NancyRN

Texas Terry, Where did you get that adorable hamster in front of your name? NancyRN

Blue Cross of CA posts its requirements for bariatric surgery on its website. I printed out a copy a week ago but couldn't find it this morning. So I called Blue Cross for help locating this document on their site. Me: Hi, I need a copy of your criteria for bariatric surgery but can't find it on your website. Rep: I'll send you a copy of your coverage booklet. Me: No, that won't work -- it doesn't have the detail the policy does. What I need is the policy itself. Rep: Well, it's not on the website. Me: Yes, I know, that's why I'm calling you. I printed it out last week so it must be available somewhere in the system. Rep: Call the surgery center and ask them. Me: How will that help? I'm supposed to get it from you. Rep: Send off your application and have the center call us. Me: That won't work either. The policy has to be submitted with the application or else they won't consider me. Rep :(Silence) Well that's all I can send you. Me: Is there a supervisor who could help us? Rep: (frostily) I just talked to her! At which point I swore (to myself) :angry and ended the call. I then found the copy I'd printed out, got on to a different Blue Cross website and printed out what I needed. NancyRN AAARGH!

Kathy, I loved the photo of Rachel's room. I too have a fashionista (11)who changes clothes several times a day, and who once refused to leave the house because her jacket was green but not the right green. It drives me nuts that she leaves her clothes all over the floor. I love folding towels -- so satisfyingly in order when I'm done. I loathe folding my husbands t-shirts. Another rant I'd like to hear about from you. I like for my family to use a towel 2 or 3 times before I wash it. After all, it's a clean towel used to dry off a clean body, so it doesn't get dirty. This has the happy side effect of decreasing the laundry. My husband, however, insists on a new towel every shower.(Grrr) At least he hangs them up to dry. My daughter uses 2 (1 body, 1 hair), and drops them in a wad on her bedroom floor, where they stay damp until someone (read me) picks them up and dries them out. NancyRN

If you click "Related Articles" at the top of Dr. C's post, you'll go to a PubMed list of articles on lapbanding. NancyRN

Dr. C, Thanks for posting this. Makes me feel I've chosen the right type of bariatric surgery for me. NancyRN

Emily, This sounds like a favorable development to me. For one thing, your insurance co. is now seriously considering your application, not just rejecting it outright. And the recommendation will come from a real bariatric surgeon, not just an insurance co. rep. Keeping my fingers crossed for you. NancyRN

Wheetsin, What a generous offer. You're a special person, and I bet your mom's special, too, for helping make you that way. I think the best idea is the "you've won a free procedure". You could say it's for research or that your doc has been so successful helping people with this surgery that he decided to "give back" to the community, and this is his way.:kiss Another option might be to write her a letter from your heart and give it to her. That way, she can't interrupt you right away! Wheetsin, I'm concerned about your mom's fixation on being a bad mom to you. My first thought was, "Something's off the beam here. It sounds like she's depressed." What do you think? Would she ever accept help to relieve those guilty feelings? Keep us posted on what develops! NanctRN

You asked for a memory jog, so here it is: please post the article on complications that you mentioned. Thanks, NancyRN

La Madam, I have not had problems with my gallbladder, although I do have a stone. Preventing gall bladder disease is one of the reasons I want the Lap Band. I know I'll have to watch myself like a hawk because gallbladder disease is common with rapid weight loss. NancyRN

Mert, I'm delighted you found some ammunition you can use. Learning that they have approved other patients should give the insurer pause. I thought the appeal letter was excellent, too. NancyRN

I'm appalled that your lapband doctor left no one on call. It's unprofessional and immoral IMHO. Can you possibly change to another lapband doctor? A doctor who cares this little about his patients isn't someone I'd want to consider seeing. Re no pain meds, this is ridiculous. You should not have to be in this much pain. (I had a similar problem getting pain med after my daughter's birth. I kept calling my OB saying my perineal pain was excruciating. He responded with a ridiculous order for bottom-wipes. Guess what it turned out to be? A broken coccyx!!) I recommend you start shrieking to the doctors you're dealing with, "I'm in SEVERE pain." And to the idiot gastroenterologist who said H. pylori doesn't cause this degree of pain, "That may be true, but this is EXCRUCIATING." You get the idea. (I say dump this gastroenterologist, too.) It might also be worth asking the docs why they won't prescribe pain med. If they say they don't think you're in severe pain, remind them that everyone feels pain differently and YOU ARE HURTING. Gee, can you tell I'm outraged about the way you've been treated??!! Sometimes we have to be aggressive about getting the care we need. And if you still can't get it, it's time to change doctors if you possibly can. NancyRN NancyRN

