Sharon1964

@@Shace Dude, it's not you. It's the level of fat in your body and how that influences your testosterone levels. As men's abdomens get larger, their level of testosterone decreases. Fat cells can actually produce estrogen (from what I've read). So when a guy is heavier, he has less testosterone and more estrogen. When that reverses, he has increased testosterone, which can cause problems with anger. Not a doctor, blah blah blah. Oops, sorry, didn't realize this was in the guys room. Pretend I used my deep voice.

Independent Health has numerous plans. You'll need to call the customer service or member service number on your card and ask them.

@@p1Sz I copied that information from the company website; I think it was on the main page.

BLISCare What Can BLIS do for you? Provide you with peace of mind BLISCare works behind the scenes with the hospital and surgeon, like a ‘factory warranty’ (comes with what you bought) rather than traditional insurance. While it is not health insurance for a patient, BLISCare is an insurance coverage plan that protects patients from complication related medical expenses. BLISCare pays for all medical expenses, authorized by an approved BLIS bariatric surgeon, caused by possible complications related to the weight loss surgery. Patients who have BLIS care and experience complications will have no financial responsibility for complication related care. Covered complications include: Cardiopulmonary Thromboembolic Bleeding Infection Leak Perforation Stenosis Band Specific complications For more information on pricing, click here. The length of protection is typically a 90 day global period; however, patients may opt to add additional protection for up to 18 months. BLISCare coverage applies during the Claim Period which may vary from 90 days to18 months. Complication must be reported during the Claim Period. Reimbursement continues up to 365 days past the Claim Period. The maximum paid benefit (on per patient/case basis) varies $25,000 (LAGB) to $100,000 (RNY/Sleeve) Range. Premiums vary based on selected protection packages.

Find out their definition of "elective". Just because they exclude the surgery from coverage doesn't mean it's elective.

Not sure why they think the letter "H" followed by the letter "M" followed by the letter "O" should be censored, but that's what the censored words are above, the abbreviation for Health Maintenance Organization.

Okay, I'm going to give you lots of information, some of which you may already know. Your insurance is Blue Cross Medi-Cal HMO. That means that a primary doctor is assigned to coordinate your care. Look on your insurance card and see if there is a pcp assigned to you (it will be printed on the card). If so, call them and make a "new patient get-acquainted" appointment. If there is no one on your card, you have two choices. The first is to start calling doctors off their provider list and ask if they are taking new Blue Cross Medi-Cal patients. The second, particularly if you strike out with the first, is to call the customer service or member service number on your card and tell them you are having difficulty finding a primary care doctor and you need their help. They will help you with this. At your first appointment with your new primary care provider (PCP), tell the doctor that you had the surgery and you would like a referral to a surgeon who will follow you post-operatively. Then one of two things will happen. The first is that they will refer you to someone - a pcp that takes your insurance will know who else takes your insurance. When you have an HMO, your pcp refers you, you don't self-refer (except in a few narrow cases such as gynecology and mental health). The second possibility is that the doctor may have a particular interest in bariatrics and may say that they would like to follow your care themselves. Since you are close to a year out from surgery, this part will most likely not apply to you. I haven't looked up the "global period" for the surgery. Every surgery has a global period where ROUTINE post-op care is included in the payment for the surgery. This means unless you have a complication, your surgeon is NOT paid for the after-surgery visits. Every global period is different, but I am unaware of any that are a year long (which means I don't think this applies to you). For anyone else who finds themselves in this situation, closer to their surgery date, they may find that another surgeon is reluctant to take them on as they will only get paid for the first visit and then none others until you are out of the global period, unless there are complications. I hope this helps.

Just wanted to stop in and give my support. In addition to the other things going on in life, most of the country is going thru a cold spell with less sunlight. That can certainly exacerbate the feelings you are talking about.

What exact type of insurance do you have? You said Medi-cal + Anthem. Is that Anthem primary and Medi-Cal secondary? Is the Anthem product a Medi-Cal replacement plan? Is it an individual policy, or a group policy? Is it on or off the exchange?

