abbylamb

Thank you. Hopefully I won't have to travel that far, but at least it's nice to know I've got options! :thumbdown:

There are two docs in my area that I'm considering for surgery. One is supposed to be the best, with fantastic stats, blah blah blah. From what I've heard, he's nice, meticulous and great to work with. BUT-it seems he's taken on more patients than he can handle-he only sees new ones on Fridays; I have my first appt this Friday, and the woman making my appointment told me to bring a good book and expect to wait, usually at least an hour, before I'll be seeing him. Plus, they require a more extensive battery of tests pre-op (at my age and with no risk factors, there really should be minimal testing required). Plus they require a $350 program fee, and the Opti-fast diet for two weeks pre-op. I really had my heart set on having surgery by the end of the year, and when I spoke with the woman at his office, she said they are already booking through the first week of December, and that it would be highly unlikely that I'll get in before the new year. The other doctor I'm seriously considering is literally 2 minutes from my house, so appointments and fills would be infinitely easier, and also has a very good track record, has done over 1000 surgeries, etc. Plus, I used to work at this hospital so I know the post op care would be good. Plus, this doc bases your pre-op testing on you and what he believes you need, and he does not require a two week liquid diet, although he does recommend it (which I'll do, I'll just do Medifast, since it's a lot cheaper and has better varieties). BUT-while my insurance co does not require any kind of supervised diet pre-op to qualify, the office does! They usually do 6 months with the dietician, but will occasionally do as little as 3 months. Again, any chance of having surgery before the end of the year is out the window. Plus, I can't lose any weight before they submit to the insurance or I won't qualify, so there's no way I could do 3 months with a dietician and then still weigh enough to qualify without co-morbidities. I just feel stuck. Neither doc will be able to get my surgery done before the end of the year (yes, I know it's not a huge deal, but I just really had my heart set on starting the new year with my band in place. kind of like my new year's resolution.). The one I'd really rather go to wants me to do 3 months on a diet that I can't afford to go on because if I do, I'll lose my qualification for surgery. What do I do? Is there any way to convince them to not insist on the 3 months of diet? I wrote the office a letter with my initial paperwork, and am still waiting to hear backf rom them, although I am not hopeful. Am I forced to go with the other doc? I really don't want to wait two hours in a waiting room just for a 5 minute fill procedure. Plus, it's a lot more money out of pocket. And to be honest, I just don't like the office staff as well. I'm just really getting down and depressed and am starting to feel like it's not going to happen for me. What's a girl to do?

Weight Watchers is a great program, and if you can stick with it it works. I lost 100 pounds on it in a little over a year. Unfortunately for me I gained 50 of it back within 3 more years. Just remember that it takes serious vigilance but good luck to you and I wish you the best!

DianaG-you rule! I don't know what else I can say!:thumbup: In response to the other post about the cost of fills, I think it depends how the office is billing them. Some offices bill it as an office visit, and the specialist office co-pay ($30) applies. Some bill it as an outpatient procedure, so then that co-pay ($100) applies.

isn't this frustrating?!? :thumbup: Although, after getting my doc's office to agree that they insurance doesn't require it, they are now telling me they do, since people with nutritional counselling do better. I'm so aggravated with this whole mess just lately! I sent them a nice letter detailing exactly why I think they should make an exception to the 3 month rule, since I've been working at the diet portion way before I went to them and have visited dieticians. It's not that I'm against seeing a dietician---I'm just against having that hold me up. I'll see her as many times as they want me to as long as I can still get my surgery by the end of the year. Well, good luck to you. I'll let you know how it goes. Hey-if my doc agrees to it, maybe you can send yours a copy of the same letter!

Thank you to everyone so far-I do appreciate the insight. This is in Cleveland, Ohio. And thankfully, because of that, I have several options for facilities. I had looked into the first place because, like I mentioned, they were the pioneers for bariatric sugery 10 years ago, but I'm definitely looking into other places too. And you are right-I'm not feeling like I'm being listened to, and I definitely have the feeling like I'm one in a herd of cattle. Get 'em in, get 'em out, etc. But I'm trying not to let the office staff's attitude cloud my opinion of the doc, who is the important person, since he may be the one doing my surgery. The other place I'm looking into also requires a 2 week meal replacement diet, but they are a little more flexible with what kind (Medifast or Optifast). And they do not have an expensive program fee. Now as far as the upper GI goes, I guess I can understand that, and both places require it, although I do wonder---are they talking a barium swallow GI series or a full scope? Anyone know? Thanks again to everyone for their help, and I'll keep up with this to hear what anyone else has to say. All suggestions and comments are appreciated! :confused:

wow this must be a universal problem! when I first heard back from my potential dr's office, the first thing they said was that I had to go on the 6 month diet!!! I had to insist BCBS FEP does NOT require that, and only after looking into it again did she agree! Now she's saying I require a separate letter from my primary doc. When I spoke with the insurance co myself, they said they only needed a letter from the surgeon stating medical necessity. This is so frustrating!:confused:

