lisw55

Hi Kristy,

You may have already been to Japan and returned, but I just wanted to let you and anyone else who may be flying to Japan know about Dr. Kazama and Dr. Seki from the Yotsuya Medical Cube which is a small private hospital located in Tokyo. You can Google the hospital and get the telephone number. Ask for the doctors and they will make sure that you get an appointment. Will you be visiting or will you be living in Japan? Chances are if you are visiting you will not have any problems during your visit. I was on mushies when I flew to Japan 2 weeks after my surgery. The Airlines allowed me to bring small bottles of baby food (meat) due to my dietary restrictions. Actually, they were quite accommodating. Hopefully, you had a great time in Japan!!

Leona

Minksymom,

I will find my letter scan and send it to you. Some kind soul sent me a copy of their letter, so I had a general idea of what I needed to address in the letter. It was an appeal letter and took 15 days for approval. I called to check on the progress and could not believe the guy when he said it had been approved. I asked if he would check it again to make sure the approval was under my name. He just laughed and told me to trust him that it had been approved. Then I was nuts for 3 weeks until I got the letter in the mail. By that time I had the surgery scheduled and was ready to go for it! It may take me a few days to find the letter and scan and send it. I'll need you email. Leona

Dear FissyLove,

I was initially turned down with a BMI of 39 and co morbiditiies. Then I spent the next 6 weeks feeling sorry for myself. Do your self a favor by skipping this part and sit down wth all the facts to write a rebuttal letter to the insurance company that includes everyting you have done to get ready for the surgery to include hard facts regarding how much money they have already spent on your care and how much they could potentially spend on you over the next 20 years for your care if you do not have the surgery. Writing this letter took one week and was the most important step in my journey. I had just lost my youngest sister to heart failure that began due to morbid obesity. The insurance company was not going to take charge of my life. Instead I took charge and am now a healthy person.

Stand up and take charge and do not let these bullies keep you from being healthy. IMO, you do not need a lawyer until all your options have been exhausted.

God Bless you!! Now go out there and get your lapband surgery approved!!

Leona

Many military treatment facilities do not have a surgeon that is credentialed to provide follow-up care that is needed after LB surgery.

hey banders!

has anyone heard of a lap band patient, a few years post surgery, join the military? i know this is obviously a question for my dr., but didn't know if this is possible.

thanks!

Hello, I am just checking in with you to see how the surgery went and how you are doing? I go to the surgeon on Wednesday so will ask about the referral. Take care! Leona

Fills are quite affordable. Adjustments done under Fluoroscope are approximately 20,000 Yen. Sounds like you will be doing fine by the time you reach Japan. I will ask for a referral and forward the info to you in the next week or so.

Will you be attached to the Marine base? I live at Yokota Air Base and was referred to Yotsuya Medical Cube in Tokyo. The surgeons are superb and both speak English. The facility is also quite nice. However, due to the distance from Iwakuni, I will ask them for a referral during my next appointment. Also, if you are attached to the military and are illegible to fly "Space A" there are many flights each month to/from Iwakuni to Yokota. Then the train to Tokyo is about one hour. When do you expect to have surgery and your expected travel date? You will need to bring ALL surgical reports and then get a referral from your doctor here in Japan. They do not accept US insurance, but have been quite helpful in providing reports necessary for me to make the claims. So, without Japanese insurance you will need to pay cash at the time of your appointment. Please, let me know if I can answer any other questions.

I am mmoving to Japan soon and am about to have the band put in...do you know of a fill center I can go to while in Japan? Any info you have would be greatly appreciated. Thanks

Hello! Where will you be living in Japan? If you will be near Tokyo I can refer you to my surgeon. Otherwise, I can ask my surgeon for a referral in the location that you will be living.

Hi JuliansMom,

The New Beginnings program cost around $1700 when I signed up for it. It was definitely worth every cent. I justified spending this much because I have always taken care of everyone else. Well, I decided that I was worth it, so this one was for me. The program prepared me for the surgery. When I got word that I would need to transfer back to Japan, I felt absolutely confident that I would survive and be a success. Had I not participated in this program I would have been very unsure of myself. Hope this helps. Why not give them a call and go over to discuss how the program works before you make a decision. Take care.

Dr. Kipnis, I am honored to make the first entry to your forum. For those seeking Lapband surgery in Burlington or Camden counties I would like to suggest that Dr. Kipnis is an excellent surgeon. He requires participation in the New Beginning Program that actually prepares you for the surgery and life afterwards. In the beginning I did not want to participate in the program because of the cost, but mostly because of the 2 hour drive round trip each time I went for an appointment or for the weekly classes. The drive was a major stressor for me during the process.

I'd like to recommend and thank Chris from New Beginnings, as well as Nancy and Deborah from Dr. Kipnis' staff. These individuals went out of their way to help me every step of the way. Thank you from the bottom of my heart.

