marketingdude

Good question CheckYes. The form (that I got from my bariatric surgeon's office) which I gave to the doctor to fill out and send to the insurance company asked the following 3 questions: 1) Has the patient been complient with calorie reduction? My doctor responded NO (which how can he say this as he never asked me...again...he just doesn't believe in the lapband because of his macho view of weightloss). 2) Has the patient followed the excercise/activity plan as instructed? My doctor responded Yes (he must know that I really do enjoy working out....not sure) 3) Has the patient been compliant with behavior/lifestyle modifications? My doctor responded NO (again....how can he say this....he never even asked me. He kept on saying periodically that all you need to do is to eat small portion sizes ect...) I know the insurance company based their decision quickly on these 3 answers as he never wrote any other notes on the paperwork outside of signing his signature (the doctor's office gave me copies of what they sent). The insurance company received my paperwork from the doctors office on 6/15/11 and this letter (which I have in my hand tonight) is dated 6/16/11. So I know they made their decision very quickly and in reference to the 3 questions above. Again...anybody have any advice on this as the state of illinois is going with a different insurance company that does not cover the lapband procedure? Thoughts?

THE #1 THING I HAVE TO OVERCOME WITH THIS APPEALS PROCESS NOW IS CONVINCING MY DOCTOR TO REBUTTAL/CLARIFY HIS CLAIM THAT I DID NOT COMPLY WITH CALORIE REDUCTION AND BEHAVIORAL MODIFICATION PLAN. The doctor never asked me questions if I did this or that on subsequent follow-up visits....so how can he say this? How would you recommend I approach my doctor to convince/clarify his statements (to the medical director of the insurance company)? The only way this surgery will get approved if he convinces/clarifies his statements to the medical director as the doctors statements failed to meet surgery guidelines of compliance. THOUGHTS?

I hear what you are saying for sure. The challenge I see here is I told the doctor about this 6 month weight loss program technically 2 months from the first visit. Again...I didn't find out the surgery was covered until 2/1/11 of this year. So...in theory...was this a full blown medically supervised weightloss program meant to submit to an insurance company....NO...ABSOLUTELY NOT. However, I did meet him on 12/14/10 with wanting to lose weight, he advised me of some things like portion control excercise and he gave me some phentermine pills to help along the way. So when you say....medical records ect... designed to submit to the insurance company....technically and formally this wasn't an "OFFICIAL WEIGHT LOSS PROGRAM until 2 months into it. However...when I told him about this plan....he outright was negative as he thinks I'm taking the easy way out. I AM OPEN TO YOUR SUGGESTIONS.....BUT AM SOMEWHAT CAUTIOUS ABOUT BEING TOO PUSHY AS HOW THIS OFFICIAL WEIGHT LOSS PROGRAM/APPROVAL CAME ABOUT.

Thanks Juliat for your response. It seems if I want this covered...I DEFINITELY NEED TO STAY WITH THE SAME DOCTOR....its just now...how do I get approved. I could go back to my original doctor in 2005 as they will have a chart on what I weighed in 2005. I've literally gained 75lbs in 6 years since moving from Arizona to Illinois. Submitting this, my foot doctor records, and going back to the doctor I have now and confronting him....is the only thing I can do. Now...THE BIGGEST CHALLENGE is going to convince the medical director from your insurance....to justify approving me when your own doctor said I didn't comply . HOW IN THE WORLD DO YOU OVERCOME THIS as the doctor doesn't want to admit he was wrong. To me...convincing the medical director is going to be THE BIGGEST CHALLENGE when your own doctor said you didn't comply. THOUGHTS?

