tkee99516

I had my first fill today (10-07-09) - 6 weeks from my surgery date. The MD had mentioned previously at my 2 week post-op appt that he starts with 2 cc's for fills. So at today's first fill appt, I told him to "GO AGGRESSIVE". He kinda laughed & said "Aggressive, huh?"... so he loaded the needle up and started at 5 cc's & backed it down to 4.5 cc's... able to prove to him that I had no problem drinking from a bottle while he was filling up the band.....

.... and just rec'd another bill.... This is the MD's bill: $8,060.00

Yes, I have Triwest Insurance which is expected to pay for the entire visit (minus my copay if I owe one). The total charges for the Hosp bill is $36,547.48 with a contractual adjustment (write off) of $29,434.58 leaving a balance of $7,112.90 due from Triwest. Yep, I had the surgery done at AK Regional (though I wanted it at Providence since I work in their building, but Dr. Searles office put it at AK Regional on the auth). Good luck on the fill & would love to know how it went.

Banded on 8-25-09 with no difficulties (I have the Discharge Note & Op Report). Just rec'd the Hospital bill yesterday & had to pick myself up off the floor.... yes, Alaska might be a little higher that other states, but my goodness! Here is what the Hospital is charging me (have yet to receive the MD's bill & the anesthesiologist's bill): Inpatient Svcs (had to stay for one day): * IV Solutions - $230 * Med-Surg Supplies - $921 * Supply/Implants - $13,394 * Lab/Chemistry - $433.68 * Lab/Hematology - $300.56 * OR Services - $5,344.64 * Drugs requiring DET code - $233.25 * Pharmacy - $1147.57 * Drgs/Other - $68.58 * Sterile Supplies - $6909.00 * Laboratory - $44.72 * Lab/Immunology - $321.36 * DX Xrays - $762.48 *Anesthesia - $1856.96 * Recovery Room - $2751.84 * Room Charges - $2751.84 GRAND TOTAL - $36,547.48 Now I'm curious - so how much was your facility bill?

This is the Protein shake I drink - Slim Fast Low Carb Diet. It has 20 grams of Protein, 190 Calories, with a Total Fat of 9grams. Total Carbs - 6 grams. I drink Creamy chocolate - and it's real good chilled.....

I had surgery on Tuesday, 8-25-09 & was back to work by 8-28-09 (Friday) - desk job. Mowed a good sized lawn on 8-29-09 (Saturday) - not a riding lawn mower. Walked dogs for 4 miles on Saturday - 4 days after surgery. I guess it all depends on how active you are before the surgery as to how fast you can recuperate.... the only twinge I felt was if I had to bend over or drive over a pothole. One other thing to mention - you can't drive while on pain meds (risk a DUI), so try not to take them when you come out of the hospital the next day. That way they will be out of your system when you do drive..... Good Luck!

Hey Guys - I was also banded on 8-25-09. As of today, lost 7 pounds since 8-24-09 (yeah, water weight, but it's a start!). Had no problems. Still have all the energy that I had pre-op. Was on clear liquids for 3 days. Now I'm on full liquids. This means I can eat Grits (yes, I'm a southern girl at heart) with melted cheese, chili (homemade - pureed really well in the blender by adding in chicken broth), yogurts, ice cream (watching the calories & serving size), and drinking a Low Carb Slimfast Protein Drink for breakfast (20 grams of protein). I will stay on this full liquid diet until 2-3 weeks from surgery date. Then it's on to mushies:biggrin:

I was initially denied due to no co-morb. But I met the 200% per Met Life Table for height (5' 3") and weight (226lbs) for a SMALL frame person. Unfortunately, the surgeon sent in the paperwork stating I was a MEDIUM frame (you know, the same standard authorization for everyone). So Triwest denied it. So I wrote an appeal letter & had my Primary Care MD sign it stating I was a small frame (yes, the nurse measured my elbow per the Met Life Table). And Triwest took ALL 60 days of waiting & approved it on the 60th day (go figure). So I had it done on 8-25-09. Tammy

Well! It's done! I just got out of the hospital today (was banded on Tuesday 25th) and it wasn't that bad. Didn't get to sleep much, as the CNA's & RN's kept coming in my room to do the temps, etc. The only negative thing I had was the referred gas pain in the shoulder, but it went away early this morning. I have 5 holes (thought I'd only have 4 - I was wrong) with my port hole in the middle above my belly button. My MD has an interesting post op plan - I am on 2-3 days of clear liquid (see thru), then I go to full liquids/mush foods for 2-3 weeks, then I go to regular food. What are you on?

I was only told to go on a Low Carb Diet 2 weeks before my banding (which was this past Tuesday 8-25-09 & got out of the hospital today Wednesday). The MD didn't say how low, so I figured anything below 100 carbs a day was ok....

I have Tricare Prime & was initially denied. Went through the appeal process & won. Just got banded on 8-25-09 (Tuesday) & came home today (Wednesday). I have a copay of $12 for the surgeon's office consult. Paid $0 for the off base sleep study. Paid $12 for the off base Psych visit. Nut visit was at the military hospital, so that was free. We will see what the hospital bill will be. I don't expect much....

