bklyn1984

ENJOY THE REST OF YOUR DAY :confused:

I have BCBS Federal NJ - Here's what it says in my benefit handbook: Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures to treat morbid obesity – a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with co-morbidities who has failed conservative treatment; eligible members must be age 18 or over. Benefits are also available for diagnostic studies and a psychological examination performed prior to the procedure to determine if the patient is a candidate for the procedure. I would check your benefit handbook too. If it says what mine says than you need to find out what they mean by failed conservative treatment. I am going through the same thing with my surgeon's office. My BMI is over 40 and I was told by the insurance company that I did not require anything but the psychological exam. The surgeon's office will not give me a surgery date or submit to my insurance until I have completed all of their requirements. I pointed out to them what the insurance company said and what the benefits handbook said and they insist it's an insurance requirement. They will not listen. I only have my sleep apnea portion to complete and once the sleep doctor sends her amended letter and gives me clearance that's when I am supposed to get a date and info sent to insurance.

Just let me know which one you are going to. There are only two more this month 18th and 25th. Then October's starts up again on the 9th

Leona, The behavioral therapist just interviewed me. Her office is in the same building where New Beginnings is located. I cannot locate her card right now but they can tell you her credentials. Yes I do go to the support groups which is combined with gastric patients too. I have found the support group to be very helpful. The behavioral therapist runs the group which is on Thursday nights at 8:00PM. There's no support group on the first Thursday of the month. The behavioral therapist has a handle on the group she does not take sides. Oddly enough there are a lot more lap band patients there. From what I have read on the board here that's not always the case. The nutrition classes are also on Thursday nights and start at 7:00PM and the nutritionists run these. You will be talking with a nurse in regards to your case and getting things together for the insurance but it is the surgical coordinator or billing person at Dr. Kipnis office who can tell you their success rates with your type of insurance. If Dr. Kipnis gave you a check list to follow bring it with you to your appointment. The nurse may already have it since they worked with him before but just in case I brought a copy. Now about the gym it's 8 sessions with the trainer not 10 sorry about that. I was there this morning and I noticed that they are running a sale $99.00 membership fee plus the monthly fee. Which is not a part of New Beginnings but I thought if you are okay working out without a trainer this maybe another option. I probably will purchase more time with my trainer since I only have 3 sessions left and I have no surgery date yet . If you choose the gym portion the trainer will go over how to spread out the sessions. In order to get more time with her I will probably pay the $250.00 for 10 sessions. It's a lot but she keeps me motivated to come and she will work you and you will feel it!!

Okay well it's $1700.00 for the program and the $250.00 is for the gym portion. Personally I think that it's worth it. I drive in from Burlington Twnshp. I have everything in one building with my appointments coordinated so that I can go upstairs and use the gym. My personal trainer is great. You have 10 visits with the personal trainer and three month gym membership. If decide to continue with the gym after the three months then all you will have to pay is the monthly fee with no additional membership fees. I am not sure of the membership fee right now that's my next question to them since mine is coming up at the beginning of October. The nurses work with you and the surgeons office to make sure you have everything is in place to send into the insurance company, if you are required to lose weight prior to surgery you will be given a plan to follow, there are the nutritional classes and other classes, it includes nutritionists, support before and after surgery with no time limit, and it includes the behavioral therapist visit who does the psych eval. I plan on submitting a claim form for the behavioral therapist and for my nutritionist visits once I have them. My insurance pays for services like this so hopefully these visits can be included too. Aftercare is a big thing for me and they will provide the necessary support and assistance for as long as I want to use them. I just won't go home from the hospital and not know what to do. I will be meeting with the nutritionists and they will go over each phase from first coming home, to mushie, and to eventually eating solid foods. Personally I would go there first and find out if it's for you. Just let them know that you are unsure and would like to go over all of the services that they provide for this cost before making any kind of commitment. Does Dr. Kipnis require you to go to New Beginnings? If not, then I would have his office give you places where you can go and get aftercare support and everything else that is required of you by your insurance company.

You're mom is the best Lot's of luck with your surgery and recovery. It's going to be a very nice holiday celebration at your house.

I do not know about Dr. Kipnis but I belong to New Beginnings. There are a number of people in the support group that have used him. I have not heard anything bad about him. What do you want to know about New Beginnings?

I cannot reply to what you can or cannot eat on this day since I have not had surgery. I do have a suggestion. How about letting an outside place cook for you. I live in NJ and we have a supermarket here called Wegman's and they have a catering service where you can order the entire meal from appetizers to deserts. If you have a place like that by you I would recommend doing that. Honestly I cannot see you lifting a turkey the size you would need to feed everyone especially if you stuff the bird. Cooking everything else is a lot of work too and if your husband does not help you which he should then I personally would consider having it catered if possible. I would take all of the good suggestions everyone here is giving you about what to eat and what not to eat. Just be careful. About telling everyone it's your business and if you choose not to tell them then that's fine you do not have to. I have people in my life too that I am never telling. It's none of their business. Like you said we do not know your in-laws and if telling them will cause everyone to be upset then I would not tell them until you are ready to if at all.

