band2RNY

Can you tell me what your pre op diet was and for how long? I have Ganta as well

That's the way she made it sound.

I just called my doctor insurance coordinator and she said they have to schedule me with an in-network hospital so all charges should be in network and she doesn't see me having to pay 30% drugs. I'm still going to double check when the hospital calls me to set up surgery and get it in writing.

Ok I will. I'm hoping all of it is in-network.

Surgery is scheduled for Nov 5th! Insurance girl at my doctors office said 150 copays and 30% drugs... but, when the hospital calls me i'll find out if it's all in-network. So, I might not have to pay the 30% drug cost. It all depends on the hospital........ either way i'm just happy i'm getting the surgery and cost isn't really too too important.

Thanks! How do you find out if everything is in network? Do you wait for the hospital insurance people to call you before the surgery?

My revision surgery is scheduled November 5th! My band slipped and the port is all messed up! He gave me the option of having the surgery in 3 weeks but I just need more time to think it all over and get things set. I'm not required to do 3 month diet, etc. He told me to decide on RNY or Sleeve and today I told him i'm leaning more towards the sleeve, so that is what he signed me up for. But, i'm actually thinking about RNY now and I might get that. I need to read a lot more on it. 150 co-pay hospital and 150 co-pay surgeon.... and 30% of drugs so i'm happy about that. I'm still going to call the hospital once everything starts getting into the process and try and get out of the 30% for drugs costs. lol

Thanks! Yes, key is to make sure all are in network. So, it is possible to not have to pay drug costs. Good luck to you!

It helps a lot. Thanks! I have the band in right now and having complications so I might not have to do the 3 month diet, etc. BCBS fed must have changed the 30% drug thing because in 2010 I didn't have to pay anything other than co-pays. I'm not going to complain though as it's still much cheaper than without insurance.

Thanks! This gives me hope. The band just flat out sucks. I don't like the feeling of it at all. You have just taken all of my negatives about the band (word for word) and it sounds like the sleeve corrects it all. I wish I would have done this surgery in the 1st place instead of being at the spot I am right now.

Yeah, they should be able to tell you everything BEFORE surgery. There should be no "may". The hospital I used last time sent me a bill for some stuff way after surgery and I called them and said no I was told everything was covered. And, they wrote the rest of the bill off. I'll keep you posted.

I talked with the insurance lady with my doctors office yesterday. She said that if there are complications with the band, that there are ways to get out of the 3 month diet, etc. But, I don't really know the full details of how to go about getting around it. I'm sure I will find out more on the 27th when I go and see them. She did say something along the lines about the band failing... (slippage, errosion, frequent vomiting, etc) would be reason for this. I think the charges really all depends on the hospitals and if all services are provided by the hospital. In 2010 for lap band with feb blue basic I only paid 100 copay for hospital and 100 copay for surgery. That was it! All services provided including anesthesia were provided by the hospital and not an outside source. I'm not for sure that is how they get you. But, i'm pretty sure that is how some people walk away with bills higher than the co-pays. You might want to check into make sure the doctor and hospital are part of the in-network providers with fep blue. That might have made a difference as well. I think this time around my doctor and hospital and the insurance coverage will be different and i'm trying to get all my ducks in a row before surgery is even set and have some sort of idea what my out of pocket will be. I'll keep y'all posted on what I learn and find out.

Thanks.... i'm thinking if the band has "failed" that it will be quicker. At least that is what i'm hoping. You went from the band to the sleeve right?IF so, can you tell me how differently it feels? Like restriction, appetite, etc.

Thanks guy..i've checked out your profile.... you have rocked it haven't you? lol

also..which is the better coverage? Standard or Basic... i'm looking now and it says pre auth is required for basic...but only 150 co-pay per day for hospital and 150 for the surgeon.... last time for my lap band surgery and having basic i know my bill was over 50K and I didn't have to pay anything about 100 co-pay hospital and 100 co-pay surgeon and that was all! seems like standard u don't pay any co-pays but you get charged a percentage of the total bill? Still sounds like basic is the way to go!

awesome thanks!.. yeah, i'm trying to look at the actual policy online now. I'm going to try and push it hard so I can get it done quick. I don't want to wait.... I think with him not being able to access the port to my lap band, he told me that I can either have surgery to go in and replace that or he can see about doing the revision (he has to look at my xrays of the band first)... I'll know more on the 27th. I'm thinking since I have gained weight.... He can't even access the port.... and lap band slippage...it may make it a lot easier for him to get the approval from the insurance just do the revision. I just hope they don't make me go through all the hoopla. I can't see having all these complications and then having to turn around and do the 3 month doctor supervised diet.

Is it better to go with Standard? I have basic right now but November is coming up and I can change. Do you know the difference in coverage?

Mostly my fault I think... I started out in Jan 2010 and lost 20 lbs before surgery and 40 lbs after.... the band was adjusted 3 times and it was really working good. I was really happy about it and things were going great. I wasn't eating all what I was supposed to but I actually hit a spot to where I was barely eating. I went in for my check-up and they noticed that the band was starting to slip. Who knows really... they took all the Fluid out and I was so freaked out I just didn't want to go back. So, I didn't go back... left my job...and didn't have insurance that would cover my fills. I gained all the weight back plus 20 lbs. SUCKED SO BAD So, I took a hiatus until maybe last year..got one fill... had to pay cash and drive 2 hours to a doctor that would take me. He did a scope before he took me in and saw that my pouch was just a tad stretched out and all looked good. Even though the band wasn't tight...I still had restriction. I finally got insurance in August 2012 and went back to this doctor in July and got another fill that took FOREVER to get the needle in... i didn't lose or gain any weight from the previous fill a year ago. Then, I went in for this 2nd fill a few days ago and he couldn't even get the needle in the port. I'm still on the fence about getting the sleeve or staying with the band.....he may have to replace the band totally tho. I'm going to talk to him about all that on the 27th. I just want the battle of the weight loss to end and I think the sleeve would just be a better option for me.

I got the lap band in 2009 and it just has not worked for me.... I finally went back to my doc in Austin after a year of not going. I asked him about getting the revision from lap band to sleeve or another procedure as a revision. He told me that I have to see him for at least 6 months consecutive with no weight loss success or have complications in order for my insurance to cover it. Does anyone know any loop holes? Or, is this the same as what has been said to you? Any help would be greatly appreciated. I have basic right now but if I need to switch to standard to make it easier to get the procedure done..I will do that..just FYI

Well I find out in two weeks of i'm able to go from band to sleeve. I went to see my doc today to get a fill. He is going to review the cd's from the barium swallow in had last month to see if the slippage is bad enough to warrant a revision surgery to gastric sleeve. He couldn't even do the fill today as he couldn't get the needle in the port. He had a hard time last month also but after awhile he got the needle in and i'm still bruised from it. So, either way i'll have to have surgery whether i'm able to stay with the band (to replace the port) or have the gastric sleeve. I'm hoping SLEEVE!

I had some xrays done so maybe they can find something with those xrays that will be a complication. The doctor that did the xray said he saw a little bit of slippage. No erosion... i wake up with pains in my shoulder blades. I'm hoping to get the sleeve.... or RNY. Thanks for your help. I have found in the past that some bariatric doctors are not familiar with our insurance and require us to do stuff that in the past our insurance didn't require...... like diet for 6 months... a psych eval.... it seems as if they make everyone do that even tho the insurance didn't require it at the time. SO, I was thinking maybe this was the same type of situation. It makes sense tho since I have not really been under the care of a doctor in a year.