Back~To~Amy

I've always had a Water bottle or cup with a straw so I need to get something I can have with me after surgery that doesn't have a straw. I've heard the straw is a bad idea because it allow one to swallow air. Do you think the water bottles with the built in straw would work or would they too allow me to suck in air? See an example of what I'm talking about here: http://www.sportsauthority.com/product/index.jsp?productId=11367011&cp=2291414.2291416&view=all&parentPage=family Thanks for any words of advice.

I too use a WW scale. People talk about their scale not being accurate, but I'm not sure they have to be so long as you are consistently weighing in on it. If you get on your scale and you are losing, then you are losing. If you get to a specific number on your scale and you are comfortable, then stay at that number on your scale. One could probably weigh on 100 differerent scales and get a lot of different weights.

I got the impression that an EGD scope was pretty much a preop test everyone has. My doctor didn't prescribe one for me? Anyone else not have to have one?

Great information. Thanks for posting it.

The CPT code for VSG is 43775. About insurance coverage, I've learned that just because you have a certain coverage, the benefits vary as the employers are selecting the benefits. I have BCBS OH but my bariatric coverage has little to do with that and much to do with what my employer selected.

That's awesome. Congrats!

Wow Denise! Congrats on the payoff of all your hard work! You rock girl!

Thanks Katenna. I had my fist office visit with Dr. nick yesterday and he told me I will hate him for about a week. :-)

If you had surgery with Dr. Nick and/or at Forest Park Medical Center, I have a couple of questions: 1.) How long did you stay in the hospital? 2.) Did someone have to bring you your stuff after you went to a room? The paperwork I got said I wouldn't be assigned a room until after recovery and there was no place safe to store personal stuff until a room was assigned. 3.) Did you have an external drain? If so, when was it removed? 4.) What was given to you for pain when you went home? I cannot think of anything else, but if you have anything thoughts you think might be useful to me, I welcome those comments too. If all works out with work, I have a date. May 29th! Yikes! This is getting really real now. Thanks in advance for any comments!

I have my first appointment the my doctor on Monday so I'm very early in this process. However, I've already starting trying different Protein powders as I am an EXTREMELY PICKY eater/drinker. I simply do not like sugar free things because I've yet to find a sugar substitute that I can tolerate. Anyway, my question for y'all is during your preop diet and liquid portion of your postop diet, did you have to drink the Protein powder with milk/water or could you actually make a smoothie/shake using fruit. I just cannot see getting it down without being able to "hide" it. Thanks!

Phillip- You need to call your insurance company. Speak to a supervisor if you have to. I have bariatric coverage on my policy. However, the benefits aren't very good so I too am doing cash pay. Because baratric surgery isn't an excluded condition, complications would be covered. If your policy has a bariatric exclusion, it could only exclude the surgery itself or it could exclude the surgery itself and and resulting complications. Best of luck to you!

What insurance do you have? I just called BCBS the other day and was assured any complications would be covered.

Band.....what band? I've 100% jumped ship over to the sleeve and cannot be more happy and confident with my decision. I'm at the beginning of the process but am moving along toward the ultimate goal.

Good luck!

I don't see what you see either. You look absolutely fabulous girl!

Thanks Mab. They don't require anything beyond 6 months proof of active participation in a non-surgical weight loss program. I'm not sure the billing records qualify as proof of "active participation" since just because I paid doesn't mean I went and actively participated. However, why would I continue to pay if I wasn't actively participating, right? Im just not sure the insurance company will see it that way. They will be getting my doctor records for the last year though because they want proof of other criteria such as my bmi and hypertension for the last year. My doc records will certainly verify my weight but not every week or month such as would be with Weight Watchers. I guess my main concern here is proving "active participation".

I have to submit proof that I was involved in a non-surgical weight management program for at least 6 consecutive months in the last year. I have already gotten proof from Weight Watchers of my payment for 6 consecutive months in 2011. What I don't have though is a record of my weight. I'm looking for some opions from anyone that has BCBS and had to submit similar proofs. Did you have to submit proof of your weight at each meeting or was record of your payment for 6 consecutive months enough? Thanks!

I'm about as out of shape as they come. Continue what you are doing. You will get farther and better as you loose weight and build endurance.

Weight Watchers is emailing me a list of the times I was on the monthly pass. Do you think I have to show proof of weight for each visit?

One of the criteria for insurance covering me is: The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery. Anyone know what do they mean by these efforts must be fully appraised by the physician requesting authorization? Thanks!

Emlefe----thank you , thank you, thank you for taking the time on your latest response and for the very detailed information you provided me. If my fees were to be similar to yours, it would still be cheaper for me to file insurance. However, you bring up a thought for me to check into. The cash price covers all follow up care (and I believe the nutritionist) for life. I'm pretty sure if you use insurance follow visits come at a cost. This year they would be free being that my sinus surgery should get me to my 2012 out of pocket maximum or very, very close to it. However, they would be free starting in 2013 so I would need to take that into consideration too. I'm definitely being careful and am going to make a mindful decision. As far as all the extras you paid for, I think that was a very wise decision on your part. Who knows if you will get dollar for dollar of your money's worth, but I think you were very smart in doing it. It looks like you got peace of mind in paying for the extras with your surgeon and that is certainly, as they say, worth it's weight in gold. Thanks again! I really do appreciate it. BTW, your profile pic is beautiful girl!