No, no, no. If you pray for strength then you also have to pray for bail money. Pray for patience instead. My gut reaction to the condescension in the original post was something along the lines of, "it must be difficult wearing that cloak of condescension every day. Glad I'm not you."

More info: When there is a National Coverage Determination, there is sometimes a Local Coverage Determination (LCD), which overrides the NCD. I did find an LCD for one Medicare geographic area, that does cover VSG. Without knowing your city or state, I don't know if there is an LCD for your area.

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Medicare has a National Coverage Determination (NCD) that covers bariatric surgery. This means it does not matter which state you live in, the coverage and requirements are the same. If you're googling, it's NCD Number 100.1 (one hundred point one). Here is the NCD: Item/Service Description A. General Bariatric surgery procedures are performed to treat comorbid conditions associated with morbid obesity. Two types of surgical procedures are employed. Malabsorptive procedures divert food from the stomach to a lower part of the digestive tract where the normal mixing of digestive fluids and absorption of nutrients cannot occur. Restrictive procedures restrict the size of the stomach and decrease intake. Surgery can combine both types of procedures. The following are descriptions of bariatric surgery procedures: 1. Roux-en-Y Gastric Bypass (RYGBP) The RYGBP achieves weight loss by gastric restriction and malabsorption. Reduction of the stomach to a small gastric pouch (30 cc) results in feelings of satiety following even small meals. This small pouch is connected to a segment of the jejunum, bypassing the duodenum and very proximal small intestine, thereby reducing absorption. RYGBP procedures can be open or laparoscopic. 2. Biliopancreatic Diversion with Duodenal Switch (BPD/DS) BPD achieves weight loss by gastric restriction and malabsorption. The stomach is partially resected, but the remaining capacity is generous compared to that achieved with RYGBP. As such, patients eat relatively normal-sized meals and do not need to restrict intake radically, since the most proximal areas of the small intestine (i.e., the duodenum and jejunum) are bypassed, and substantial malabsorption occurs. The partial BPD/DS is a variant of the BPD procedure. It involves resection of the greater curvature of the stomach, preservation of the pyloric sphincter, and transection of the duodenum above the ampulla of Vater with a duodeno-ileal anastamosis and a lower ileo-ileal anastamosis. BPD/DS procedures can be open or laparoscopic. 3. Adjustable Gastric Banding (AGB) AGB achieves weight loss by gastric restriction only. A band creating a gastric pouch with a capacity of approximately 15 to 30 cc’s encircles the uppermost portion of the stomach. The band is an inflatable doughnut-shaped balloon, the diameter of which can be adjusted in the clinic by adding or removing saline via a port that is positioned beneath the skin. The bands are adjustable, allowing the size of the gastric outlet to be modified as needed, depending on the rate of a patient’s weight loss. AGB procedures are laparoscopic only. 4. Sleeve Gastrectomy Sleeve gastrectomy is a 70%-80% greater curvature gastrectomy (sleeve resection of the stomach) with continuity of the gastric lesser curve being maintained while simultaneously reducing stomach volume. It may be the first step in a two-stage procedure when performing RYGBP. Sleeve gastrectomy procedures can be open or laparoscopic. 5. Vertical Gastric Banding (VGB) The VGB achieves weight loss by gastric restriction only. The upper part of the stomach is stapled, creating a narrow gastric inlet or pouch that remains connected with the remainder of the stomach. In addition, a non-adjustable band is placed around this new inlet in an attempt to prevent future enlargement of the stoma (opening). As a result, patients experience a sense of fullness after eating small meals. Weight loss from this procedure results entirely from eating less. VGB procedures are essentially no longer performed. Indications and Limitations of Coverage B. Nationally Covered Indications Effective for services performed on and after February 21, 2006, Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index ≥ 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. These procedures are only covered when performed at facilities that are: (1) certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (program standards and requirements in effect on February 15, 2006). Effective for services performed on or after February 12, 2009, the Centers for Medicare & Medicaid Services (CMS) determines that Type 2 diabetes mellitus is a co-morbidity for purposes of this NCD. A list of approved facilities and their approval dates are listed and maintained on the CMS Coverage Web site at http://www.cms.gov/Medicare/Medicare-General-Information/MedicareApprovedFacilitie/Bariatric-Surgery.html, and published in the Federal Register. C. Nationally Non-Covered Indications The following bariatric surgery procedures are non-covered for all Medicare beneficiaries: Open adjustable gastric banding; Open and laparoscopic sleeve gastrectomy; and, Open and laparoscopic vertical banded gastroplasty. The two previous non-coverage determinations remain unchanged - Gastric Balloon (Section 100.11) and Intestinal Bypass (Section 100.8).

