DrHekier

Good luck! If they have any questions about the Band itself, point out to them that as of January 1, it has an official CPT code. (See the sticky thread http://www.lapbandtalk.com/showthread.php?t=11845 ) To be honest with you, I am surprised that people haven't jumped on the potential significance of the the CPT code come January 1. You see, until now, many insurance companies have said the Lap Band is investigational (even though I think about 200,000 have been placed worldwide) because a 'code' doesn't exist for it. Well, now it is official, and has a code that can be billed for it, just like gallbladder surgery, an office visit, immunizations shots, etc. I am hopeful that the new CPT code will cause many insurance companies to change their tune about the supposed 'investigational' nature of the Band.

I went to Tufts University School of Medicine in Boston, so I might be biased, but I would recommend you check out Dr. Scott Shikora, at http://www.obesityconsult.org/index.htm , who operates at the New England Medical Center. Dr. Shikora is a long time bariatric surgeon, and has peformed a large number number of bariatric operations. He started off many years ago performing gastric bypass, and also performs the Lap Band and offers that to his patients as well. I think there are potential benefits to being a patient in an established bariatric program. I remember when I was a medical student in Boston 10 years ago, hearing about Dr. Shikora and his bariatric program (at the time gastric bypass) and many of us thought to ourselves 'what is bariatric surgery?' He has been doing this for quite a long time compared with many other surgeons. Take a look at his website. Seems quite academic to me; links to nutritional websites, a list of their complication rate (how often do you see that?), info on medical weight loss. I'm impressed. Unfortunately as med student I never rotated on his service, so I have no first hand experience with him, but I did speak with him at the American Society of Bariatric Surgeons meeting a couple of years ago and he seemed like an extremely nice person. He is quite popular on the academic lecture circuit for bariatric surgery, and seems to be a genuine advocate for patients trying to overcome the disease of morbid obesity.

From Aetna's clinical policy bulletin ( http://www.aetna.com/cpb/data/CPBA0157.html ) I have cut and pasted just one small section here from the entire bulletin. ---------------------------------------------------------------- Vertical Banded Gastroplasty (VBG) and Laparoscopic Adjustable Silicone Gastric Banding (LASGB or Lap-Band): Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) or laparoscopic adjustable silicone gastric banding (LASGB, Lap-Band) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following comorbid medical conditions: Hepatic cirrhosis with elevated liver function tests; or Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or Radiation enteritis; or Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV) (see Appendix). --------------------------------------------------------- Basically it appears that they would prefer you to get a gastric bypass because it appears to indicate that a Lap Band would be approved only if you are a poor candidate for a gastric bypass.

We would never deny chemotherapy from someone with metastatic cancer which might have a 6 month likelihood of survival. It is all a matter of public perception as to what we 'expect' from our healthcare system. I personally think there are much more frivilous uses of healthcare dollars than bariatric surgery. 1) Approximately 127 million adults in the U.S. are overweight, 60 million obese. Does anyone really think this is simply a disease of laziness? If so, are 127 million Americans lazy? That is rather disparaging to suggest that. Also, the IRS accepted obesity to be a "medical disease in its own right" in 2002. 2) See above But I suppose I'm preaching to the choir here. It's other people that need to be made aware.

See the 'sticky' thread above regarding the CPT code. This provides a standardized approach to gastric band surgery charging and reimbursement.

There is no 'permanent/official' CPT code for adjustments as of yet.

Some potentially big news came out a couple of days ago. Lap Band now has its own CPT code from the AMA! As many of you know, the way a physician files for a service performed is by providing a CPT code to the insurance company. When a new service is 'invented' there is generally a several year lag period until a CPT code is assigned. Until that point the physician needs to use an 'unlisted procedure' code which has been the case until now for Lap Band. This creates problems for both the patient and the physician, since the insurance company can essentially say 'this procedure doesn't officially exist' and will assign any value to it that they wish, or just deny it. The new code is valid January 1, 2006 I am told. It is 43770. 43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components). In our practice we will probably have people who were denied coverage for the Lap Band being 'investigational' or 'experimental' refile with their insurance company January 1st. However, the new CPT code will probably not help those who have an outright exclusion for morbid obesity surgery on their policy.

We've had at least one if not more patients have this timing occur to them. We would suggest wearing a pad. It's no big deal. Good luck tomorrow!

In the USA only one type of Band is FDA (food and Drug Administration)approved; that is the Lap Band from Inamed.

See other threads for discussions on Walter Lindstrom at www.obesitylaw.com He is a lawyer who had the GB, then a Lap Band, and is an advocate for obesity discrimination and getting insurance companies to pay for obesity surgery.

The hospital buys the Lap Band and so far as I know all of the 3 different sized bands cost exactly the same, so I do not see any reason why there would be "sales tactic" factors involved.

You could try to call Walter Lindstrom and see what he says. Your case may be easier to handle if he has one success against Fed BCBS already.