Emily, Mert, and anyone else who needs help with insurance: Here are some ideas for finding info. on your insurance company and help on appealing a denial: 1. Go to www.obesityhelp.com. Find the aqua band across the top and click on "insurance" and then on "appeal help". 2. On the same aqua band, click on "Q and A" or "FAQs" (I can't remember exactly which one). Click on "search keyword". You have 2 options: enter "insurance" and you'll go to a huge list of comments organized by insurer name. Or don't enter any keyword, but look at the list of topics below the empty entry site. On the left side, click on "preoperative insurer research" and then look for your specific insurer. 3. On the ObesityHelp homepage, look across the top and find "forums". Click on it and go to the 4th category, on the bottom of the page. Click on "insurance help". 4. On this lapbandtalk site, check out the forum called "insurance". If you go to these areas, would you post on whether or not they're helpful to you? Thanks, NancyRN

Hi Missie, Sorry to hear you're so miserable. I'm worried -- know you are, too. Here are some ideas: 1. Your surgeon should have someone as competent as he is on call when he's away. Is that who you've been seeing? 2. Has anyone checked you out for heart pain? I know this sounds off the wall, but women often have unusual symptoms when they're having angina or a heart attack, and that was the first thing that popped into my head when I read your post. 3. Can't your doctor give you a prescripton for pain medication? Something stronger than just Tylenol. You shouldn't have to hurt so much, even if they haven't yet identified the cause. 4. Get a consultation from another doctor, preferably one from a university teaching hospital or large medical center. Sometimes a fresh mind can spot what's going on. 5. The site www.obesityhelp.com has several posters with lots of experience who might be able to help you. I suggest you post there also. The 3 I'm thinking of are SandyR, Dr. C (a bariatric surgeon) and Nancy Diebenkorn. Try emailing them from that site, too. Keep us posted, NancyRN

I'm an RN who has suffered from breast cancer. My daughter definitely will get this. What a blessing to have it. NancyRN

Joyce, Thanks for the info on the Red Hat Society. I'm checking into joining! NancyRN

Emily, Who is your insurance company? I recently saw on a website a post from someone who works with Blue Cross who might be able to help. NancyRN

Dr. C, I'm really looking forward to seeing the article you mentioned on complication rates. Thanks so much for caring and being on this forum -- your involvement is a gift to us. NancyRN

HootieBelle, I'm troubled by the tone of your message. First of all, I didn't know the data was outdated. Perhaps you didn't notice the words "Citation? Date?" that I included in the top of my post, which were intended to alert others that it might be outdated? Second, I hadn't yet received the reply from Dr. C before I posted it on the other site. Third, I posted in 2 areas because I wanted it to help people going to either area. Is there something wrong with doing this? And finally, my only intent was to help others. It's unfortunate you took it so negatively. NancyRN

