Ddem

I am going to call the care coordinators tomorrow in West Hollywood and see what happened with the paperwork, I will try to get their help in this situation. They are the ones who got me in this situation in the first place with their paperwork error. Then I will see about filing for an appeal and let them know that I don't agree with their decision.

I will keep you posted but will still appreciate any comments.

I had my surgery at Cedar Sinai with Dr. Khalili. This is the only place that my PCP and insurance would allow me to go. The insurance company claims that Cedar Sinai didn't fill the paperwork out correctly or incompletely and as a result, they denied the claim. I have all my authorization approvals in writing and called for confirmation before each process. When I called my insurance company prior to surgery regarding if I was approved or not, they said that if Greater Newport Physicians approved then they would pay.

After going through all the tests, being pre approved, having the surgery and had my first fill. Now after 3 months post op, my insurance says that the paperwork from the hospital wasn't filled out properly so they haved denied all proceedures! What the <%$*&!!

I have always checked in advance with my insurance and the care coordinator before proceedures to make sure that each process was approved and got confirmation and approvals.

Now, since the insurance company claims "We have previously requested additional information regarding the listed claims. The requested information was either not received, or received incomplete, within the 45 days specified under ERISA. As a result we have processed this claim with the information we have available to us and have determined that NO BENEFITS ARE PAYABLE." They then sent me 2 faxes - claims that I now owe!! One is for the surgery at $53,300.75 and another for my first fill at $1,520.73. Where am I supposed to get that???

I don't understand. I have an HMO, I went to my PCP to get the referral, Everything was approved in advance. How can they now say, "We will not pay" after the fact! If I knew they wouldn't pay in the beginning, I wouldn't have proceeded...but now that I have had the surgery what am I supposed to do??? My husband is afraid we will lose our house over this.

They say that an appeal can take up to 60 days.....what happens if I get turned over to collections before they make their decision! I have worked to hard to have great credit for this to blow up in my face. Even though I have lost over 36 pounds, I am wondering if this surgery wasn't the worst mistake I have ever made for myself and my family. I am afraid that I have put my family in a terrible financial crunch.

Anyone ever had this happen to them? Any suggestions? Any ideas???

My husband and I are devistated!!!!!! :confused2:

My doctors group says 90 grams of Protein right from the start. Average women may get 65 per day but we are not average women anymore. With the band, all protein goes to maintaining and keeping muscle but we need the extra to keep our hair healthy as well. With this amount of protein along with Biotin supliments, my doctors group has had a high rate of their patients maintaining healthy hair with minimal lose.

I do it because my doctor told me to. I also do the high protein breakfast as well as the tuna, chicken and tofu (there are great flavored tofu in the markets today).

If I still fall short of my 90 grams a day, I will do a New Whey protien bullet (this has 42 protein in a 3 oz drink) or I will do a Protein Bar.< /p>

My doctor had me take fleets before surgery which cleaned my system out. Then with a 3 week pure liquid diet afterwards, I only had 2 BM's in the 3 week span, and they were both very liquid as well (liquid in - liquid out). I didn't start having BM's again until I started on foods again and at first I was constipated. I was told to get Traditional Medicinals Smooth Move herbal all natural tea. I got mine at Mothers Market for around $4.00. One cup and I was right as rain and have been ever since! You can get it in natural and chocolate flavors. It is a natural herbal stimulant laxative and caffeine free to boot!

I know my doctor refuses anyone who smokes. You have this surgery to have better health, if you continue to smoke...it destroys that concept. Also, in the pre op class, he said that smoking erodes the band.

Your boss is right....I don't think they consider you as a canidate unless you can prove that you haven't smoked for 6 months. Since the procedure takes about 5 - 6 months to go through, you can quit now and by the time of surgery it will be around 6 months.

:thumbup:I use tampons...unbleached from Trader Joes. Also, I am taking Seasonique birth control, 4 periods a year and no spotting. Lovin it!!!

Kami, my doctor has me on 90 grams of Protein a day, which I always get in. I take all my Vitamins and Calcium and I watch the calories and carb intake as well. I walk a mile a day, sometimes more. I hadn't thought of the Fiber but have been eating alot of mushed Beans this past week. I also didn't consider upping my calorie intake, seems all I can do to get 3 meals down during the day. I will try it and see what happens.

Thanks girls!

I am right at 4 weeks post op and during my liquid phase (3 weeks post op) I was losing 2-3 pounds per day. Now that I am eating again (approx. 800 cal. per day) I have only lost 2 pounds in the past week. anyone else having this problem? I have my first fill on July 15th and figured that might kick start the loosing again....I sure hope so!!! I had surgery on May 29th and have lost 23 pounds so far, mostly in the first 3 weeks on the liquid phase.

BTW, cash pay for the adjustments at Cedar Sinai is $800.00! I wil need insurance to pay that kind of money!