My surgery was performed on 14 April 09, at the Marlton hospital. Overall, the whole process from beginning to end went well excluding the effects of the anesthesia (Dilaudin). Unfortunately, due to circumstance beyond my control, I received a short notice transfer to Japan within days of the surgery so was unable to follow-up with Dr. Kipnis. However, I am currently waiting for a referral from the Tricare Referral Office at the base hospital to a well known Japanese bariatric surgeon in Tokyo.

I have continued to loose 1-2 pounds each week and have healed wonderfully. I was well prepared for the surgery and life after due to the New Beginnings program and the skills of Dr. Seth Kipnis.

Dr. Kipnis, thank you so much and I will be sure to send you a photo of me as I reach the summit of Mount Fuji!

Leona S. Rader

Hi all, I have spent about a month now researching and doing all the necessary steps to get the lapband. Found out today that I need proof of not being a drug addict or alcoholic. Has anyone else faced that problem, and if so how do I prove something like that. Even my doctors office were confused by that question. I am a nurse and have to have periodic drug checks, do you think that would be sufficient for Tricare?

Never done drugs, and have about 4 glasses of wine a month.

Would love to hear from someone who went through the same stuff.

Drhodes,

Do you live near a military installation? If so, you could contact the Drug and Alcohol Program. I believe they would be more than willing to write up a statement for Tricare to indicate you are not an abuser. They may want to do a brief assessment, but having worked with these folks for many years they might enjoy helping you. It's just a thought. Take care

I just recieved my second denial. They waited the whole 59 our of 60 days to deny my appeal. Does anyone know if you can appeal more than once? I am 218lbs. 5'3 and have hyperthyroid and hyperlidmia.

They say I do not meet the 100lb requirement. Any tips hints or ideas for dealing with this total frustration? :ohmy::thumbup:

Hello, With a BMI of 38.6/218, you only need to gain 12-15 pounds. If you are set to have the LB that is the easiest and fastest way to solve your problem. Have you been tested for sleep apnea? If not have your PCM refer you for testing. Just my 2 cents. Try not to be so frustrated by the insensitivity of Tricare, but at the same time you may need to go above and beyond what others have had to do to get the approval. This is based on myown personal experience. Take care and bee good to yourself.

I will have UHC as of May 1, I can't wait. I have Aetna now, and the company I work for does cover bariatric, and will with UHC also. That was a requirement before I agreed to pay another year of insurance premiums. I went to orientation 2 weeks ago, and am calling to find out when my first appt is with the surgeon tomorrow. No referrals needed.

Hello Thinner,

I'd like to suggest that you request the specific requirements for WLS in writing from UHC. It may take a while to accomplish this goal of getting the requirements in writing, but I can guarantee it will be well worth your time and energy in the end. This was a key document for my appeal process. Good luck and take care!

I agree with Restless 100%. Be honest and tell them what you think, it will be okay.

Hello Tauns,

I would like to welcome you and hope that you learn whatever you need to know from this forum. I'd like to suggest that you contact your insurance company to request the specific policy requirements in writing. This may take multiple calls to get, but please protect yourself up front. I know just how important that step is from personal experience. Next choose a surgeon that requires a comprehensive approach to the lapband qualification process. Nutrition classes, nurse case management, behavioralist, support groups, and exercise. There is so much to learn that will support your success. Take the time to learn from others.

Also, your question about telling others. Each person you tell has a different opinion about WLS, so I might suggest that you take it slow and only talk to others if they have a need to know until you are confident that WLS right for you.

Take care and Be good to yourself along the way. Seeking WLS can be an emotional journey. :rolleyes2:

I believe there is just a general chart that they use that goes by your height............I **should** be between 124-138, for my frame and height. I believe they look at bone frame too..........here is a chart at Height and Weight Chart - Women, Men, and Teens ? Height / Weight Tables ? Recommended Weight for Males and Females. This should give you a GENERAL idea. I'm 262 so I know at 5ft4 without a doubt i'm 100lbs over......lol. No question for me..........Have you talked to your doctor yet??? Is this something you are researching????

I should be in the 136-150 range, so at 248 it is a close call. I have been working on this since last August. My PCM and surgeon are ready to go, but my primary insurance decided to exclude 35+ with comorbilities as of 1 Jan 09. I faxed my appeal to UHC yesterday, which I believe will be denied so am thinking plan B is Tricare or plan C to change to another company in Nov during Open Season. It's so hard for me to believe that my employer (US Army) would exclude wls when they are generally very supportive of the health and wellness of thier civilian workforce. I promised myself there would be no more whining, so I better get a grip and think positively!! Thanks for the direction with the chart.

Hi Karina,

I am just wondering what you think about my situation. I have Tricare standard and am wondering if you think they may approve a BMI of 37.4 with sleep apnea, hypertension, high cholesterol, and hypothyroidism?

I wonder what scale/chart that Tricare uses to determine if you are 100 pounds over weight?

Can't wait fo rmonday to find out about my surgery date. I wonder how long I will have to diet. Good like on yours.