My personal recollection is that I believe that Fed BCBS will not pay for the LapBand; however repoertedly Walter Lindstrom, an attorney specializing in obesity discrimination, has represented a client/patient and got Fed BCBS to pay for it and the hope is that all patients with Fed BCBS nationwide will be eligible for Lap Band. Walter is an interesting guy, having had first the gastric bypass, and then the Lap Band, and I have heard him speak at a few conferences. (Not too many lawyers get invited to medical conferences!) From his website at www.obesitylaw.com : "A bariatric surgery patient himself (both gastric bypass and Lap-Band®) and personally having experienced the discrimination, physical and emotional pain of being morbidly obese, and now considering himself an "obese person in remission," and carries an empathy and passion to his representation that no advocate can share with regard to obese and morbidly obese clients. His personal battle to obtain insurance coverage for his treatment, combined with his extensive experience as an insurance law expert, make him the best qualified and most passionate advocate for those persons suffering from obesity and morbid obesity."

I believe it is labelled by the manufacterer for a maximum fill volume of 10cc, but on another board somewhere I read of people getting higher fills than that. [LEGAL DISCLAIMER ON] Of course, filling higher than the suggested maximum could lead to problems.[LEGAL DISCLAIMER OFF]

In another thread a while ago I referenced an article by Dr. Paul O'Brien. http://www.gisurgery.net/OverviewObesityBariatricSurgery.pdf In that article, take a look at figure 3, and you will see that at full inflation at about 10 cc, the VG band has a stomal opening, e.g. is about as tight, as the other bands.

Perhaps your surgeon could elect to hold the Coumadin for a few days to allow the INR to return to normal levels (i.e. let your blood clotting function return to normal levels), do your fill, and then restart the Coumadin afterwards.

I would just try to get a straight answer becuase it sounds liek you have a serious health issue in place. Sounds like you had a pulmonary embolism which is potentially life threatening, in fact in the USA about 200,000 people die from pulmonary embolism each year. Often treatment with blood thinning agents (e.g. warfarin) can be stopped after 3 months, but before stopping some physicians will want to perform testing to check both the lungs and the leg and pelvic veins which is where the blood clot usually originates. Ask your surgeon what his/her specific plan is.

Since the Band has only been FDA approved in the US since 2001, longer term reports from the US are only beginning to come out now. As I posted in another thread, in this month's Journal of the American College of Surgeons, there is a report from a group in Atlanta, detailing their results with over 1000 bands. See the thread : http://www.lapbandtalk.com/showthread.php?t=10835 No operative procedure is without risks, but I think the data clearly shows that risk of severe complications, such as death, is much lower with the Band than with GB. To each their own, when GB works, it works great. My personal opinion is that the Band has a much better safety profile for similar results.

In the October 2005 issue of the "Journal of the American College of Surgeons" is an article by a group in Georgia that has performed over 1000 Bands. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T91-4GTW92Y-4&_user=10&_coverDate=10%2F31%2F2005&_rdoc=1&_fmt=summary&_orig=browse&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c2f254ffea7d3c1eeafe02ce49c89872 The abstract is free and you can buy the entire article for $30.

Try some of the free templates from Microsoft for Office http://office.microsoft.com/en-us/templates/CT010482871033.aspx The one titled "Fitness Chart for Women" seems good.

(Danger, the following contains boring medical information.) The diaphragm muscle is supplied by cranial nerves 3, 4, and 5. If something irritates the diaphragm, it irritates those nerves as well. As it happens, cranial nerves 3, 4, 5 supply sensory innervation to the shoulder. So if something irritates the diaphragm then your spinal cord and brain interprete that pain as coming from your shoulder. For example, long ago it was noted that people with a rupture of the spleen (such as in a traumatic event) complain of left shoulder pain. (This is known as Kehr's sign.) This is a result of blood and irritation of the left diaphragm causing referred pain to the left shoulder.

(Blushing smiley) My wife went to Yale and graduated with honors, got a perfect 800 on the SAT verbal (she missed a few on the math) so I tell everyone that between us, my wife is the brains, and I am the beauty!

The closure, whether absorbable suture, glue, or staples is the surgeon's preference. Surgical staples are removed with a small staple removal tool that most patients don't feel at all. Some say it is like a mosquito bite. The benefit of staples is that they are more reliable since they don't fall out or get pulled out, and they quicker for the surgeon. The disadvantages of staples are that they must be removed in the office, and can leave a couple of small pinpoint scars where the staple enters the skin on each side of the wound.

Check out the following thread, especially the link to the article by Dr. O'Brien in message number 10 in that thread. http://www.lapbandtalk.com/showthread.php?t=9192&page=1&pp=15 In that thread take a look at figure 3 which shows the diameter of the stomach opening for the three Bands based upon the volume of the fill. Also, figure 2 shows the difference between a VG band and a 10cm Band.

Many surgeons will operate on people over 65 if you are otherwise healthy. (We have operated on three patients over 70.) Ask your surgeon if he/she has taken out a gallbladder, or a colon cancer, on someone over 65? Of course the answer will be yes. So why not the Band? I personally discourage people from having the surgery far from their local lap band surgeon, because I feel they should follow-up close to home. For example, if someone contacts our office from a fair distance away, we direct them to their nearest Lap Band surgeon.