<TABLE style="MARGIN-LEFT: -10px" cellSpacing=0 cellPadding=5><TBODY><TR><TD vAlign=top> <TABLE style="BORDER-COLLAPSE: collapse" borderColor=#cccccc cellSpacing=0 cellPadding=4 border=1><TBODY><TR style="BACKGROUND-IMAGE: url(/shared/images/gradient-e7eef6.gif); BACKGROUND-REPEAT: repeat-x; BACKGROUND-COLOR: #e7eef6"><TD style="PADDING-LEFT: 4px" align=top>Hi all (especially Penny Merrick), I've seen several versions of "Questions to Ask Your Surgeon" lists. I integrated Sandy R's list of questions and the post by Dr. C (on www.obesityhelp.com) with posts by Penni Merrick and in the section on weight loss surgery on lapbandtalk.com. (The spacing is weird, because the format in which I wrote it didn't transfer properly to this site.) Would you review this and let me know what you think? A couple of possible problems: it's very long, and I don't know where it should be posted to help the most people. Any ideas? I hope to post it on both this site and lapbandtalk.com. NancyRN _______________________________________________________________________ Your Initial Consultation: Finding Out the Key Information Necessary to Decide on Weight-Loss Surgery Note: Ask the surgeon the following questions. About The Surgeon’s Recommendations: 1.Which weight loss procedure is best for me? Why? (Write down the exact name of the surgery if you think you may not remember it.) 2.What are its benefits and risks? 3.What is your success rate? 4.What is the likelihood my problem will return after surgery? 5.Can this surgery be performed by laparoscopy? 6.Am I a good candidate for surgery, even if I have one or more other health conditions related to my obesity? 7.What do you consider a successful outcome? 8.What is the typical excess-weight loss? 9.What is the typical improvement in associated health conditions? 10.Tell your doctor your preference for treatment, if you already know. 11.Tell your doctor the results you expect from the surgery. What outcome would you consider a success? 12.Discuss your biggest concerns about the surgery. 13.Are there other options I should consider? I want to be sure to consider all of them. 14.(If you are unsure what treatment is best for you), tell the doctor you’d like to get a second surgical opinion. (This is a common practice. The surgeon should not be threatened by it. It’s wise to get a second opinion even if you feel sure about the surgery you want. ) About Your Surgeon: 1.How many Lap-Bands have you done?* (Most important. Bands only, not bypasses too. Should be at least 50, preferably 100.) 2.How many have converted to open?* (If more than a handful that's a problem) 3.What is your skin-to-skin time on an average case?* (Skin-to-skin means from the first skin incision to the skin closure. If it's over an hour that could imply poor laparoscopic skills.) 4.How many band patients have you reoperated on for slips, erosions, or port problems?* (If more than around 5% run!) 5.Are you board-certified in this area? Cost 1.What is the complete cost of the surgery? (In addition to the surgeon’s fee, you will be charged for use of the operating room, anesthesia, tests before, during, and after surgery, and hospitalization. Your surgeon should be able to give you a ballpark total cost. If he or she says it depends on what care is given – which is true – ask the cost for the typical patient.) 2.What is your contracted rate with my insurance company? (Health care professionals commonly bill at an inflated rate, because they know the insurance company will automatically pay only part of the bill. The professional should have a rate at which he or she contracted to provide the care. This amount varies from one insurance company to another. What you need to know is the amount that is the rate at which the surgeon contracted with your insurance company. The amount your insurance company will expect you to pay (your share of the charges) will be based on this number. 3.What does that fee cover? Only the operation? Preop visits? Post-op visits? 4.What are my options for payment? 5.Will anesthesia be billed separately? 6.Do you contract with a group of doctors to provide anesthesia? (If so, you will be billed separately for the anesthesia.) 7.Do you contract with a group of doctors to provide anesthesia? If so, what are the name and phone number of the group? 8.Do you have information about other surgical costs? If not, who does and how do I reach them? Partnering With Your Doctor 1.Tell the doctor your expectations of the relationship with him or her. (Do you want a collaborative relationship? Or do you prefer to know as little as possible about what will be happening?) 2.What do you expect from me as your patient? 3.Do you like to have well-informed patients asking you questions? 4.Do you have patients who are willing to share their experiences, both positive and negative? 5.May I have the names and numbers of 5 or 6 of your patients? (Then be sure to TALK to them.) 6.What kind of information can you give me to help family and friends understand my surgery? Once You’ve Decided on Lap-Band Surgery: Finding Out the Details that Will Make Your Surgery a Successful Experience Note: The following information can usually be learned from the doctor’s handouts and the staff. The Practice 1.How many doctors are in the practice? (One person can’t be on call 24 hours a day, 7 days a week.) 2.How many BANDED people with PRACTICAL knowledge are on the staff? (Makes a huge difference.) 3.What is your after-hours and weekend policy? (Someone should be available 24 hours a day. If you have a big overfill on Friday, you can’t wait ‘til Monday for an unfill.) Preoperative Procedures 1.What nutritional support do you provide? 2.Is the nutritionist Band-knowledgeable? 3.What preop tests do you do? Why? 4.What preop diet do you use? 5.Do you have a support group for Band patients only? (Go to a meeting and ask questions.) 6. What can I do to improve the likelihood of success? The Operation 1.Is banding done in the hospital or in an outpatient surgery center? 2.How long will I be in that facility? (A few hours? Overnight? Two days?) 3.How long will I be in surgery? 4.Will you be performing the operation yourself or will others perform some of it? (In a teaching hospital, a resident may perform part of the surgery, but he or she should be closely monitored by the surgeon.) 5.Will you be using any new equipment during the surgery? If so, have you been fully trained in its use? 6.Will anyone be in the operating room other than the doctors and nurses needed to perform the surgery? (An example would be a person involved in training your surgeon on a piece of new equipment.) 7.How critical is the timing of the operation? Is there any flexibility when it is scheduled? (Be prepared to discuss your scheduling preferences.) 8.What band do you use? (The correct answer is: it depends on the patient’s needs. In the U.S., a surgeon can only use the Inamed band, but there are 3 sizes available. The correct size can be chosen only after the surgeon sees your insides. Beware the surgeon who says he or she only uses one size.) 9.Where do you place the port? Why? (There are several spots possible, and all have pros and cons.) Anesthesia 1.Who will provide my anesthesia? 2.What kind of anesthesia will be used? 3.When will I meet my anesthetist? Recovery Period 1.What is normal to expect during the recovery period? 2.Will my activities be limited during recovery? 3.If so, which activities and for how long? 4.What help might I need while I recover? 5.What are the post-surgical signs or symptoms for which I should call you? Ongoing Postoperative Care 1.How often do you see clients for follow-up? (Monthly is good, to assess progress, continue teaching, review band rules, and so on.) 2.What type of long-term aftercare services can you provide for me? (Examples are support groups and nutrition counseling.) 3.What kind of postoperative diet do you use? Fills 1.How many fills have you done? (He himself, not his assistants. If the surgeon has a “fill person”, how many has that person done?) 2.What is your policy on the amount of fills? (Run if the surgeon says a certain amount every month. Should be “as needed, individualized amount, any time, etc.”) 3. When do you give the first fill? (Trick question. Should not be “at 6 weeks”. Should be “at 6 weeks IF NEEDED.”) 4.What is your policy on fill fees? (Free the first year? Pay for each fill and unfill? Free the first year, then $800 each the next year? [An actual case – and plenty of fills are needed.]) 5.If you or your staff damages the port, what is your policy on port replacements? (The fill person may goof and puncture the tubing during a fill. Even the best can accidentally do this.) Do you replace it for free? For hospital charges only? 6.After a good fill, what is the expected rate of weight loss? * Identified as top questions to ask a surgeon, by Dr. C, a surgeon performing Lap-Band surgery (from lapbandtalk.com; also at www.TheBandDoctor.com) Credits: This section is adapted from the contributions of many people. Special thanks to Sandi R. (on obesityhelp.com), and Penni Merrick and Dr. C (on lapbandtalk.com) . Please direct any questions or comments to me on either site or at nancy.holloway@insitutech.com. NancyRN 6/26/06 </TD></TR></TBODY></TABLE> </TD><TD id=rightspace> </TD></TR></TBODY></TABLE>