Hey everyone. Hoping someone can give me some insight here. I'm looking into 2 surgeons in my area. My original first choice (because of the fantastic track record, stats, doc is supposedly wonderful, etc.) is kind of giving me the runaround, and I haven't even had my official consultation yet! When I originally heard back from them, they told me that I had to do the 6 mo supervised diet, and to get started on that first. Well, I don't, according to my insurance. After I pointed that out, they told me to get a letter of recommendation from my primary doc. I don't need that either, according to my insurance co. She did schedule my initial consult, but tells me to bring a good book with me, because wait times can be quite a bit. (yeah, that's exactly what I want to hear). Then she asked if I had my heart set on the lap-band, and I told her yes. Then she tells me all the downsides of the band-fills for life, etc-which I already knew about. I told her that, and that I was certain I was only interested in the band, not the bypass. And she just blows it off, telling me "well he (the surgeon) will talk to you about both anyway" She's also telling me about this $350 registration fee, which according to her is for educational handouts and access to their website. Seriously? $350 for website access? Plus, she'll telling me that even though my insurance doesn't require a psych consult, they do. And I have to go on Optifast for two weeks prior, and I can only buy that from them, and it's $150 a week. Oh, and I'll have to undergo an upper GI before surgery. I have zero history of GERD or reflux. Why is that necessary? Now I understand the pysch eval, because they want to make sure I'll be able to commit to the life changes, blah, blah, blah. But in respect to the rest of it, it kind of seems like they are trying to milk me and my insurance company for as much money as possible! Has anyone else had these issues, and are any of their requirements legit? Like I said, this is supposedly the premier facility in the area, but I'm starting to question if I really want to go there.

TinaM-obviously you can tell you aren't the only one who feels this way. I, too, have always been the girl with "such a pretty face" a "great smile", or my personal favorite "an amazing personality". All of them are just euphemisms for "would be pretty if she dropped 100 pounds". I understand what you're going through on that one. With my job too, I'm required to give in-services, and I can't help but feel I'm being judged because of my size. And, like you, I plan on being banded by December, come hell or high water! Congrats on doing this for you. I wish you nothing but the best in your journey.

ParrotheadCathy--thank you! I've just breathed a big sigh of relief on this one!:thumbdown: I appreciate your reply and your taking the time to answer this for me!

Quick question for anyone who may know--can your body really "reject" the lap-band? I'm looking to have my surgery by the end of the year, and I like to think I've done my homework--I know mortality stats, and complication stats, and whatnot, but I've never read of a band rejecting until this website/section. That really worries me. I've had 9 different piercings at any given time, and every last one of them has rejected, regardless to the nature of the metal (gold, silver, surgical stainless, titanium). Can silicone reject in the same way? If so, how come it's not mentioned as a possible complication? Is there any way to treat or prevent this? Thanks!

Hey there. I'm looking to have the Lap-Band done and am debating about who and where to go for it. I'm considering St. Vincent Charity Hospital with Dr. Ben-Meir, Parma Community General Hospital with Dr. Craig Eyman, or the Cleveland Clinic, not sure with who yet. Anyone who has had any experiences here or who has heard anything about these places or these docs, PLEASE let me know what you think! Thank you very much!

Awesome!!!!

I am SO glad to see your post! I too, work for the VA. I'm based in Cleveland, Ohio. I carry the BCBS Basic, what about you? I called them and spoke with a rep who said all I needed was a letter from the surgeon stating my name, DOB, my insurance number, the CPT code, the DX code, and any pertinent info related to medical necessity. I HOPE that is all. They did not say anything about a psych eval, or documented physician diet program for 6 months, or anything like that. I am not a patient person. It's taking all my patience to wait to hear back from the surgeon's office to schedule my consultation! Well, I will keep you updated on my progress, please keep me updated on yours! Good luck to you!

Well, I'm not a nurse, but a respiratory therapist, so I guess I'll have to do! There are 200mg of ibuprofen in one Advil tablet. Look at the label on the children's Advil bottle and find out how many mg of ibuprofen are in 1 ml of the liquid. Then you'll just have to multiply till you get 200mg of ibuprofen! Hope this helps!

Hey there. I'm just curious if anyone else out there has Blue Cross and Blue Shield for Federal Employees in Ohio? And if so, how hard are they to get approved for the surgery? I've done the seminar, called them, found out what they want (no one mentioned the 3 or 6 month doctor supervised diet). All they SAID they want is a letter of medical necessity from the surgeon and the CPT and diagnosis codes. It just seems a little too easy. I haven't met with the surgeon yet, but I'm anticipating that the insurance is going to be the hardest part. Suggestions? Thanks!

Hi there. I just made the first call to my insurance company to find out the rules to get pre-authorized for the lap-band surgery. I have BCBS for Federal Employees, and was told that the surgery is definitely covered if approved. I was told I need a letter from the provider detailing my name, age and member number, the provider info, the CPT code, a diagnosis code, and "supporting documentation and relevant info including any test results that support medical necessity". First of all, what does "supporting documentation" entail? I'm 5'5" and have a BMI of 40.7, so by regular medical standards, I qualify, right? I don't think I have any other qualifying things I can count, besides the obvious aches and pains from being fat. I have asthma, but it's well controlled, and I've had it since I was a kid, so I don't think that counts. But I don't have sleep apnea, high blood pressure or cholesterol or diabetes. Does that mean that they will refuse me even if my BMI is 40 or better? I've tried diets, and exercise and Weight Watchers more times than I can count, but I've never kept a documented book outlining exactly what I was doing (unless you count the weight I weighed-that I have records of for years), and it was never "doctor supervised" or anything like that. Will that be enough or does everyone have to do the medical supervised diet first? The insurance company didn't say anything about that. They just told me I needed the things I mentioned previously in order to get pre-authorization. Also, what is the typical wait from first doctor visit to approval to actual surgery date? I'm just really excited to get this show on the road, as it were. I've done so much research my eyes are crossing and I'm convinced this is what I want to do, and I don't want the insurance derailing my hopes and dreams on this one. Any thoughts or comments would be greatly appreciated. :thumbup: Thanks! -abby