, my co-worker using the same insurance did NOT have to wait 6 months. :banghead:

I have BCBS of Louisiana. They told me NO 6 month wait period 3 different times by 3 different people when I called in to verify coverage from the beginning to check on this. That was February of this year. Then when my WLS office called they said 6 months consecutive visits! My first WLS visit was in May, then I went in June, I didn't go in July because I was moving, but went in Aug, Sept, October. I have a pre-op Nov 17 and surgery penciled in for Dec 7th. There is a chance they will deny me coverage! Even after my WLS told me this I called them and again they said NO 6 month waiting period! This was in August.. Criteria was BMI 35+ with co/morb or BMI 40+. My BMI was 42. Then with all this testing they found 2 co/morbs so I could drop below 40. My co-worker had WLS 2 years ago and did not have a 6 month wait period. I am really upset about this. I have met my max out of pocket because of all this testing and if I have to wait until next year it will cost me another $4,000 out of pocket!!! This sucks out loud!! Anyone else have this kind of thing happen? If I had known this I would have went to that July appt between all the moving. My WLS is sending in for approval this next week. URGH!!!!

Can I ask what agency you used to book your surgery? Thanks!

There are so many! We are considering Dr. Fernando Garcia Govea. It seems they are all the same price and they offer the same package and the same doctors. So far I've seen: Successfully Slimmer, Ready 4 a Change, Mexico Weight Loss Surgery, A Lighter Me, and Obesity Solutions International. There are probably more. Does anyone know which is the best one to use? It's time for us to choose and I want to make the right choice. One wanted a $2,000 deposit and another only $500 deposit. $500 isn't such a risk, but $2,000 is. How do we know we arent' getting scammed? Please tell us who you used and your experience. Thanks so much for your help.

BettyBoop, I'd have to pay all that money $3,000+ again if it gets pushed into next year. I have a $3,000 max per year out of pocket for 2011 which I have met this year because of all these tests. Next year my max out of pocket goes up to $4,000 so I would end up paying a total out of pocket of $7,000 for this surgery. I could have gone to Mexico and self paid without all these tests.

It's him, not the insurance company. The other doctor said I had taken all the tests he required. Then he left the private practice to go work at Kaiser. I got turned over to this doctor, his partner who has been in private practice for many years. He's the one who wanted more tests. I know this doctor has many years experience and has a good reputation. I can't image what else he could possibly want.

It has to be this year or not at all for me. I'm helping my 29 year old daughter get this surgery in Mexico next Jan-Feb. She doesn't have insurance. What little money I have left that I saved up I'm giving her to help her pay for her surgery. I'm hoping she won't have to live her life like I did by getting her this tool.