Lapband Talk Members: I'll try to condense the situation as much as I can. The following are the facts with my (about to retire & skinny) filipino doctor and my 6 Month Diet Program. Although I didn't know this beforehand, I found out that my doctor has a prideful attitude about weightloss thinking you can do anything if you put your mind through ect....even though he knows my families history of obesity and my brothers successful lapband surgery where he was 429 lbs and now down to 160lbs. * 12/14/10 - 1ST DOCTOR VISIT - given phentermine to help with weight loss (Weighed in at 284lbs at 5'9) * 1/18/11 - wife works for the state and we now have lapband coverage through our insurance. * 2/1/11 - found out that the lap band is covered through our health insurance with a 6 month weight assistant diet plan * 2/23/11 -2ND DOCTOR VISIT (lossed 6 pounds - now at 278) TOLD DOCTOR ABOUT HOW I WANT THE LABPAND PROCEDURE and how my insurance will cover it with a 6 month diet program. Told him the insurance company will take the 6 month diet program and make it retroactive when I first started seeing him back in December. I originally wanted to go with him because he is familiar with my families obesity (we lived right behind him growing up) and HE KNOWS ABOUT MY BROTHERS SUCCESSFUL LAPBAND SURGERY * 4/14/11 - 3RD DOCTOR VISIT (lossed 4 more pounds - now at 274) Re-emphasized the insurance program requirements for lapband. Again the doctor was kind of negative again....HE HAS THE MOCHO ATTITUDE saying its not a big deal....just lose the weight even though he knows my families history of obesity. *5/25/11 - 4TH DOCTOR VISIT (gained 2 lbs - now at 276). Doctor got mad that I gained 2 lbs. I told him hey...I lossed every other visit...stop giving me a hard time. Again...he was kind of arrogant and prideful when it comes to losing weight. * 6/14/11 - 5TH DOCTOR VISIT (lost 6.5 lbs - now at 269.5) Told the doctor that we needed to submit the paperwork and have him fill out a sheet that my lapband surgeon's office told the doctor to fill out. The form was documenting each visit and documenting if I followed the behavioral modifications and dietary modifications ect... I just got off the phone with my insurance company and they said they denied me because I did not conform to the behavioral and dietary modifications based on what the doctor submitted. She said however, I can dispute and appeal this denial. So the question is....NOW WHAT DO I DO? Please note that my doctor never asked me if I did certain behavioral modification of diet even though I did. I just think he was turned off that I wanted the surgery and how I was trying to get it approved through insurance. To me...you can't blame me for wanting to get the surgery. ANY ADVICE ON WHAT I SHOULD DO? PLEASE NOTE MY WIFE'S HEALTH INSURANCE IS ONLY GOING TO BE AVAILABLE FOR ANOTHER 100 DAYS (UNTIL AUGUST 31ST).I really want this surgery and to not have to go to Mexico to get it. It would only cost me $175 out of pocket with my current insurance provider and wouldn't have the added risk of traveling to Mexico. The option of going to another doctor is not a valid choice since I my insurance coverage is only valid for another 100 days. Discouraged, MD

Why do you think the reason is that Dr. Atkinson in Las Vegas can get his patients to have NO FILLS and still lose so much weight? iF HE HAS A TRACK RECORD OF THIS....THERE MAY BE SOME MAJOR PATENTS IN THE WORKS...BECAUSE THIS WOULD REVOLUTIONIZE THE PRACTICE THAT MOST LAPBAND DOCTORS HAVE. Thoughts?

No...most on the board describe head hunger as the need for more food due to the taste. The more I'm thinking about it ..it seems that the nerve endings does cure the heads desire for more food.....HOWEVER IT DOESN'T CURE YOUR TASTEBUDS DESIRES FOR MORE FOOD.

Bandsters: I've read many posts from many different people about "head hunger" and have come away with a BIG question. Since the band is around the top part of the stomach (where the nerve endings are to tell you when you are normally full) this should tell YOUR HEAD to stop eating because it thinks you are full. So in essence THIS SHOULD stop the head hunger. However, I'm reading on many posts that head hunger is still there even after you eat -- which is going against my theory that the food sitting in the pouch (where the nerve endings are) REALLY DOES NOT TELL YOUR BRAIN THAT YOU ARE FULL AT ALL. I do understand that head hunger can still be there because you miss the taste. My brother had the band done and went from 429lbs to 165lbs and looks phenomenal in 4 years. I'm wondering this as I'm approaching getting my own band in place this coming June. In Summary, I really did think the nerve endings did more of a role to control head hunger then previously thought. Thoughts or Experiences Anyone - Please Chime In as I've haven't read to much about this particular topic in terms of the nerve endings control more of the head hunger issue. Thanks again, Marketing Dude

My fiance and I are thinking of going on Honeymoon in Costa Rica for 3 weeks and then come back to the states. The first 2 weeks will be our honeymoon and then the 15th day get the surgury (with 6 days rest) and come back to the States. Will I have a problem with post operation care (or band adjustment and fills) if the doctor (that the performed the surgury) was in Costa Rica? How would this work if I came back to the United States? Will doctors see me and do any band adjustments if the band deflates and need it filled again? Curious....thanks guys (this is all new to me so hope you understand)