This is the lap band that Dr. Goldstein uses: Home That's how I found him when I was looking for seminars. I checked the realize band website and Virtua is not a part of any seminars coming up. Dr. Goldstein does only lap band WLS to my knowledge. Did his office not give both of you the lap band literature from Allergan about how the system works etc...? They gave me a packet containing this information with one of the packets to give to my primary. I would call them to get this.

I agree 100% with Tanita as a choice for scales we have the BC-554 model at home and it's great. My surgeon uses this brand too.

Restless Monkey has described a lot of the reasons I chose not to have GBPS. I also did a lot of research and given my current health I felt that I did not need to rush losing the weight. The other thing high on my list was all of the loose skin that requires plastic surgery and I am not for that at all. Another thing on my list was three of my doctors told me that they would not support me in anyway for GBPS. They did not make up my mind for me but I took a lot of what they said into consideration. There's a lot of information out there on both so do not let anyone sway you one way or the other it's completely your choice no one can make that choice for you. I hope to have surgery by the end of the year so I cannot tell you what to expect afterwards. I am sure you know that there are several links here containing post-op information. One thing I would highly recommend regardless of WLS you choose. Make sure you have aftercare available. Like support groups, and nutritionists that will be there to help you once surgery has been completed. Available aftercare is one of the reasons I chose my surgeon. I wish you all the best in whatever you decide to do :tt1:

Change of clothes of course, pajamas, slippers, insurance cards, check for copay (only if required mine did not require it some do) they request you bring it there with you, mine wanted identification, tooth brush, tooth paste, and a good book is all that I brought. Leave valuables at home. Also, bring medications that you need to take before sleeping if any. They had me come in and change into my pajamas, filled out some more paperwork they took my insurance card to copy it and then from there they took me into the hook up area which took about 45 minutes. They had a television so I just watched that I lost interest in reading.

My surgeons office required me to do tests and provide written documentation of weight loss, letters of clearance from the cardiac doctor, primary doctor, and pulmonary/sleep doctor. My insurance says if your BMI is 40 + the only other thing I required was the psychological exam. I confirmed this with my insurance BCBS Federal. Even though my surgeons office said it's insurance it's them not the insurance. It's fine because I found that I have sleep Apnea and if I did not do the pulmonary/sleep part I would have never known because my test two years ago said I did not have it.

I just voted :omg_smile: All the best to you :scared2:

I agree with you about this. I stressed so much about my second one being so long after the first (4 weeks) and how much more time would I have to take afterwards. Well this past Saturday I finally had the second one for the CPAP machine (god I hope nothing went wrong) and I have to wait for the sleep doctor to review the results then hopefully she will order the machine. Then I have to use it for two weeks and do a phone survey if everything goes okay then the sleep doctor will send the surgeon clearance. It's only then will the surgeon's office submit my paperwork to the insurance and give me a surgery date. So while I am worried (cannot help it) there's not much more I can do but wait. I cannnot believe how happy my doctors have been to hear that I have sleep apnea because they told me that it helps a great deal in getting insurance approval. I still have the crap glue stuff in my hair and I have been washing and combing while washing it. I have very thick hair so if anyone has any tricks that will help me get the rest of it out I would really appreciate it.

Hello Everyone! I had a good day. I hope everyone did too. I kept telling my DH I have to go and buy my coach sunglasses (knowing he did not buy my bday gift) this weekend using my bank account. So I waited patiently for him to get the hint and finally he's taking me tomorrow to buy them with his account not mine :tt2: We save money on our own separate from the house and spend it on luxuries only. I hope Hanna dies down and everyone just gets rain. I know someone who is more concerned about Ike than Hanna it's a monster of a storm right now and they are not sure just yet when and where it will go. For those of you in the path of Hanna please stay safe. I have a CPAP study happening on Saturday and then I will get this machine oh joy. I cannot believe that they are going to make me wait until I use it for two weeks and call the sleep doctor to do an over the phone survey. Once that's done hopefully she will clear me so my surgeon's office can finally give me a date and submit my file to the insurance company. Oh well I guess it could be worse. Have a good day tomorrow :smile2:

I too had a Sleep Apnea test done and I do have Moderate Obstructive Sleep Apnea. I do not sleep very long either and I thought that I did not stop breathing either but they found I did during this test. I was very surprised by this. I informed my surgeon and his coordinator were actually very happy I was diagnosed with it. They said don't get us wrong it's not a healthy thing to have but for insurance purposes it's a very good thing to have. I have BCBS Federal and they pay for the test as long as you go to an approved sleep center. In my plan they 85% and I pay 15% of what BCBS pays the sleep center. So I say go for it you never know.