Thanks for all the advice and suggestions. Emlefe--I won't have to pay 50% of the total bill and it sounds like the prices you are giving me that the providers gave you are total charges and not the approved amount by the insurance company. At least, I hope so. Anyway, I only pay 50% of the amount approved by my insurance company and they reduce the total amount of the bill quite significantly. Like I said they are only giving an approved amount of about $2000 for charges of over $11,000 by my ENT. They did the same huge cut back on the facility charges too. I just don't remember what they were to post here. I'm hoping I have the same luck. BTW, If you don't mind me asking, how did you end up paying the majority of $6,000 to your surgeon if you only had to pay 10%? That would mean your insurance company's approved amount would have been nearly $60,000 thus making his total actual charges probably over $100,000. Thanks for the things to consider though especially about the other charges such as anesthetist, lab, etc. Lisa'sHope--yes, the facility is in network. 2bsmallagain-thanks for the advice. I will definitely have my i's dotted and t's crossed before I proceed with WLS. Cookies--Your comment about having complications covered by insurance is on my list of questions to ask. I believe though they will be covered. However, I am checking on it. fattymcfatterson--yes, 50% of approved amount is for bariatric surgery and yes, that is the amount for an in network provider. Other non-bariatric surgery is covered at 80% in network. I'm still waiting on the final word of my coverage from the "bariatric department" about my coverage. However, the manager at BCBS who is over our insurance company read right from our company's page about bariatric surgery and the information I've given is what I got from her. Also, I don't have an out of pocket maximum for bariatrics according to this supervisor. Here's hoping she was wrong and I have better coverage! However, I am prepared to pay the cash price if I have to. I AM GOING TO HAVE THIS SURERY....one way or another! Amanda-My doctor is actually the Medical Director over the WLS at the hospital on the Center of Excellence list. He doesn't have any ownership in the surgery center he uses. It is inside a full-fledged hospital but just not a hospital on the list. He uses it when possible to save on costs. Thus, passing the savings onto the patients. The other thing I love about him is if you pay cash, it is the total amount for EVERYTHING. All preop, surgery, hospital charges, other provider charges and all post of visits for the rest of your life. I will have to take that into consideration when deciding if insurance or cash pay is the best option for me.

So, I originally thought my insurance would pay 100% of my WLS since my sinus surgery on April 11th will cover my deductible and, I expect, all of my out of pocket for the year. Then, I was told it will only cover 50% after I meet my deductible and that there is no out of pocket maximum. I'm still waiting on final confirmation of this but I suspect this is the case. Oh, and if I go with insurance, I have to have it at a Center of Excellence. Only hospitals qualify as a Center of Excellence. My doctor does the majority of his surgeries at at "outpatient" surgery center where you can stay confined for up to two days to help cut costs. If I have to have it at a hospital, my fees would greatly go up. The office told me I'd be better off paying their cash price ($12,200.00) then to file insurance because my 50% would definitely exceed the cash price being that the hospital fees are quite hefty. I kinda got it in my head that I'd be paying cash for the procedure but was still holding out hope I had better benefits than having to pay 50% of the bill. Then today it happened. The lightbulb in my head turned on. I shouldn't have to pay 50% of the total bill. I should only have to pay 50% of the amount of approved charges by my insurance, right? Well, I called my surgeon's office and they were closed. Patience is not my strong point, so I decided to call another local doctor. The insurance girl there confirmed my thoughts. She told me my 50% of the physician's approved charges would only be around $500 to $600! OMG! That is great! Now, I know the hospital charges will be higher than the doctor's and thus a higher approved amount but it still shouldn't total their cash price of $11,900.00. The lady at the doctor's office didn't think so either but told me I'd need to call the hospital to verify. Unfortunately, they were closed for the weekend so the wait contines. One thing I do know though is insurance companies pay WAY under what doctors and hospitals bill. My sinus surgery physician's fee is over $11,000 but the approved amount is only a little over $2,000. It appears it will be that way with the WLS surgeon based on my conversation with a WLS office today. Therefore, I assume the hospital approved fees will be the same way. I can't wait to find out! So much so, I almost wish it was Monday now. See, I told you patience isn't my strong point. I'm just hoping I get to keep more of my money in my bank than I originally thought. Woo Hoo! (I hope)

Wow Modee. Your doctor gave you a lot better numbers than mine. My surgeon said 36% to 42% for lap band and 70% for the sleeve. From what I've seen on the lap band boards, I think their loss is somewhere in the middle of your doctor's statistics and mine. I've 100% decided now to go with the sleeve.