Hi Bill! I just had my Lapband done on 8-25-09 (Tuesday) & got out of the Hospital today. It wasn't bad at all! I did have some gas (referred) pain in my shoulder, but it went away. That's the only "bad" thing that happened, but it was doable. Good Luck to you & keep in touch.... Tammy

Greetings! Just had my surgery yesterday (8-25-09) & stayed over for a day. All went well. Good luck to you & welcome back! P.S. Dr. Searles did my surgery....

Hi! I'm also being banded on 8-25-09 (Tomorrow!).... The only pre-op diet I was given was a "Low Carb" one - didn't have to do a liquid only diet. Good Luck to you & let's stay in touch! Tammy from Alaska....

Good luck to you! Tammy

Barbara - If you have the surgeon's office in their request for authorization for Lap band state that you are a small frame (documented by them along with your height & weight) you would meet Tricare's 200% requirement (see below) for 5'4" at 250lbs. You take 116 lbs X 2 (for 200%) = 232 or more pounds..... This is the route I took & it worked & got approved via appeal letter. The surgeon initially told Tricare I was a medium frame. After going back to my primary care MD & finding out I was a small frame, I then wrote the appeal letter with supporting note from primary care MD.... Here's Tricare's Policy (found in the TPM section entitled Surgery for Morbid Obesity, CH 4 Section 13.2): Description: Morbid Obesity means the body weight is 100 pounds over ideal weight for heith & bone structure, according to the mose current metropolitan Life Table, and such weight is in association with severe medical conditions known to have higher mortality rates in association with morbid obesity; or, the body weight is 200 percent or more of ideal weight and bone structure. POLICY: A. Gastric bypass, gastric stapling or gastroplasty, to include vertical banded gastroplasty is covered when one or the following conditions is met: 1. The patient is 100 pounds over the ideal weight for height & bone structure & has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints. (NOTICE NO HIGH CHOLESTEROL IS NOT IN THIS LIST) 2. The patient is 200 percent or more of the ideal weight for height & bone structure. An associated medical condition is NOT required for this category.

I had high cholestrol & Tricare didn't consider it a co-morbidity (I was denied for Lap Band). I instead went to the 200% route & wrote an appeal letter (had MD sign it) stating I was "small bone", not "medium bone". That's when I was sucessful with my appeal. THEY TOOK ALL 60 DAYS OF THE APPEAL PROCESS TO DECIDE IN MY FAVOR. That's the rotten part....

I was initially denied by Tricare. The surgeon's office had told Tricare I was a medium frame. I went back to my other MD & had him (really me - he just signed it) write an appeal letter stating I was small framed (it was legit - had the nurse measure my elbow). Sent it in & Tricare took ALL 60 days & then came through & approved the Lap Band (set for 8-25-09). I suggest you measure your elbow - you never know.... Tammy

Hello! I'm Tammy from Anchorage, Alaska. After appealing the denial with Triwest (and winning!), my surgery date is 8-25-09 & can't wait!

August 25th!:tongue2:

That's why they advise you to go to your MD because a "A physician would use a caliper" per the directions.....

Congrats! I'm glad your appeal was sucessful... Best of Luck to you & keep us informed of your weight loss journey!

Way to go! 28 lbs is great! I thought about going to Mexico if I couldn't get Triwest to pay for my Lap Band. They first rejected my authorization, but I did an appeal & it is now approved. I'm having Dr. Searles do the band on 8-25-09 (after dipnetting for the Kenai fish in July, of course!). Let us know how you are doing in your weight loss journey! Tammy

Cool - 2nd post ever! I also am seeing Dr. Searles & have scheduled my surgery for 8-25-09.... Keep in touch & would love to hear how you do.... Tammy

I also was originially denied by Triwest Prime due to the fact they stated I didn't meet the critieria of 100 lbs + 2 co-mobidities or over 200% my idea body weight using the Met Life Table. My stats: Height: 5'3" and 227 lbs with no co-mob other than high cholesterol (doesn't count with Triwest). The denial from Tricare was based on the fact the surgeon's office stated in their request for authorization letter that I was a MEDIUM BUILD (they did not measure my elbow). The Met Life Tables states for my height & Med Build to be in the range 121-135. So using the 200% method (the only one I could qualify for) I would have to weigh in at 242 plus. So what I did was go back to my off base MD, had him measure my elbow, and found out I was a SMALL BUILD (at 2 1/8 inch). Having a small build, a woman, height of 5' 3", and weighing 226 PUT ME IN THE 111 - 124 LBS ideal weight bracket. Then I had this same MD write an appeal letter for me telling Triwest they had misinformation from the surgeons office regarding my frame (again, surgeon's office never did take a measurement & assumed I was a Medium frame). In the appeal letter we used the 200% (111 x 200 = 222 lbs) as my being overweight & requiring the surgery. So Triwest took ALL 60 days (yes, they are little buggers, arent' they?!) and authorized approve for my lap band which will be scheduled for 8-25-09. So folks - MEASURE your elbow. You just never know....:confused::blushing: P.S. Here's a website for the elbow measurements (scroll all the way down) using the Met Life Table that Triwest uses: MetLife Height-Weight Tables