Thank you Sherry for starting September. Thank you for the welcomes that I have received I hope everyone had a happy and healthy labor day weekend :thumbup: I was at the gym most of the weekend including today and it was packed. Andrea you're right I am very close to Westampton. I am calling the surgeon's office in the morning to confirm they have received the sleep doctor's letter and go from there. It's funny they laughed at me when I told them in June that I expected to have this surgery by the end of 2008. They told me no it will be much sooner than that we'll see.

_____Name______Start Weight____Current Weight____Goal________Lbs lost *****:biggrin:***********:wink2:*************:frown:************:thumbdown:*********:thumbup:**** 2BHealthE!.........194............179............194............0 ahsem2bme..........244............244............225............0 aJoneen............223............223............213............0 Aphrodite1984......208............208............190............0 Ariel..............199............199............180............0 Barb12590..........228............228............213............0 Bea1128............210.5..........210.5..........188............0 bklyn1984..........302............302............280............0 Caramia71..........208............208............195............0 Crzytchr...........310............281............265............0 DebinFl............181............181............168............0 georgiagirl........245............245............230............0 HarleyGirl.........188............188............175............0 HeatherA...........210.5..........210.5..........200............0 HeatherO...........155............155............140............0 Jazzyywan..........255............255............190............0 Jodi_620...........196............194............177............2 Leslie2Lose........220............220............205............0 LisaB..............205.5..........205.5..........180............0 livn4thm...........235............235............210............0 Long2bthin.........248............248............230............0 Luu2008............203............203............183............0 Mamanmidwife.......299............299............285............0 memom..............210............210............170............0 mominlv13..........299.8..........299.8..........275............0 nip50..............175............175............160............0 NurseNiki..........258............258............239............0 odamay.............242............242............225............0 paige65............252............252............232............0 Renewedhope........171............171............150............0 SpecialK...........294............294............280............0 Tess...............304............304............280............0 Turler.............225............225............210............0 wowox7.............195............195............170............0 WyominGirl.........327............327............312............0

Dr. Bobila and I very comfortable with him as my choice. Since I have Chronic Asthma I spent many years in and out of Virtua Mount Holly and received wonderful care while I was hospitalized. There's also Dr. Goldstein who is in Marlton. A lot of members in my support group have him as their surgeon and they are very happy with him. I was not comfortable having him as my surgeon but that's me. Plus Virtua Marlton changed anesthesia groups who were out of network and I was not paying any more than I have to. Everyone involved with this procedure in Mount Holly is in network so it was great that I was happy with Dr. Bobila as my choice. Other name I have heard of is Dr. Kipnis but I never met him. Just for your information. In order to make consultation appointments with any of the surgeons in Virtua you need to attend the seminar first. They will also require you to join New Beginnings. It costs $1750.00 plus $250.00 for the gym portion. I chose both. It includes behavioral therapist visit, nurses visit, nutrition classes, nutritionists, and support group. The gym portion gives you a trainer for 8 sessions to be used before or after surgery. Afterwards if you decide to stay with the gym your membership fee is waived and all you would have to pay is the monthly fee for maintaining your membership at the gym. The gym, New Beginnings, Behavioral Therapist, Nutrition Classes, and Support are all located in the same building which works out great for me. I am going to try and submit claims for the behavioral therapist and nutritionists to my insurance company to see what happens. I may just get some money back :thumbdown: Thanks for your response I am trying to keep positive thoughts. I am at the place where I am saying okay already let's go I am so ready to have this surgery and start my new life. Oh and I will tell you that Dr. Bobila will require you to do a liquid diet two weeks prior to surgery. I am okay with that because post-op I will be on liquids to mushie so it's preparing me. Also, I heard that Dr. Goldstein will give you an amount of weight to lose prior to surgery and if you do not meet that requirement even on the day of surgery (you will be weighed at the hospital) he will not operate on you. So honestly I would do a lot of research first before choosing one which you already know I am sure. I went to two seminars. One at Penn and the other at Virtua. Penn was inconvenient for me but the surgeons there are very nice. I look forward to talking with everyone here. I have been mostly lurking around in the NJ part and I have not posted here because I really have nothing to contribute.