Hi all, The complications data in the Inamed patient booklet are reported in order of frequency. I find it hard to make sense of them that way, because I tend to think chronologically. Here is my attempt to organize the information into operative and postoperative phases. I apologize if you have trouble comparing the percentages. I originally set this up as a table, but none of that format transferred to this post. The most amazing information is that 88% OF PATIENTS HAVE COMPLICATIONS. Does this mean we shouldn't have weight loss surgery? Well, no. You have to remember to compare information on complications to the known risks of continuing morbid obesity. Does this mean we shouldn't have Lap-Band surgery? That one's trickier to answer. You need to compare effectiveness, complications, cost etc. of the various surgeries to find the answer that's right for you. If you're considering Lap-Band surgery, it's important to be aware of the overall complication rate, as well as those of the types of complications. You may well decide to get the Lap-Band (I have), but you'll be better prepared for complications, knowing that you may well encounter them during your recovery. NancyRN P.S. I have posted this data in the FAQ section also. ____________________________________________________________________ From US clinical study of 239 patients 3 years after surgery (Citation? Date?) As reported in, “A Surgical Aid in the Treatment of Morbid Obesity: Lap-Band System Information for Patients” (Inamed booklet) (Note: the following complications are not mutually exclusive, that is, patients could have more than one) Problem/ Percentage Overall Complication Rate: 88% During surgery: Death 0% Gastric perforation 1% After surgery: Major complications: Band slippage or pouch dilatation 24% Stoma obstruction 14% Poor esophageal function 11% Erosion 1.3% Side effects: Nausea & vomiting 51% Gastroesophageal reflux 34% Constipation, diarrhea, difficulty swallowing 9% Other 1 % Second surgery: 18% Band problems 9% Stoma problems 9% Band removal: 25% By choice 9% Due to adverse event(s) 16% By laparoscopy 60% By open procedure 40%