You don't get to decide what doctor to have your procedure done, you will have to go with who your PCP is affiliated with. I have edinger Medical Group and they only use Dr. Khalili in West Hollywood at Cedar Sinai.

I just got my bill in and with Anthem Blue Cross, it cost me $100.00 on the day I was checked in for surgery and all my co pays for the testings. The total cost for the surgery was 55,000.00.

I had to keep up my Cobra insurance since being laid off, that total was $900.00 for 3 months worth.

My portion was a small price to pay when compared to what the insurance paid.

maddss - I will keep the cobra until the first fill. Cedar Sinai in west hollywood charges 800.00 per fill so I won't drop the insurance. After I have my first fill, I will switch to my husbands insurance who will pay for the other fills, (it's a PPO so they pay 80% anyway).

I am on the liquid diet post op and have lost around 17 lbs. in a week and a half. But I think it is much different after the surgery then before.

Good luck to you.

Good luck, Kansascase. My recovery was 13 hours dry heaving from the anasthesia. But after that, its going well. I had my surgery on May 29th. I have dropped about 17 lbs since surgery day. I lose about 2 pounds a day, more if I walk. I do a half mile in the morning and half a mile in the evenings.

Keep us posted!

mpope - the same thing happened to me. I worked on the process since January and was laid off on April 7th. Since I had made it so far, I was determined. I have purchases 3 months worth of Cobra insurance at 319.00 per month and am now 2 weeks POST OP. Sure glad I did it. 3 months of Cobra sucks but it is better than self pay and I knew I couldn't take off all that time once starting a new job.

With unemployment paying my bills (well almost) I can take off the time I need to heal. I have lost about 2 pounds a day since surgery on May 29th. The hard part now is......the liquid diet!!!!!!

If you are serious and collecting unemployment, I would say GO FOR IT!

Who knows when you have the chance again!

Day 6 post op and really starting to feel good. A little soreness around the middle but everything else is great. I feel like walking all the time. I have no problem getting in my Protein but haven't got up to getting all the Water in. I get terrible hunger pains when it is time for the Protein Drinks, mainly at night time. I have heard noises from my stomach area that I never heard before...boy does it get vocal when it is hungry! I have pretty much stopped taking the pain meds and everyday the comfort levels get a little better. I have lost 5 pounds since the surgery.

Congrats to all of you who were banded, it is nice to hear the stories from people who are around the same time and hear what is to be expected in the next few weeks. It really helps!

Finally! Got my band on May 29th. Cedars Sinai with Dr. Khalili. It was kind of rough at first. I am going to be as blunt and honest as possible for all you who are waiting to be banded. I know you want all the info you can get before it is your turn.

I was the second patient so I had to wait in my little bed with my booties, lovely size x10 gown and hairnet thingy until the RNY patient was done. She had a blood clot so there were complications with her. I laid there for around 2 hours with those things on my legs....so when I had to go to the bathroom (after 2 hours of IV drip bag...my bladder got very full) it was quite an ordeal getting out of the bed and taking my IV to the bathroom with me.

Finally it was my turn, I was soooo excited. I was scheduled for surgery at 7:45 am and went in around 8:45am. I came to around 1pm and was wheeled to my room. As soon as they got me to my room, I was so nauseated that I was dry heaving (I always have difficulty with anesthesia). This was an interesting stage since dry heaving leads to puddling on the floor when you have to pee, if the nurse takes her time getting you out of those legging things. This is not a time to be modest. All modesty is gone when they try to pull up your gown to give you those heprine shots and the is a stranger in the hall that can see you in all your glory. At this point you won't even care. You get used to the pattern...have to pee, call the nurse, while the nurse is moving you around to get the leggings off, you get motion sick and start to dry heave....you race for the bathroom and leave little puddles on the floor. I stayed nauseated and dry heaving until around 3 am that morning at which point I was telling my husband, "If I had known that it would be this bad, I would have never done it!" I gave up calling for the nurse to go to the bathroom because she took to long to get there. I just kicked off the straps to the leggings and went to the bathroom. I could go to the bathroom without heaving so when I got up to go to the bathroom around 3 am the nausea had passed, no more piddling on the floor on my way to the bathroom!!! YEAH! Then things got alot better, I had made it through the rough part and was heading down the path of my new journey. The gas, for me, settled in my back-between my shoulder blades. This is a time where you are up at 2 am counting the hours from your last pain shot until you can have another one. You will beep the nurse a little earlier to see if you can get it a little sooner this time. At one point I told her I needed the pain meds because my back hurt so badly...she simply said, "have you tried sleeping on your side?"...DUH!! Why didn't I think of that??? I rolled over and my back pain desolved immediately. Sometimes when you are in pain, you don't always think to clearly. It was as easy as that, I waved off the pain meds at that point and was able to wait until morning before getting another shot. The second day was so much better. Without the nausea, you start walking the halls pulling around your IV stant and meet other people doing the same thing. I had fun doing this. I met up with people that I had met in the pre op classes that just had their RNY or lapband done too. You get to share stories and find out that alot of them are going through the same thing you did. You'll have a lot of fun doing this.