Hi I am not new to the forum but I am new to all of you here. I live in Burlington Twnshp. and I am still in the process of getting approval. I have been so frustrated this weekend. I have all of my paperwork together and I was called in to meet the surgeon last Tuesday. I thought they were going to tell me that I was ready to go and that they were submitting my file to my insurance company. The surgical coordinator told me no because she did not have my pulmonary clearance yet. I was like WTH :thumbdown: why bring me in for nothing. I had a sleep study and I have moderate obstructive sleep apnea (this news made my surgeon and the surgical coordinator very happy bad for my health but not bad for insurance approval). The sleep doctor said I have pulmonary clearance and I am go to go for the surgery once I have the second sleep study to get measured and then get the machine. She wants me to call her once I have been using it for two weeks to check in. Since they are basically right next to each other I drove over to the sleep doctor's office to find out the status of the letter and if they had it I would take it over to the surgeon myself. They did not have it ready but they put a rush on it and informed me that it said I had pulmonary clearance but I did not have sleep clearance until I had the machine and called her after the two weeks. I told the surgical coordinator this and she told me that if it did indeed say this that she would have to consult with the surgeon first before sending it to the insurance company for approval. Because he may make me wait until I have the machine and all is well and have the sleep doctor update the letter. I honestly cannot believe this it would mean I will have to wait at least another month before the paperwork is even sent and the fun of waiting for the insurance company (BCBS Federal) will begin another frustrating time for me. The insurance company benefits plan do not require half of the stuff they had me do. The surgical coordinator said yes they did require it and without it I would not be approved. My surgeon said why are you so worried about being approved? With my BMI >40, chronic asthma, and now this sleep apnea they will definitely approve me. I am more than satisfied with my choice of surgeons but this waiting is getting to me. Sorry for the length of this post and thanks for letting me vent :wink2:

I would also go to the employer and ask them about this because it may not be the insurance it may be the employer who chose to have bariatric surgery excluded from the plan.

I would check the insurance forum here too. What I do know is very little but like the other person here said yes they do cover this surgery. They also require that you go to what they call "Centers of Excellence" in Bariatric Surgery. If you do not then they will not cover you at all. Here is a link to locate a Center of Excellence in your area: Surgical Review Corporation I would call Medicare to find out exactly what they require. But here's what I found for you. http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=160&

I do not think that it was too much and actually I am going to see if I can submit a claim to the insurance for the Behavioral Therapist visit and some of the Nutritionists visits. What's the worst they can say no and if they do oh well I tried. I know one of the nutritionists there who I worked with at one time and she works with the kids in Fit Smart. She's very nice I have not seen her in some time I think her name is Jess. I am not that great with remembering names. I was hoping to have a date in October since I am done with everything. But I was recently diagnosed with sleep Apnea and I have to go another sleep study to get measured for the machine. My sleep doctor wrote the surgeon and informed him that I have pulmonary clearance but not sleep clearance. The surgical coordinator told me that since it says no sleep clearance in the letter she has to follow-up with the surgeon to see if it will be a big deal to send it to the insurance company like that. So if he says wait and get sleep clearance I add at least another month to my wait time before they even send in the paper work to the insurance which sucks believe me. Because what happens is once this measurement is done they send the information to my sleep doctor. She then orders the machine from the company who takes my insurance. They come to my house and I use it for two weeks then I have to call and report in how I am doing. Which is how I am guessing it will add another month to my wait time. My surgeon told me that I am worrying over nothing. With Chronic Asthma, Moderate Obstructive Sleep Apnea, and BMI over 40 he said I will not be denied. I guess someone has to remain positive. I think I am in for a fight but that's just me. I have read enough here to make me pessimistic about the insurance approvals. I am so ready to have this done it's very frustrating waiting. It's good that you have a gym membership. I went today and the trainer kicked my butt. I am going to the support groups so once you know when you will be able to go to the first one let me know. You can send me a private message here and we can meet up before it starts. Talk with you soon :thumbup:

Hi I also live in South NJ and decided to go with Dr. Bobila who's a surgeon out of Virtua Mount Holly very close to home and I am very comfortable with my choice. I have not had surgery yet but I am done with testing just some back and forth with the pulmonary clearance and once that is done then submittal to the insurance. I met Dr. Goldstein and he was just not the surgeon for me. He's a good surgeon from what I hear and a very nice man but I went with who was best for me. Dr. Bobila also required New Beginnings and it is $1750.00 without the gym package and $1950.00 with the gym package. I think they have a payment plan? I am not sure since I did not pay that way. I chose the gym package and I love the gym and my trainer. You cannot make an appointment with them until you have had your consultation with Dr. Goldstein. There are nutrition classes to attend, a behavioral therapist, nutritionists, nurses, and most important support group which meets on Thursday evenings at 8:00PM after the nutrition classes which start at 7:00PM. There is no support group meeting on the first Thursday of every month. On Thursday's I go to the gym first take my shower then go to support (I finished nutrition). Lots of luck to you.