Hi all, The complications data in the Inamed patient booklet are reported in order of frequency. I find it hard to make sense of them that way, because I tend to think chronologically. Here is my attempt to organize the information into operative and postoperative phases. I apologize if you have trouble comparing the percentages. I originally set this up as a table, but none of that format transferred to this post. The most amazing information is that 88% OF PATIENTS HAVE COMPLICATIONS. Does this mean we shouldn't have weight loss surgery? Well, no. You have to remember to compare information on complications to the known risks of continuing morbid obesity. Does this mean we shouldn't have Lap-Band surgery? That one's trickier to answer. You need to compare effectiveness, complications, cost etc. of the various surgeries to find the answer that's right for you. If you're considering Lap-Band surgery, it's important to be aware of the overall complication rate, as well as those of the types of complications. You may well decide to get the Lap-Band (I have), but you'll be better prepared for complications, knowing that you may well encounter them during your recovery. NancyRN ____________________________________________________________________ From US clinical study of 239 patients 3 years after surgery (Citation? Date?) As reported in, “A Surgical Aid in the Treatment of Morbid Obesity: Lap-Band System Information for Patients” (Inamed booklet) (Note: the following complications are not mutually exclusive, that is, patients could have more than one) Problem/ Percentage Overall Complication Rate: 88% During surgery: Death 0% Gastric perforation 1% After surgery: Major complications: Band slippage or pouch dilatation 24% Stoma obstruction 14% Poor esophageal function 11% Erosion 1.3% Side effects: Nausea & vomiting 51% Gastroesophageal reflux 34% Constipation, diarrhea, difficulty swallowing 9% Other 1 % Second surgery: 18% Band problems 9% Stoma problems 9% Band removal: 25% By choice 9% Due to adverse event(s) 16% By laparoscopy 60% By open procedure 40%

Joyce, How can I find out information about the Red Hat Society? I know a bit about them and love the whole idea. NancyRN

Hi Emily, That sucks! Here are some ideas for what to do now: 1. Find out exactly why you were rejected. For instance, if they decided it wasn't medically necessary, why not? You may be able to find this out from the insurance co. or maybe your doctor will need to. 2. Check out www.obesityhelp.com. Click on forums and scroll down until you see "types of surgery" and "lapband".Look on this forum until you find their "how to" guides: calling your health plan, choosing your strategy, etc. Find the section that contains a sample letter to send to your insurance company. It's excellent and perhaps you could enter an appeal following its format. If you can't find it that way, go to http://obesityhelp.com/content/chooseyourstrategy.html. The letter I refer to should be somewhere in that vicinity, perhaps the topic after this one. I'm sorry I can't give you better information right now on how to find this. My computer won't let me access the site for some weird reason. If you can't find it, let me know and I'll keep trying to get on the site and find it for you. 3. Ask your surgeon to reapply using the new CPT code for lapbands. For details, see the sticky at the top of this forum. Keep us posted, NancyRN