The trip home (from LA to Orange County was about an hour) was a breeze. So were the 3 flights of stairs to my condo. I did them without problems. Today is my 3rd day and I am getting used to my baby tummy and how to feed it. It is almost like having a baby right now with feedings around the clock.:thumbup:

It was great to sleep in my own bed although it takes some getting used to getting into and out of it (I have a tall pillowtop Cali King bed). I have already lost 2 pounds and feel excited to be among the bandit gang. I have to remember to sip slowly and get in 4 to 6 oz. every hour. I have had my shower, kicked my husband out of the house for a few hours running errands and am having a protien Breakfast. Things are definately looking alot better, I am sore around the middle but the pain meds keep that at bay. I am concentrating on keeping a log of my meds and protien. It's a brand new day and things are looking up!

So.....how did the rest of you do with your surgery? Hopefully, most of you will not experience the sickness from anesthesia and it will be alot easier for you.

Bobbie - no diet except the day before surgery. Tomorrow I have to have a healthy Breakfast and then liquids the rest of the day. At noon I will take a Fleets orally so it cleans the system out by the time you have surgery. Then I cannot eat or drink anything after midnight tomorrow evening.

I have to check into the hospital by 5:45am on Thursday and will have surgery at 7:45am. Doc says I may not even have to spend the night since I am his first patient. I have a terrible time with Anesthesia though, it tends to make me very nausious and vomit after surgery. Hope to speak with the Doc before surgery to tell them to go easy on the anesthesia and give me some anit sickness meds before hand.

I will keep you posted on how it goes.

Hi all,

I live in Westminster, CA and have a band date for May 29th (two days away). It was a long road to get to this date, I started back in January 08. They have me going to Dr. Khalili at Cedar Sinai so it takes a long commute to get there. Every appointment has been about a month appart so it takes an ecessive amount of time to go through the whole process. My Dr. told me that they do that on purpose to weed out the ones who are not really committed to the surgery. I have HMO Anthem Blue Cross - it covered the surgery and approved it within 3 days of submitting the forms. Dr. Khalili demands all the pre test done, EKG, Ultra Sound, Barium, blood test, Chest Xray, gosh, I cannot even remember them all. But with all the tests, I know that he knows me inside and out! :huh2: I found out that I have a huge gall stone already and inflamation around the heart that they will keep an eye on over the next year. Those are great reasons to get the surgery no matter what! They are going to leave the gall stone alone til it starts to give me problems. My doctor says that some people go their whole lives with a gall stone and never even know it because it never gives them problems. The inflamation should clear up with a healthy diet and exersize. all of which should happen after the surgery.

Only 2 days to go....I only have to do a liquid diet on Wednesday. Yeah me!!!

I'll keep you posted on my progress!!

Thanks for all the good info, Gwen. I have a friend that had the surgery about a year ago, she said when things got stuck like that she would lay down so that it doesn't block the opening and then she would dissolve a teaspoon of meat tenderizer in a small glass of Water and drink that. She got a piece of papaya stuck once when she swollowed it before chewing it up well. She said it took a few minutes but worked.

She got that tip from someone who had the surgery for over 2 1/2 years ago.

I know if something like that happens to me....I think I will try it out.

:thumbup:I finally have my surgery date. I am to be banded on May 29th (my wedding anniversary) at Cedar Sinai with Dr. Khalili.

Only a few days away. I start my liquid diet on Wednesday.

Hubby is such a HUGE support in all of this, he has been so great!!

Yeah!!!

GDF18 - I am having Dr. Khalili do my lap band surgery on May 29th, this thursday (my 9th wedding anniversary).

Any tips that I should know about? The nurse you talked to wasn't Brandy, was it?

Just curious!

Good luck to both of us!:rolleyes2:

I'm a bit confused. My doctor requires the Fleet as well, but it is the 1.5 DRINKABLE kind. You drink it - it clears you out for surgery.

Are you SURE your doctor isn't referring to the Fleets drink instead of the enema? The only time I have heard of that is when you are having the complete gastric bypass.

BrownBear, I hear you. My husband and I have been together for 9 years this month. He is several years younger then I (by 14 years) and has never once brought up my weight. We are truly blessed with the men we have chosen, or who have chosen us. I was mainly interested in work environment when I started this thread. After my surgery, I will be in the "interviewing for another job" process and was curious as to what to expect while I am "shrinking".

That is good news! Good luck with the insurance and keep us posted.