When they said "whatever is owed to the office has to be paid before the procedure is done," do they mean your balance has to be paid off or do they mean you have to prepay the procedure? If the former, then if your insurance allows $75 for each office visit, for example, then you would have to pay $75 each visit until your surgery (I doubt you would rack up $4000 in office visit charges). Generally, a deductible is what you pay before the insurance pays. That can mean different things for different policies. Here are some examples, the first one is my own policy: 1. Office visit copays are $35, and the deductible does not apply. Everything else has a $1250 deductible (xrays, tests, etc.). Once the $1250 deductible is met, my insurance covers 70% and I pay 30%. The total I ever have to pay in one year is $5000, then insurance pays 100%. 2. The patient pays $4,000 in deductible before insurance pays a dime. 3. The first three office visits in a calendar year are $25 each, then the patient has to meet a deductible of $2,000, then the insurance pays 80% and the patient pays 20%. So as you can see, depending on the terms of your policy, your deductible may work in different ways.

Blood sugar in the 200's is not "good". Is this your regular doctor, or is this an endocrinologist? If you are not seeing an endo, ask your regular doctor for a referral to one.

Soooo, ummm... were you in Target?

Drinking a lot of Water before the test would not have mattered. I think it would be perfectly fine to reach out to the doctor and request another test. Ask him if he can order a blood test.

You're welcome. I work in a pain management office, and we run those reports all the time. In our case, what we're looking for is that the patient is only getting controlled medications from us, and that they're only using one pharmacy. The patient tells us what medications they are taking when they do the urine test. If they say something like "Adderall", and it's not on their drug report, we're having a serious discussion about where they are getting their medication, because it's not a legitimate prescription.

That's not going to help you; it will just make it look like you got the drugs from a non-legitimate source (you "borrowed" or bought from someone).

We urine drug test our patients. The way I understand it, the test won't show that you took Adderall; it will show that you took something that comes up as positive for amphetamines. I believe, but am not positive, that a blood test will be more accurate (as it doesn't depend on what is excreted by your kidneys). You may want to ask for that.

I'm just past the halfway point of my 6-month wait. In the beginning, I was like a woman possessed. All of my free time was spent watching youtube videos, reading blogs, reading forums, etc. Then the frantic need for research lessened quite a bit. Now I obsess over the clothes I will be wearing when I'm thin! I follow a blog called "The Vivienne Files"; here is one of my favorite wardrobe color schemes: http://www.theviviennefiles.com/2012/03/packing-for-claudia-and-russian.html and this one: http://www.theviviennefiles.com/2014/10/the-french-5-piece-wardrobe-common.html

Thank you!

When you say you were approved for surgery, does that mean that the surgeon approved you, or that you have a written authorization for the surgery? If you already have written authorization they can't ask for more info unless they rescind the authorization, also in writing. I would definitely call your insurance company.

My surgeon's office gave me a documentation checklist, since I wanted my pcp to do the monthly visits. My doctor had to document at every visit for six months weight, discussion of nutrition and eating habits, discussion of exercise, and a couple of other things. Just a weight check would not be enough. I would definitely call your insurance and ask them directly.