Hi Karina,

I am just wondering what you think about my situation. I have Tricare standard and am wondering if you think they may approve a BMI of 37.4 with sleep apnea, hypertension, high cholesterol, and hypothyroidism?

Hi All,

TriCare(Standard) offically started processing my request on the 21st., I just checked the web site and it has been approved as medically necessary:party:. However the date of service listed is 3/5/09, hope I really don't have to wait that long.

I would like to talk with you offline regarding Tricare Standard coverage. My email is lisw50@yahoo.com Thanks Leona

Just make sure if you are using them, you have been denied for something other than WLS being an exclusion on your policy. If you have an exclusion on your policy for WLS, that is REALLY cut and dried and nothing a lawyer can help you with. You can appeal that until you're blue in the face and all you will have is a lot of wasted time.

I began this journey in August 08. In Sept after many calls to the insurance company they provided me with a letter stating what the requirements were for WLS. 40 BMI or 35 plus comorbities. My BMI was 37.4 in addition to the following diagnoses: sleep Apnea, hypertension, high cholesterol, and hypothyroidism. I completed all requirements, returned to my surgeon 15 Jan 09 and was denied on 22 Jan due to the change in the policy as of 1 Jan.

Today, is the first day I have been able to think about the situation since the denial. Do you think I have a chance with an appeal? Thanks for any information.

Leona

I got my approval today!!! No out of pocket cost for me. I can hardly believe it. I will have a March surgery date. I going to start my pre-op diet tomorrow, just in case I can get in on a cancellation. I might be one of the few people that likes Protein Shakes. I am soooo Happy I can barley sit still to write this.

Anya:thumbup:

I am so happy to hear you have been approved!! I would like to speak with you offline regarding your Primary and Secondary insurances. My email is lisw50@yahoo.com Thanks so much!

This is my first night to read the forum and I'm so glad I was linked to it -- I've learned a ton in just a few hours already.

My situation is ordinary in some ways, unusual in others. My BMI is 43 right now and after looking around I'm pretty convinced the band is the right choice for me.

The problem is I live in Japan, have for the last three years, and will for at least six months more. My job is low-stress, I have some vacation time in a few months and if I can get everything together, it seems like a good time to get banded and start settling in with the change. (I'll start law school in the US next fall, so I'd have student-type insurance and MUCH more stress than I do now.)

However, there's not much of an obesity problem in Japan (yet) and as far as I've been able to determine there's one main clinic in the country that does bariatric surgery, plus maybe a small handful of hospitals that are experimenting with various techniques. None of this is covered by the national insurance plan, and surgery at this main clinic is about 20 grand, in US dollars.

For my part, I would far prefer to travel somewhere to get the op, India, Mexico, or Singapore, and pay much less. The problem is on the fill side -- this main clinic will not provide fills, etc, if they don't do the surgery. I can see that this is a very common issue in the US, too.

I'll be in the States at Christmas, three months after the surgery date I'm trying to set up (early October.) I'll be back for good next spring. Assuming I can't find a fill doctor in Japan, would three months post-surgery for the first fill be too long? Would six months be too long for the second follow up? Other than fills, does the fill doctor do anything that a general doctor couldn't do?

I'm also posting this question to the doctors thread -- thanks so much for any advice.

I am considering a position in Japan, but must locate a Dr. for fills before I will even consider making the move. Do you know of any Dr's that might provide fills? Any information is greatly appreciated! Arrigato!

Regarding UHC, does anyone have the APWU UHC Consumer Driven coverage? If so, can you tell me how to get a copy of the requirements? Is there a weblink that I can tap into to find the specifics. Thanks

BKLYN1984,

Once again "thank you" so much! It's beginning to make sense and I am feeling better. Hopefully we will meet at the support group meeting. Take care.

Leona

BKLYN1984,

Thank you for your response. Dr. Kipnis requires that his patients participate in this program. I was just a bit irritated because someone at his office told me he did not require the program. So, I spent many hours locating similar services (free) on Fort Dix and McGuire to be told I had wasted my time. I understand where he is coming from in that he does not know the registered dietician, exercise physiologist, or personal trainer that I had lined up. So, I will go forward and join the program like it or not.

I guess to help myself justify the cost of the New Beginnings program, I will plan to use the base resources for follow up care. See now, I am feeling better about the whole thing.

Does the behavioral therapist just use interviews or a combo of interview and personality testing to accomplish the psych eval? Do you know his/her qualifications?

Have you attended the support groups? If so, were they helpful? Also, do the cae managers talk about their success rate with the insurance companies? I am just full of so many questions.

This is my last hope. I want to retire sometime in the next 10 years, but I do not want to retire because of my health. Many years ago, I worked on a physical rehabilitation unit and each day I would interview new patients that would tell me their stories about how they had been waiting to retire so they could travel or do other exciting things. Unfortunately, for many of them they experienced life changing health problems such as stroke, heart disease, diabetes, etc. and their dreams were taken away. My goal is to stop this from happening. I am commited to the process.

Thanks for listening and know that I appreciate any information. I hope you have a wonderful day!

Leona